One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): randomised controlled trial

Abstract

Objective To study whether stopping elastic compression stockings (ECS) after 12 months is non-inferior to continuing them for 24 months after proximal deep venous thrombosis.Design Multicentre single blind non-inferiority randomised controlled trial.Setting Outpatient clinics in eight teaching hospitals in the Netherlands, including one university medical centre.Participants Patients compliant with compression therapy for 12 months after symptomatic, ultrasound proven proximal deep venous thrombosis of the leg.Interventions Continuation or cessation of ECS 12 months after deep venous thrombosis.Main outcome measures The primary outcome was the incidence of post-thrombotic syndrome 24 months after diagnosis of deep venous thrombosis, as assessed by the standardised Villalta scale in an intention to treat analysis. The predefined non-inferiority margin was 10%. The main secondary outcome was quality of life (VEINES-QOL/Sym).Results 518 patients compliant with ECS and free of post-thrombotic syndrome were randomised one year after diagnosis of deep venous thrombosis to stop or continue ECS therapy for another year. In the stop-ECS group, 51 of 256 patients developed post-thrombotic syndrome, with an incidence of 19.9% (95% confidence interval 16% to 24%). In the continue-ECS group, 34 of 262 patients developed post-thrombotic syndrome (incidence 13.0%, 9.9% to 17%), of whom 85% used ECS six or seven days a week during the study period, for an absolute difference of 6.9% (95% confidence interval upper limit 12.3%). Because the upper limit of the 95% confidence interval exceeds the predefined margin of 10%, non-inferiority was not reached. The number needed to treat to prevent one case of post-thrombotic syndrome by continuing ECS was 14 (95% confidence interval lower limit 8). Quality of life did not differ between the two groups.Conclusion Stopping ECS after one year in compliant patients with proximal deep venous thrombosis seemed not to be non-inferior to continuing ECS therapy for two years in this non-inferiority trial.Trial registration Netherlands Trial Register NTR1442.

The postthrombotic syndrome: current evidence and future challenges

“…In addition, the lack of a placebo control may have influenced patient reporting of symptoms. Nevertheless, the findings suggest that, in selected patients, compression might still be an important management strategy, even 1 year after DVT .…”

Prevention and treatment of the post‐thrombotic syndrome

“…Three studies have found a significant preventive effect of compression and two did not . Other studies were focused on either shortened duration of therapy or late onset of therapy or on comparative effectiveness of different types of compression stockings …”

“…A more recent online meta‐analysis with continuous updates focused on compression initiated in the acute and sub‐acute phase, also including the recently published 1 year vs 2 years of elastic compression stockings for prevention of post‐thrombotic syndrome (OCTAVIA study): randomized controlled trial which found that continuing elastic compression stocking (ECS) treatment after initial treatment for 1 year in patients without PTS was significantly better than cessation of treatment, with a number needed to treat (NNT) of 14 …”

Stockings to prevent post-thrombotic syndrome

“…5 The findings suggest that compression might still be an important preventive strategy, even one year after their DVT, in selected patients with no evidence of post-thrombotic syndrome (based on low Villalta scores).…”