Compression therapy for treating stage I and II (Widmer) post-thrombotic syndrome

Abstract

Background: Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis characterised by chronic complaints, swelling, and skin changes in the affected limb. One in every three patients with deep vein thrombosis develops post-thrombotic complications within five years.

Objectives: To assess the effectiveness of compression therapy in patients with stage I and II post-thrombotic syndrome according to the classification of Widmer. Interventions of interest included elastic compression stockings and mechanical devices, compared with no intervention and with each other.

Search strategy: The reviewers searched the Cochrane Peripheral Vascular Diseases Specialised Trials Register (last searched April 2003), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2003). In addition, journals, conference proceedings and bibliographies were hand searched. Personal contact with other investigators involved in the clinical area was sought to get information about missed or unpublished studies.

Selection criteria: Trials that evaluated compression therapy for stage I and II (Widmer) post-thrombotic syndrome. Primary outcomes were leg ulceration, or deterioration of post-thrombotic syndrome. There were no restrictions on date or language. One reviewer (DNK) assessed titles and abstracts for relevance. This was verified independently by a second reviewer (MWCS).

Data collection and analysis: Details of eligible studies were extracted and summarised using data extraction sheets. Data extraction was undertaken by one reviewer (DNK) and verified by a second reviewer (MHP).

Main results: Only two trials were identified that addressed physical treatment of post-thrombotic syndrome. Both trials were initiated by the same group of investigators. A cross-over study lasting two months compared low and high pressure with intermittent compression units for severe post-thrombotic syndrome. This showed a beneficial effect of higher pressures. The second study, in patients with mild to moderate post-thrombotic symptoms, showed no effect of elastic compression stockings (30-40 mm Hg at the ankle region) when compared to 'placebo' stockings that were one to two sizes too large.

Reviewer's conclusions: There is some evidence of a beneficial effect of intermittent pneumatic compression units, but the study was too small and of too short a duration to draw strong conclusions. Further research is needed in order to assess whether intermittent pneumatic compression units give long term reduction and relief of the symptoms caused by post-thrombotic syndrome, and prevent deterioration and leg ulceration. The use of elastic compression stockings to treat post-thrombotic syndrome cannot be supported on the basis of the currently available data.