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 Compression Stockings Don't Prevent PTS, BUT...

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PostSubject: Compression Stockings Don't Prevent PTS, BUT...   Sun Feb 10, 2013 6:49 pm

http://www.medscape.com/viewarticle/776393



By Lorraine L. Janeczko

ATLANTA (Reuters Health) Dec 19 - Elastic compression stockings (ECS) don't prevent post-thrombotic syndrome (PTS) after a first episode of proximal deep vein thrombosis (DVT), according to multicenter data presented here December 10 at ASH 2012, the annual meeting of the American Society of Hematology.

"In this first large randomized placebo-controlled trial, active ECS did not prevent PTS after a first proximal DVT, and did not influence the severity of PTS, rate of recurrent venous thromboembolism (VTE), or quality of life," said lead investigator Dr. Susan R. Kahn from McGill University, Montreal, Quebec, Canada, in an email to Reuters Health.

These findings contradict those of two earlier single-center studies that did not use a placebo control.

"The benefits of ECS to prevent PTS reported in two previous smaller, single-center studies could be due, at least in part, to bias from their open-label design," she added.

"Based on our results, it would appear to not be indicated to prescribe elastic compression stockings to all patients after a first proximal DVT," Dr. Kahn said in her email.

PTS is a costly DVT complication with limited treatment options, she said.

To determine whether active ECS (A-ECS) was any better than placebo ECS (P-ECS) for preventing PTS after a first, symptomatic proximal DVT, researchers enrolled more than 800 patients at 24 centers in Canada and the U.S. between 2004 and 2010.

Stockings were mailed to patients directly and worn on the DVT-affected leg daily for up to two years. The intervention group wore knee length, 30-40 mm Hg, Class II graduated ECS. The placebo stockings appeared identical to A-ECS but lacked therapeutic compression.

Patients did not wear the stockings at study follow-up visits at one, six, 12, 18 and 24 months to maintain study blinding.

The primary study outcome, PTS, was diagnosed at or after the six-month visit using the Ginsberg measure (leg pain and swelling of one-month duration that is worse at the end of the day or after prolonged sitting/standing and improved after rest/leg elevation).

Altogether, 398 patients were randomized to A-ECS and 408 to P-ECS. Baseline features were similar in both groups. Sixty percent were male, the mean age was 55 years, and the most proximal extent of DVT was the iliac or femoral vein in 70% of patients and the popliteal vein in 30% of patients.

The cumulative incidence of PTS at 750 days was 14.8% in A-ECS vs. 12.3% in P-ECS (p=0.49).

Approximately 70% of patients in both groups continued wearing the stockings throughout study follow-up, and over 80% of these patients in both groups reported wearing them for at least three days per week.

"Whether ECS may be of benefit to manage symptoms of established PTS should be evaluated in future studies," Dr. Kahn added in her talk.

"Stockings are known to have clinical benefit in improving symptoms such as leg swelling and heaviness after DVT. While our study suggests that stockings do not actually prevent the development of the post-thrombotic syndrome, they may still have a role in the management of venous symptoms after DVT," she noted in her email interview.

In the opinion of Dr. Charles S. Abrams, Associate Chief of the Division of Hematology-Oncology of the University of Pennsylvania, "Previous studies were always considered to be flawed since the patients and their treating physicians in these trials always knew who was wearing compression stocking and since the symptoms are somewhat subjective. In the cleverly designed blinded SOX trial the patients did not know if they were in the treatment or no-treatment arm of the study."

"To me, these results are of very high quality and demonstrate that there is no benefit to wearing the uncomfortable compression stockings. I think that many patients will be relieved to hear the news," Dr. Abrams added. He spoke with Reuters Health by email and was not involved in the study.

The SOX Trial was funded by Canadian Institutes of Health Research, with active and placebo stockings provided as in-kind support by Sigvaris.

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What this means is that yes comp. socks will help reduce the swelling and pain from DVT and it also helps fight the swelling and pain from PTS . What it does NOT mean is for everybody to stop wearing their comp. socks.
I did talk with my Hemotologist who was taking part of the SOX Trial ( so was I, as a patient) and she said that I should keep wearing them as I have been wearing them, when needed.
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