Paolo Prandoni, MD, PhD; Anthonie W.A. Lensing, MD, PhD; Martin H. Prins, MD, PhD; Michela Frulla, MD; Antonio Marchiori, MD; Enrico Bernardi, MD, PhD; Daniela Tormene, MD; Laura Mosena, MD; Antonio Pagnan, MD; Antonio Girolami, MD
Grant Support: By a grant from New Medical Service, Linea Flebologica Flebysan, Rovigo, Italy.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Paolo Prandoni, MD, Department of Medical and Surgical Sciences, 2nd Division of Internal Medicine, University Hospital of Padua, Via Ospedale Civile 105, 35128 Padua, Italy; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Prandoni, Frulla, Marchiori, Bernardi, Tormene, Mosena, Pagnan, and Girolami: Department of Medical and Surgical Sciences, 2nd Division of Internal Medicine, University Hospital of Padua, Via Ospedale Civile 105, 35128 Padua, Italy.
Dr. Lensing: Center for Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Dr. Prins: Department of Clinical Epidemiology and Technology Assessment, Academic Hospital, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
Author Contributions: Conception and design: P. Prandoni, A.W.A. Lensing, M. Frulla.
Analysis and interpretation of the data: M.H. Prins, A. Marchiori, E. Bernardi.
Drafting of the article: P. Prandoni, A.W.A. Lensing, M.H. Prins, E. Bernardi.
Critical revision of the article for important intellectual content: A. Pagnan, A. Girolami.
Final approval of the article: P. Prandoni, A.W.A. Lensing, M.H. Prins, M. Frulla, A. Marchiori, E. Bernardi, D. Tormene, L. Mosena, A. Pagnan, A. Girolami.
Provision of study materials or patients: P. Prandoni, M. Frulla, D. Tormene, L. Mosena.
Statistical expertise: M.H. Prins, A. Marchiori, E. Bernardi.
Obtaining of funding: P. Prandoni.
Administrative, technical, or logistic support: P. Prandoni, D. Tormene, A. Pagnan, A. Girolami.
Collection and assembly of data: P. Prandoni, M. Frulla, D. Tormene, L. Mosena.
Because only limited evidence suggests that elastic stockings prevent the post-thrombotic syndrome in patients with symptomatic deep venous thrombosis (DVT), these stockings are not widely used.
To evaluate the efficacy of compression elastic stockings for prevention of the post-thrombotic syndrome in patients with proximal DVT.
Randomized, controlled clinical trial.
180 consecutive patients with a first episode of symptomatic proximal DVT who received conventional anticoagulant treatment.
Before discharge, patients were randomly assigned to wear or not wear below-knee compression elastic stockings (30 to 40 mm Hg at the ankle) for 2 years. Follow-up was performed for up to 5 years.
The presence and severity of the post-thrombotic syndrome were scored by using a standardized scale.
Post-thrombotic sequelae developed in 44 of 90 controls (severe in 10) and in 23 of 90 patients wearing elastic stockings (severe in 3). All but 1 event developed in the first 2 years. The cumulative incidence of the post-thrombotic syndrome in the control group versus the elastic stockings group was 40.0% (95% CI, 29.9% to 50.1%) versus 21.1% (CI, 12.7% to 29.5%) after 6 months, 46.7% (CI, 36.4% to 57.0%) versus 22.2% (CI, 13.8% to 30.7%) after 1 year, and 49.1% (CI, 38.7% to 59.4%) versus 24.5% (CI, 15.6% to 33.4%) after 2 years. After adjustment for baseline characteristics, the hazard ratio for the post-thrombotic syndrome in the elastic stockings group compared with controls was 0.49 (CI, 0.29 to 0.84; P = 0.011).
This study lacked a double-blind design.
Post-thrombotic sequelae develop in almost half of patients with proximal DVT. Below-knee compression elastic stockings reduce this rate by approximately 50%.
Paolo Prandoni, Anthonie W.A. Lensing, Martin H. Prins, Michela Frulla, Antonio Marchiori, Enrico Bernardi, et al. Below-Knee Elastic Compression Stockings To Prevent the Post-Thrombotic Syndrome: A Randomized, Controlled Trial. Ann Intern Med. 2004;141:249–256. doi: 10.7326/0003-4819-141-4-200408170-00004
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Published: Ann Intern Med. 2004;141(4):249-256.
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