Compression – from thrombosis to post-thrombotic syndrome

Summary

Introduction: The recommendation concerning compression and mobilization of patients with acute deep vein thrombosis, in addition to exact anticoagulation, is mainly based on experience. Most therapy studies focus on the fate of the clots. Some randomized controlled trials were able to demonstrate that this regime is not complicated by a higher rate of pulmonary embolism.

Methods: The existing literature was scanned concerning compression therapy.

Results: Subjective complaints of patients were investigated only in a few randomized controlled trials, which showed a reduction of pain and leg swelling and an improvement of quality of life. This has become the basis for ambulatory management consisting of anticoagulation, compression and mobilization.

Based on reported evidence further compression for 2 years is able to reduce the incidence of a post-thrombotic syndrome significantly. The recommendation to use compression stockings after deep vein thrombosis, which is also emphasized in different guidelines, was recently challenged in a Canadian-American multi-center trial. In this study the effects of stockings were compared with those of placebo-stockings (5 mmHg) in patents with a first episode of proximal thrombosis. Up to two years the outcome was not significantly different between the two groups, neither based on Ginsberg’s criteria (pain and swelling for more than one month) nor following the Villalta scores (sum score from subjective symptoms and clinical signs). Stockings were sent to the patients by ordinary mail, more than half of the patients were unable to tell if they got a compression or a placebo-stocking. Those 55 % of patients who wore their stockings more than 3 days per week, were termed as „frequent users“. Besides several other problems with this study the question remains open, how in a „controlled trial“ a therapeutic effect can be assessed if therapy was obviously applied only sporadically.

Conclusion: The anti-inflammatory effect of proper compression resulting in a reduction of pain and swelling in the leg with acute thrombosis should be maintained for several months by the ongoing use of compression stockings and further management should be guided mainly by clinical criteria. More studies are recommended concentrating on the role of compression on the clinical symptoms between the acute stage of thrombosis and the late sequel of a post-thrombotic syndrome.

Keywords

Compression therapy - deep venous thrombosis - post-thrombotic syndrome - ulcer

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