Stephan Moll, MD writes… A new publication in the Lancet [ref 1] shows that elastic compression stockings after a first episode of proximal DVT do NOT prevent postthrombotic syndrome (PTS) as assessed over 2 years. This is a good-quality, large, randomized placebo-controlled trial, called the SOX-trial.
The SOX Trial
Two previous studies showed that wearing elastic compression stockings did decrease the risk of developing PTS [ref 2,3]. However, the limitation of the study has been their small size, the fact that they were single-center trials, and that they were not placebo-controlled. Based on these 2 studies until now compression stockings (30/40 mm Hg) have been suggested for patients with DVT to prevent PTS [ref 4].
This was a multicenter, randomized, placebo-controlled trial in patients with acute first episode of proximal DVT. Patients wore either 30-40 mm Hg graduated elastic compressions stockings or “placebo stockings” with identical appearance but less than 5 mm Hg compression at the ankle. The follow-up period was 2 years.
- 806 patients were enrolled: 410 received elastic compression stockings, 396 placebo stockings.
- PTS (as assessed by the so-called “Ginsberg’s criteria”) developed in 14.2 % in the active stocking group, and in 12.7 % in the placebo stocking group (hazard ratio 1.13, 95% CI 0.73-1.76; p=0.58).
- By the so-called Villalta score (a different PTS scoring system) there was also no difference in PTS development between the 2 groups: 7.5 % and 5,8 % developed severe PTS in the active stocking group and the placebo stocking group, respectively; 8.3 % and 10. 5 moderate PTS; 33 % and 32.1 % mild PTS; and 51.3 % and 51.4 % no PTS.
Elastic compression stockings did not prevent PTS after a first proximal DVT.
This is a very interesting and relevant study. Compression stockings used to be fairly strongly recommended by many physicians, in the belief that they would prevent postthrombotic syndrome. We now have evidence from a large and well-done trial that they do NOT prevent PTS. Therefore, the discussion with the patient now is that he/she can wear stockings if he/she feels that they make the leg feel better – less pain, less swelling while being worn. However, I now discuss with my patients that the stockings do NOT have a lasting beneficial effect – thus, if they do not make the leg feel better or if they are actually uncomfortable to wear, then there is no reason to wear them.
- Kahn SR et al. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet, published online Dec 6, 2013.
- Brandjes DPM et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349: 759–62.
- Prandoni P, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004; 141: 249–56.
- Kearon C et al. Antithrombotic Therapy for VTE – Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2_suppl):e419S-e494S.
Disclosures: I have no financial conflict of interest.
Last updated: Dec 18th, 2013