Effect of compression stockings on post thrombotic syndrome in patients with deep vein thrombosis: a meta-analysis of randomised controlled trials

Abstract

Whether compression stockings are effective in the prevention of post thrombotic syndrome in patients with deep vein thrombosis remains unknown. Since the recently published SOX trial, no meta-analysis has been done to re-evaluate the available literature on whether compression stockings are beneficial in these patients. We aimed to determine the effectiveness of elastic compression stockings on preventing post thrombotic syndrome in patients with deep vein thrombosis. For this meta-analysis, we searched PubMed, the Cochrane Library, and Embase databases from inception to July 29, 2015, with no language restrictions, for randomised controlled trials comparing compression therapy with placebo (either none or placebo stockings) in patients with deep vein thrombosis. We did a meta-analysis with primary outcome as incidence of post thrombotic syndrome. Secondary outcomes analysed were mortality and recurrence of deep vein thrombosis. Sensitivity analysis was done for heterogeneity, study quality, diagnosis by Villalta scoring, and non-delayed randomisation. We identified 674 reports, of which six were randomised controlled trials including 1462 patients. Use of elastic compression stockings was not associated with prevention of post thrombotic syndrome compared with controls (OR 0·56 [95% CI 0·27-1·16]; 36% [269/739] vs 45% [322/723]; p=0·12). Subgroup sensitivity analysis showed that elastic compression stockings were not associated with prevention of post thrombotic syndrome despite trying to account for heterogeneity (OR 0·63 [95% CI 0·29-1·33]; 27% [63/234] vs 37% [85/231]; p=0·23), diagnosis by Villalta scoring (0·81 [0·36-1·84]; 43% [228/535] vs 45% [235/517]; p=0·62), nor those that patients randomised within 1 month of diagnosis (0·57 [0·22-1·45]; 41% [258/631] vs 49% [304/615]; p=0·24). Secondary outcomes such as mortality (OR 0·98 [95% CI 0·68-1·41]; 10% [68/703] vs 10% [67/690]; p=0·92) or recurrence of deep vein thrombosis (OR 0·93 [95% CI 0·66-1·31]; 6·4% [70/1094] vs 6·8% [73/1066]; p=0·69) did not differ significantly between the treatment and control groups. In patients with deep venous thrombosis, use of elastic compression stockings does not significantly reduce the development of post thrombotic syndrome, however the current body of evidence is limited and we believe at present there is equipoise and further conclusive studies are needed to establish the role of this therapy. None.