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

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.