Review on the value of graduated elastic compression stockings after deep vein thrombosis

Abstract

SummaryGraduated elastic compression stockings (GECS) are commonly used in the primary prevention of deep vein thrombosis (DVT); however, their role in preventing recurrent DVT and also post-thrombotic syndrome is less well established. The aim of this review was to investigate the effect of GECS after DVT. A literature search was performed by two independent searchers in order to identify randomised controlled trials on the effect of GECS in preventing recurrent DVT and post-thrombotic syndrome. Four randomised trials, including 537 patients, were identified. Two of the studies demonstrated that below-knee GECS significantly reduced post-thrombotic syndrome during follow-up, while a smaller study showed equivocal results. GECS reduced the incidence of post-thrombotic syndrome from 54% to 25.2% [relative risk (RR) 0.47, 95% confidence interval (CI) 0.36-0.61] with the number needed to treat (NNT) being 4 (95% CI 2.7-5.0).The rate of recurrent asymptomatic DVT was also significantly reduced by GECS (RR 0.20, 95% CI 0.06-0.64; NNT 5); the reduction in symptomatic DVT was not significant (RR 0.79, 95% CI 0.50-1.26; NNT 34). In conclusion, there is level Ia evidence to suggest that GECS can significantly reduce the incidence of post-thrombotic syndrome (PTS) after DVT, and therefore these should be routinely prescribed. The evidence for recurrent DVT is less conclusive. Further research is needed towards standardising PTS diagnostic criteria and evaluating more effective preventive measures after DVT.

Management of venous thrombosis in pregnancy

“…10 They may act by preventing overdistension of veins, so preventing endothelial damage and exposure of subendothelial collagen. They can therefore be combined safely with pharmacological thromboprophylaxis, both in the antenatal period and postnatally.…”

“…For women with confirmed deep venous thrombosis (DVT), compression stockings can reduce the risk of postthrombotic syndrome if used for up to two years after the event. 10 It is, however, important that correctly fitted class 2 graduated stockings are used, with repeat fittings as pregnancy progresses. 10 Various strategies combining pharmacological and physical therapies to minimise the risk of primary thrombosis and VTE recurrence have been put forward based on the woman's past VTE and risk factor history ( Table 1).…”

“…10 It is, however, important that correctly fitted class 2 graduated stockings are used, with repeat fittings as pregnancy progresses. 10 Various strategies combining pharmacological and physical therapies to minimise the risk of primary thrombosis and VTE recurrence have been put forward based on the woman's past VTE and risk factor history ( Table 1). 11 Clinical assessment of pregnant women with suspected VTE By itself, the clinical diagnosis of DVT and pulmonary thromboembolism (PE) is unreliable (Box 2).…”

“…10 Postnatally, either warfarin or LMWH can be used, but most women prefer to use LMWH because they have become accustomed to it, and they appreciate the convenience of not having to attend clinics or GP practices to have their INR checked. Alternatively, should a woman wish to be started on warfarin, she can be loaded appropriately on day 3 after delivery and the INR checked according to the British haematology guidelines, 37 with subsequent referral for anticoagulant monitoring.…”

Eficácia da compressão pneumática intermitente (CPI) nos membros inferiores sobre o fluxo sanguíneo das veias femorais comuns

“…A profilaxia do tromboembolismo venoso pode ser feita por métodos farmacológicos, principalmente com uso de heparina de baixo peso molecular [2][3][4] , ou por méto-dos mecânicos, como o uso da meia antitrombo 3 e da compressão pneumática intermitente (CPI) 3,[5][6][7][8] .…”