Compression stockings = placebo stockings in preventing post-thrombotic syndrome

POEMs Research Summaries

Clinical Question

Are compression stockings effective in preventing post-thrombotic syndrome in patients with deep vein thrombosis?

Bottom Line

Compression stockings are no better than placebo stockings in preventing post-thrombotic syndrome in patients after their first proximal deep vein thrombosis (DVT). (LOE = 1b)Bottom Line

Reference

Kahn SR, Shapiro S, Wells PS, et al, for the SOX trial investigators. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 2014;383(9920):880-888.
Study Design: Randomized controlled trial (double-blinded)
Funding

Government

Setting: Outpatient (any)
Allocation

Concealed

Synopsis

In this multicenter study, patients with their first proximal DVT were randomized to 2 years of compression stockings (30 to 40 mmHg gradient; n = 410) or placebo stockings (5 mmHg; n = 396). The stockings were given within 2 weeks of the DVT and were replaced every 6 months (sooner if they wore out, got torn, or the patient’s leg changed size). The researchers evaluated the patients at baseline and 1, 6, 12, 18, and 24 months. The patients did not wear their stockings to these visits (scheduled for the afternoon) to facilitate the evaluation of signs of post-thrombotic syndrome. The authors defined post-thrombotic syndrome as ipsilateral pain and swelling that lasted at least 1 month that was worse at the end of the day or with prolonged sitting or standing and better in the morning or with leg elevation. Overall, the rate of post-thrombotic syndrome was not statistically different in patients treated with compression stockings than in patients treated with placebo stockings (14.2% vs 12.7%; P = 0.6). These findings are strengthened in light of the potential bias introduced by the authors’ analytic approach.

Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
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