Compression for the prevention of post-thrombotic syndrome after deep vein thrombosis: What is the ideal therapy duration?

This One-Pager discusses the prevention of post-thrombotic syndrome following deep vein thrombosis. It reviews whether stopping elastic compression therapy after 12 months is non-inferior to continuing it for an additional 12 months. This One-Pager is published in English, German, French, Italian, Polish and Russian.

Current consensus

Elastic compression stockings (ECS) are recommended in the prevention of post-thrombotic syndrome (PTS) following deep vein thrombosis (DVT).

Problem

The optimal therapy duration still remains undefined.

OCTAVIA study

The OCTAVIA study (1) was designed to assess whether stopping ECS therapy after 12 months is non-inferior to continuing it for an additional 12 months.

Participants

n = 518

PTS-free and compliant with ECS therapy (34-46mmHg) for 12 months subsequent to DVT diagnosis.

Patient randomization

The patients were divided in two groups after DVT diagnosis:

Group 1: Stop-ECS = Stop after inital 12 months

n = 260
4 ineligible (excluded)
Assessed: n = 256
Lost to follow-up: n = 6
Withdrew: n = 13
Died: n = 2

Group 2: Continue-ECS = Continue for +12 months

n = 262
0 ineligible
Assessed: n = 262
Lost to follow-up: n = 6
Withdrew: n = 6
Died: n = 0

Results

Primary Outcome = PTS incidence 24 months after DVT diagnosis

In group 1 (stop-ECS), 51 patients got sick from post thrombotic syndrome, while in group 2 (continue-ECS) it were 34 patients. The risk for PTS in the stop-ECS group is 60% higher compared to the continue-ECS group.

To prevent one case of PTS by continuing ECS therapy for 24 months, the number of patients needed to treat is 14.

The continue-ECS group showed a high compliance rate, as 85% of this group wore the ECS for 6-7 days per week.

Conclusion

Stopping ECS after 12 months in compliant patients with proximal DVT was not non-inferior than (≈ was "not as good as") continuing ECS therapy for an additional 12 months in preventing PTS.

Author's suggestion

Compression therapy should ideally be continued for 24 months after DVT.

This One-Pager discusses different types of compression products in veno-lymphatic disorders. It focuses on characteristics of compression therapy types and on how to choose the best garment for an individual patient. This One-Pager is published in English, German, French, Italian, Polish and Spanish.

The effect of medical compression stockings and leg elevation on local inflammatory biomarkers in healthy subjects & CVI patients

This One-Pager reviews the effects of medical compression stockings and leg elevation on local inflammation. The participants in this study were healthy or diagnosed with an advanced CVI. They had to conduct the experiment under the three different conditions of standing without medical compression stockings, standing with medical compression stockings and lying without medical compression stockings. Their blood was taken to measure inflammatory biomarkers (microparticles, annexin V and matrix metalloproteinases). Wearing medical compression stockings as well as leg elevation resulted in reduced microparticles, annexin V and matrix metalloproteinases. Therefore, compression therapy and leg elevation may protect against local inflammation induced by gravitational stress.

Deep vein thrombosis (DVT)

DVT (deep vein thrombosis) is a serious condition in which a blood clot forms in the deep veins of the lower leg or calf and blocks blood flow. DVT can lead to leg swelling, redness, and pain, but it can also occur without these symptoms. DVT can become a life-threatening condition if the blood clot breaks loose from its original location in the vein and travels through the bloodstream into the lungs. This potentially fatal event is known as pulmonary embolism (PE). Here you can find more information on DVT in general and solutions for its prevention.

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