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was sought to get information about missed or unpublished studies.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.
