Compression Stockings to Prevent Post-Thrombotic Syndrome

The history of clinical research on compression stockings to prevent post-thrombotic syndrome after deep venous thrombosis (DVT) is convoluted. Although several small studies initially suggested benefit, the larger SOX trial, in 2013, was negative (NEJM JW Gen Med Jan 15 2014 and Lancet 2014; 383:880). Then, in 2016, the OCTAVIA study showed that 2 years of compression was more effective than 1 year (NEJM JW Gen Med Jul 15 2016 and BMJ 2016; 353:i2691). Poorer adherence to treatment in the SOX trial was one possible reason for its negative result. Now, we have the latest contribution in this sequence.

Researchers provided custom-fitted, knee-high compression stockings (ankle pressure, 30–40 mm Hg) for 865 patients with proximal DVT. After using the stockings for 6 months, patients were randomized into two groups. The standard-treatment group continued to use compression stockings for another 2 years. Individualized-treatment patients were evaluated periodically during 2 years of follow-up and were instructed to stop using compression stockings if persistently favorable scores were noted on a standardized assessment tool for post-thrombotic signs and symptoms. In the individualized group, 55% of patients discontinued stocking use after 6 months, and another 11% stopped after 12 months.

The incidence of post-thrombotic syndrome was nearly identical in the two groups (28% and 29%); most cases developed during the first 6 months of follow-up. Severity of post-thrombotic syndrome also was similar in the two groups.