Consensus Group: Eberhard Rabe, Hugo Partsch, Juerg Hafner, Christopher Lattimer, Giovanni Mosti, Martino Neumann, Tomasz Urbanek, Monika Hübner, Sylvain Gaillard, Patrick Carpentier
1. Use of MCS to alleviate venous symptoms in CVD
Five studies have reported compression provides relief of aching, pain, leg cramps and restlessness (2), (3), (4), (5), (6) (Grade 1B)
2. Use of MCS to improve QoL and venous severity in CVD
Three studies have reported compression either improves QoL, healing and pain or treatment effectiveness as measure by the VCSS (7), (8), (9) (Grade 1B)
3. Use of MCS to prevent leg swelling in CVD and in healthy individuals at risk of leg swelling
RCT conducted in Australia demonstrated that low-ankle pressure GCTs help to prevent flight induced ankle edema (10) (Grade 1B)
4. Use of MCS to reduce leg swelling in CVD and occupational leg swelling
Three studies have reported compression stockings are able to reduce ankle and leg edema (11), (12) (Grade 1B)
5. Use of MCS for improvement of skin changes in patients with CVD
Regularly observed in routine clinical practice; there is a paucity of evidence from RCTs (Grade 1C)
6. Use of MCS for improvement of lipodermatosclerosis in patients with CVD
RCT of 153 patients randomized to either below-knee MCS or no MCS showed MCS can improve skin changes in patients with lipodermatosclerosis (13) (Grade 1B)
7. Use of MCS to reduce recurrence of VLU
Three RCTs and a Cochrane review show trends of lower rates of venous ulcer recurrence with higher-compression MCS; compliance was lower in “high” compression groups and had positive outcome (14), (15), (16), (17) (Grade 1A)
8. Use of ulcer MCS (“ulcer kits”) to improve VLU healing
Five RCTs reported improvement in VLU healing with use of ulcer MCS (18), (19), (20), (21), (22) (Grade 1A Upgraded from 1B in the 2008 consensus statement)
9. Use of ulcer MCS (“ulcer kits”) to reduce pain in patients with VLU
RCT showed that, in patients treated with MCS and bandages, pain is alleviated promptly and effect is equivalent between two treatment modalities (18) (Grade 1A)
10. Further studies needed to provide data on use of MCS for prevention of CVD progression
Insufficient information from RCTs on prevention of CVD progression by MCS to allow for evidence-based recommendation (No Grade)
11. Use of MCS in initial phase after GSV treatment to reduce postoperative side effects
Five RCTs reported reduction of side effects with use of MCS (23), (24), (25), (26), (27) (Grade 1B)
12. Use of additional eccentric compression to enhance effectiveness of MCS in reducing postoperative side effects
Two RCTs reported postoperative reduction in pain (28), (29) and one RCT reported reduction in pain and hematoma (30) (Grade 1B)
13. Limit prolonged use of MCS to improve clinical success after GSV interventions
Seven RCTs either did not follow patients for long enough or failed to demonstrate benefits from ongoing MCS use (23), (24),(28), (29), (30), (31), (32) (Grade 1B)
14. Use of MCS after liquid sclerotherapy of C1 veins to achieve better outcomes
RCT reported improved vessel disappearance with MCS (27) (Grade 2B)
15. Use of immediate compression to reduce pain and swelling, thereby allowing instant mobilisation in acute DVT. Compression should be used immediately after DVT event
Two RCTs reported reduction in pain and swelling with use of immediate compression (33), (34) (Grade 1B Downgraded from 1A in the 2008 consensus statement); One RCT reported that when compression is initiated ≥ 2 weeks, there is no effect on resultant pain levels (35) (Grade 1B*)
16. Use early compression and mobilization in addition to anticoagulation to avoid thrombus propagation after the DVT event. Compression should be used immediately after the DVT event.
Two RCTs reported less thrombus progression with immediate compression, compared with no compression or delayed compression (33), (34), (35), (36) (Grade 1B)
17. Use of MCS in patients with SVT (*Downgraded from 1A in the 2008 consensus statement)
A Cochrane review supports that compression of thrombosed vein relieves symptoms of SVT and accelerates healing (37) (Grade 1C); One RCT reported that in patients with SVT treated with LMWH, aside from reduction of thrombus growth after 1 week, no additional benefit for symptomatic outcomes has been demonstrated (38) (Grade 1C)
18. Use of MCS as early as possible after diagnosis of DVT in order to prevent PTS
Six RCTs have reported benefit of compression in reducing PTS incidence (39), (40), (41), (42), (43), (44). One RCT emphasizes importance of immediate application of MCS in acute phase of DVT (44). One RCT reported no benefit from compression to prevent PTS when compression was started 2 weeks after diagnosis and when at ≥ 3 days compression per week was accepted as good compliance (45). Current evidence still supports compression therapy for PTS prophylaxis in clinical practice, at least in symptomatic patients (Grade 1B Downgraded from 1A in the 2008 consensus statement)
19. Use of MCS for treatment of symptomatic PTS
Data on the physical management of PTS are sparse (46), (47), (48). RCT reported significant improvement in haemodynamic parameters (49) (Grade 1B)
20. Use of TPS as basic component of mechanical prophylaxis in patients undergoing major surgery
Several studies support use of TPS in patients undergoing surgery (50), (51), (52), (53), (54) (Grade 2C)
21. Mechanical methods of thromboprophylaxis, including TPS, should be considered, especially where anticoagulants are contraindicated
Current guidelines (55), (56) and a meta-analysis support use of compression where anticoagulants are contraindicated (57) (Grade 2B)
22. Use of MCS during long-distance travelling, to prevent DVT incidence in patients at risk; in high-risk patients, combine use of MCS with anticoagulant thromboprophylaxis
An RCT (58), Cochrane review (59) and several consensus meetings (60) support use of MCS for preventing DVT in long-haul travellers and high-risk patients (Grade 2B)
23. Do not use below-knee TPS as sole method for DVT prophylaxis in stroke patients
A Cochrane review reported there is insufficient high-quality evidence to say whether thigh-high or knee-high TPS is more effective (61) (Grade 2B)
24. If TPS is considered in stroke patients for DVT prophylaxis, we suggest use of thigh-length TPS over knee-length TPS stockings
An RCT reported less frequent DVT with thigh-length TPS (62) (Grade 1B)
25. Use of MCS for lymphedema maintenance therapy (Not enough evidence to make a recommendation on the use of compression for the prevention of lymphedema)
2013 consensus of ISO reports MCS are mainly used to maintain long-term lymphedema reduction; the highest level of compression that patients can tolerate (20-60mmHg) is likely to be most beneficial (63) (Grade 1A Upgraded from 1B in the 2008 consensus statement)