Compression Stockings Don’t Prevent Postthrombotic Syndrome

May 23, 2014

Background:
Postthrombotic syndrome (or PTS, sometimes referred to as postphlebitic syndrome) is a condition that can occur in up to 20% of patients who experience a DVT. It involves pain and swelling of the affected leg. In some cases the symptoms can progress, leading to reduced mobility and reduced quality of life. The main strategy to reduce the risk of developing PTS has been the use of special compression stockings, which reduced edema. Previous studies have demonstrated benefit with use of compression stockings; however, as they were not blinded, they were not very conclusive.

The Study:
Investigators conducted the aptly named SOX trial (cute, right?!). The study was a double blinded, placebo-controlled, randomized trial. The intervention was the use of elastic compression stockings exerting 30 to 40 mm Hg at the ankle vs placebo stockings, which exerted only 5 mm Hg at the ankles.

The investigators found no significant difference in the incidence of PTS between the two groups.

Conclusion:
The results of this well-done analysis contradict findings of previous studies that suggested compression stockings may reduce the incidence of PTS. This study casts doubt on routine use of compression stockings to prevent PTS. While there may yet be a role for compression stockings, we will have to wait for further studies to elucidate which group of patients may have the greatest benefit from them.

The entire article, Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial, appears in The Lancet.

Deep Ramachandran is a pulmonary, critical care, and sleep medicine physician and Social Media Section Co-Editor at CHEST Journal.  He writes and maintains Caduceusblog.com. He is on Twitter @caduceusblogger.