Use Of Elastic Compression Stockings Research Articles

RANDOMIZED CLINICAL TRIAL OF ASPIRIN AS PROPHYLAXIS FOR THROMBOEMBOLISM IN HIP ARTHROPLASTY.

This study aims to evaluate aspirin as a chemical prophylaxis (200 mg) in total hip arthroplasty. the study compared two groups and used ultrasonography (USG) to screen for low-deep venous thrombosis. Group 1 received 600 mg (control), and Group 2 received 200 mg of (intervention), associated with the use of elastic compression stockings and early walking. fourteen patients were allocated to Group A (200mg), and 16 to Group B (600mg); in group A (200mg), 3 cases with thrombus below the popliteal vein were detected at the first USG examination. All of them are in the left lower limb (21.4%). In group B (600 mg), 5 cases were identified after the first exam (31.2%). All cases were asymptomatic and followed the protocol with prophylaxis only with Aspirin. In the statistical data, there were no differences in the presence of thrombus between the 200- and 600 mg groups, which is credited to using low-dose aspirin in low doses (200mg). Hematimetric levels returned to baseline levels and suggested there was no chronic or acute bleeding related to the use of aspirin. The manuscript was prepared according to the CONSORT guideline 2010. Level of Evidence I; Longitudinal Randomized Comparative Clinical Study.

Post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension: diagnosis and management.

Post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension are two distinct clinical syndromes associated with adverse patient outcomes following a venous thromboembolism. Clinical manifestations of post-thrombotic syndrome include persistent pain, swelling and ultimately venous ulceration following a deep venous thrombosis. Patients experiencing chronic thromboembolic pulmonary hypertension may have symptoms ranging from exertional dyspnoea to overt right heart failure. From a physician's perspective, the most effective preventative strategy is good quality anticoagulation for prophylaxis of primary and secondary venous thromboembolism. The treatment of post-thrombotic syndrome mainly involves lifestyle modifications alongside the use of elastic compression stockings while patients with chronic thromboembolic pulmonary hypertension should be offered targeted surgical and medical treatment options available at expert centres. Further research is warranted for both conditions to determine the role of direct oral anticoagulants when used with a preventive or therapeutic intent.

Changes in Transcutaneous Oxygen Pressure in the Lower Limb Associated with the Use of Elastic Compression Stockings.

Objective: Elastic compression stockings are used to prevent venous thrombosis in postsurgical patients. However, they have been associated with skin complications, such as medical device-related pressure ulcers. This study aimed to assess the effect of elastic compression stockings on the skin tissue status of the lower limbs. Methods: Transcutaneous oxygen pressure (TcPO2) was measured in the anterior tibia and corresponding soft skin of healthy subjects before, during, and after continuous use of elastic stockings for 30 min. Results: Wearing elastic stockings significantly reduced TcPO2 in the skin of the anterior tibia, and removal of the stockings restored TcPO2 values. Both individuals who exercised regularly and men had lower TcPO2 at all measurement points than both individuals who did not exercise and women. Older subjects (50-60 years) had reduced TcPO2 in the sural region than younger ones (20-30 years). Conclusion: The use of elastic compression stockings caused an early decrease of TcPO2 in healthy subjects. Clinical patients were predicted to be at a high risk of wounding.

New perspectives for prevention of the post-thrombotic syndrome

While on conventional anticoagulation, up to 50% of patients with one or more episodes of proximal deep vein thrombosis (DVT) can develop post-thrombotic (PTS) manifestations. The potential strategies for PTS prevention are the treatment of acute DVT with catheter-directed thrombolysis (CDT), the use of elastic compression stockings (ECS) and that of the direct oral anticoagulants (DOAC) in place of vitamin K antagonists (VKA) for the initial and long-term treatment of DVT. Based on the results of three randomized clinical trials, CDT cannot be recommended on a routine basis because of its invasiveness, the associated risk of major bleedings and the uncertainty about its efficacy. According to the results of a placebo-controlled randomized clinical trial, ECS are no longer recommended for PTS prevention on a routine basis. However, based on the results of a recent subanalysis of a prospective cohort study, patients with residual vein thrombosis and/or popliteal valve reflux at three months are likely to benefit from ECS for at least six months. Finally, following the demonstration that the inadequacy of VKA therapy plays a key role in the PTS development, several retrospective and prospective studies have shown that the use of DOACs for the initial and long-term treatment of DVT in place of VKAs reduces the risk of PTS by approximately 50%. In conclusion, the availability of DOACs and the potential of ECS in selected patients with proximal DVT are expected to play a key role for decreasing the rate and the severity of PTS in the forthcoming years.

Prevention of the Postthrombotic Syndrome with Anticoagulation: A Narrative Review.

The postthrombotic syndrome (PTS) is chronic venous insufficiency secondary to a prior deep vein thrombosis (DVT). It is the most common complication of venous thromboembolism (VTE) and, while not fatal, it can lead to chronic, unremitting symptoms as well as societal and economic consequences. The cornerstone of PTS treatment lies in its prevention after DVT. Specific PTS preventative measures include the use of elastic compression stockings and pharmacomechanical catheter-directed thrombolysis. However, the efficacy of these treatments has been questioned by large randomized controlled trials (RCTs). So far, anticoagulation, primarily prescribed to prevent DVT extension and recurrence, appears to be the only unquestionably effective treatment for the prevention of PTS. In this literature review we present pathophysiological, biological, radiological, and clinical data supporting the efficacy of anticoagulants to prevent PTS and the possible differential efficacy among available classes of anticoagulants (vitamin K antagonists [VKAs], low molecular weight heparins [LMWHs] and direct oral anticoagulants [DOACs]). Data suggest that LMWHs and DOACs are superior to VKAs, but no head-to-head comparison is available between DOACs and LMWHs. Owing to their potentially greater anti-inflammatory properties, LMWHs could be superior to DOACs. This finding may be of interest particularly in patients with extensive DVT at high risk of moderate to severe PTS, but needs to be confirmed by a dedicated RCT.

Effects of the use of elastic compression stockings among dental hygienists

Effects of the use of elastic compression stockings among dental hygienists

Compression therapy for prevention of post-thrombotic syndrome.

Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) that is characterised by chronic pain, swelling, and skin changes in the affected limb. One of every three people with DVT will develop post-thrombotic complications within five years. Several non-pharmaceutical measures are used for prevention of post-thrombotic syndrome during the acute phase of DVT. These include elevation of the legs and compression therapy. Clinicians and guidelines differ in their assessment of the utility of compression therapy for treatment of DVT. This is an update of a review first published in 2003. To determine relative effectiveness and rate of complications when compression therapy is used in people with deep vein thrombosis (DVT) for prevention of post-thrombotic syndrome (PTS). For this update, the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (20 March 2017) and CENTRAL (2017, Issue 2). The CIS also searched trial registries for details of ongoing or unpublished studies. We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of compression therapy, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS. Two review authors (DK and EvL) identified and assessed titles and abstracts for relevance, and a third review author (DA) verified this assessment independently. Review authors imposed no restrictions on date or language of publications. Three review authors (DA, DK, EvL) used data extraction sheets to independently extract study data. We resolved disagreements by discussion. We identified 10 RCTs with a total of 2361 participants that evaluated compression therapy. The overall methodological quality of these trials was low. We used only five studies in meta-analysis owing to differences in intervention types and lack of data. Three studies compared elastic compression stockings (pressure of 30 to 40 mmHg at the ankle) versus no intervention. Two studies compared elastic compression stockings (pressure 20 to 40 mmHg) versus placebo stockings. Overall, use of elastic compression stockings led to a clinically significant reduction in the incidence of PTS (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.38 to 1.01; P = 0.05; 1393 participants; 5 studies; low-quality evidence); no reduction in the incidence of severe PTS (RR 0.78, 95% CI 0.53 to 1.15; P = 0.21; 1224 participants; 4 studies; low-quality evidence); and no clear difference in DVT recurrence (RR 0.94, 95% CI 0.69 to 1.28; 1212 participants; 4 studies; P = 0.69; low-quality evidence). We did not pool data on the incidence of pulmonary embolism because this information was poorly reported, but we observed no differences between groups included in individual studies (low-quality evidence).Two studies evaluated effects of compression in the acute phase versus no compression treatment and found no differences in the incidence of PTS (RR 0.76, 95% CI 0.49 to 1.16; P = 0.2; 101 participants). One study reported that thigh-length stockings did not provide better protection against development of PTS than knee-length stockings (RR 0.92, 95% CI 0.66 to 1.28; P = 0.6; 267 participants). Another trial reported that wearing compression stockings for two years seemed to be superior to wearing them for one year in terms of PTS incidence.Two of the 10 included studies described patient satisfaction and quality of life (moderate-quality evidence), using different measurement systems. The first study showed significant improvement in well-being and DVT-related quality of life with compression treatment (P < 0.05) compared with bed rest, and the second study showed no differences in quality of life scores between compression and placebo groups. Four studies poorly reported side effects (low-quality evidence) that included itching, erythema, and other forms of allergic reaction and described no serious adverse events. Compliance with wearing of compression stockings was generally high but varied across studies. Low-quality evidence suggests that elastic compression stockings may reduce the occurrence of PTS after DVT. We downgraded the quality of evidence owing to considerable heterogeneity between studies and lack of or unclear risk of blinding due to clinical assessment scores. No serious adverse effects occurred in these studies. Large randomised controlled trials are needed to confirm these findings because of current lack of high-quality evidence and considerable heterogeneity.

Patients' perceptions and experiences of the prevention of hospital-acquired thrombosis: a qualitative study

ObjectiveTo examine patients' understanding of hospital-associated thrombosis, and their experiences of thromboprophylaxis.DesignQualitative study using semi-structured interviews with 31 patients requiring venous thromboembolism (VTE) prophylaxis following a recent hospital admission. Interviews...

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

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.

Guidance for the prevention and treatment of the post-thrombotic syndrome.

The post-thrombotic syndrome (PTS) is a frequent, potentially disabling complication of deep vein thrombosis (DVT) that reduces quality of life and is costly. Clinical manifestations include symptoms and signs such as leg pain and heaviness, edema, redness, telangiectasia, new varicose veins, hyperpigmentation, skin thickening and in severe cases, leg ulcers. The best way to prevent PTS is to prevent DVT with pharmacologic or mechanical thromboprophylaxis used in high risk patients and settings. In patients whose DVT is treated with a vitamin K antagonist, subtherapeutic INRs should be avoided. We do not suggest routine use of elastic compression stockings (ECS) after DVT to prevent PTS, but in patients with acute DVT-related leg swelling that is bothersome, a trial of ECS is reasonable. We suggest that selecting patients for catheter-directed thrombolytic techniques be done on a case-by-case basis, with a focus on patients with extensive thrombosis, recent symptoms onset, and low bleeding risk, who are seen at experienced hospital centers. For patients with established PTS, we suggest prescribing 20–30 mm Hg knee-length ECS to be worn daily. If ineffective, a stronger pressure stocking can be tried. We suggest that intermittent compression devices or pneumatic compression sleeve units be tried in patients with moderate-to-severe PTS whose symptoms are inadequately controlled with ECS alone. We suggest that a supervised exercise training program for 6 months or more is reasonable for PTS patients who can tolerate it. We suggest that management of post-thrombotic ulcers should involve a multidisciplinary approach. We briefly discuss upper extremity PTS and PTS in children.

The post-thrombotic syndrome.

The post-thrombotic syndrome (PTS) is a frequent, sometimes disabling complication of deep vein thrombosis (DVT) that reduces quality of life and is costly. This article discusses risk factors for PTS after DVT and available means to prevent and treat PTS, with a focus on new information in the field. After DVT, PTS will develop in 20% to 50% of patients, and severe PTS, including venous ulcers, will develop in 5% to 10%. The principal risk factors for PTS are anatomically extensive DVT, recurrent ipsilateral DVT, persistent leg symptoms 1 month after acute DVT, obesity, and older age. By preventing the initial DVT and ipsilateral DVT recurrence, primary and secondary prophylaxes of DVT will prevent cases of PTS. Based on recent evidence from a large multicenter trial, routine use of elastic compression stockings (ECS) after DVT to prevent PTS is not advocated, but in patients with DVT-related leg swelling that is bothersome, a trial of ECS is reasonable. Selecting DVT patients for catheter-directed thrombolytic treatment as a means of preventing PTS should be done on a case-by-case basis, with a focus on patients with extensive thrombosis, recent symptoms onset, and low bleeding risk. For patients with established PTS, daily use of ECS may help to relieve symptoms and edema. Intermittent compression devices can be tried in patients with moderate-to-severe PTS whose symptoms are inadequately controlled with ECS alone. A supervised exercise training program may improve PTS symptoms. Management of post-thrombotic ulcers should ideally involve a multidisciplinary approach. Important areas for future research are summarized.

Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

This article provides recommendations on the use of antithrombotic therapy in patients with stroke or transient ischemic attack (TIA). We generated treatment recommendations (Grade 1) and suggestions (Grade 2) based on high (A), moderate (B), and low (C) quality evidence. In patients with acute ischemic stroke, we recommend IV recombinant tissue plasminogen activator (r-tPA) if treatment can be initiated within 3 h (Grade 1A) or 4.5 h (Grade 2C) of symptom onset; we suggest intraarterial r-tPA in patients ineligible for IV tPA if treatment can be initiated within 6 h (Grade 2C); we suggest against the use of mechanical thrombectomy (Grade 2C) although carefully selected patients may choose this intervention; and we recommend early aspirin therapy at a dose of 160 to 325 mg (Grade 1A). In patients with acute stroke and restricted mobility, we suggest the use of prophylactic-dose heparin or intermittent pneumatic compression devices (Grade 2B) and suggest against the use of elastic compression stockings (Grade 2B). In patients with a history of noncardioembolic ischemic stroke or TIA, we recommend long-term treatment with aspirin (75-100 mg once daily), clopidogrel (75 mg once daily), aspirin/extended release dipyridamole (25 mg/200 mg bid), or cilostazol (100 mg bid) over no antiplatelet therapy (Grade 1A), oral anticoagulants (Grade 1B), the combination of clopidogrel plus aspirin (Grade 1B), or triflusal (Grade 2B). Of the recommended antiplatelet regimens, we suggest clopidogrel or aspirin/extended-release dipyridamole over aspirin (Grade 2B) or cilostazol (Grade 2C). In patients with a history of stroke or TIA and atrial fibrillation we recommend oral anticoagulation over no antithrombotic therapy, aspirin, and combination therapy with aspirin and clopidogrel (Grade 1B). These recommendations can help clinicians make evidence-based treatment decisions with their patients who have had strokes.

The use of compression stockings for venous disorders in Brazil

ObjectiveThe aim of this study was to analyse the medical indication and the use of elastic compression stockings, and to assess patient adherence to treatment in different regions of Brazil.MethodThe prescription and clinical indication of elastic stockings were evaluated in a prospective, descriptive, cross-sectional, multicentre study for a population of private patients. In 2009, 3414 patients from 123 treatment centres in southern, south-eastern and north-eastern Brazil were evaluated using a questionnaire. The following variables were analysed: sociodemographic (gender, age, occupation and education), lifestyle (physical activity and time spent standing); classification of venous disease (CEAP [clinical, aetiological, anatomical and pathophysiological] classification – clinical criteria), indications for prescription, consumer behaviour (strength, acquisition and use of stockings) and criteria of satisfaction (improvement, duration of use, adherence). The effects of compression therapy were assessed at a follow-up visit approximately 30 days after starting treatment with the following items being assessed: complaints about pain, discomfort, burning sensation and oedema of the leg while using elastic stockings. Multivariate analysis was used to compare data with an alpha error of 5% (P value < 0.05) being considered acceptable.ResultsThe average age increased with the severity of chronic venous insufficiency; the main indications used by physicians were leg pain and discomfort; 89.3% of patients bought stockings and thus started treatment with more than 90% of these reporting improvements in symptoms.ConclusionElastic stockings are available to the Brazilian population, look acceptable at the time of purchase and provide good results; however, some limitations regarding their use need to be addressed.

The Post-Thrombotic Syndrome

The post-thrombotic syndrome (PTS) is an important chronic complication of deep vein thrombosis (DVT). The present review focuses on risk determinants of PTS after DVT and available means to prevent and treat PTS. More than one-third of patients with DVT will develop PTS, and 5% to 10% of patients develop severe PTS, which can manifest as venous ulcers. PTS has an adverse impact on quality of life as well as significant socioeconomic consequences. The main risk factors for PTS are persistent leg symptoms 1 month after acute DVT, anatomically extensive DVT, recurrent ipsilateral DVT, obesity, and older age. Subtherapeutic dosing of initial oral anticoagulation therapy for DVT treatment may also be linked to subsequent PTS. By preventing the initial DVT and DVT recurrence, primary and secondary prophylaxis of DVT will prevent cases of PTS. Daily use of elastic compression stockings for 2 years after proximal DVT appears to reduce the risk of PTS; however, uncertainty remains regarding optimal duration of use, optimal compression strength, and usefulness after distal DVT. The cornerstone of managing PTS is compression therapy, primarily using elastic compression stockings. Venoactive medications such as aescin and rutosides may provide short-term relief of PTS symptoms. Further studies to elucidate the pathophysiology of PTS, to identify clinical and biological risk factors, and to test new preventive and therapeutic approaches to PTS are needed.

Post-Thrombotic Syndrome: Assessment of Patient and Health Care Provider Knowledge and Awareness.

AbstractAbstract 3835 Background:Despite evidence demonstrating that the post-thrombotic syndrome (PTS) is a common and burdensome long-term complication of deep vein thrombosis (DVT), we hypothesized that patient and health care provider awareness of this condition was poor, thereby limiting the use of measures to prevent and screen for PTS. Objectives:We designed a quality improvement project to (1) identify existing gaps in health care provider and patient knowledge and awareness of PTS, and (2) use this information to guide the development and implementation of a PTS educational curriculum. Methods:Health care providers (internal medicine or family medicine physicians and anticoagulation pharmacists) at two clinical centers were asked to complete a brief survey about PTS knowledge and practice patterns. Patients diagnosed with proximal lower extremity deep vein thrombosis (DVT) who were managed in the Thrombosis Service at each center were asked to complete a brief survey with questions about basic PTS knowledge (University of Utah) or PTS education received and use of elastic compression stockings (ECS) for PTS prevention (Jewish General Hospital). Results:Provider survey: Of the 358 surveys sent to health care providers from both institutions, 77 surveys were completed (17/134 for the University of Utah, 60/224 for Jewish General Hospital). Survey respondents included 59 physicians or resident physicians, and 18 pharmacists. When asked to identify the average incidence of PTS after DVT, only 35% of providers responded correctly. Providers correctly identified that wearing ECS following DVT can prevent PTS in some cases (94% correct), and that diuretic medications are not used to treat PTS (100% correct). However, only 31% of providers at both institutions “always” or “frequently” discuss the risk of PTS with DVT patients, only 25% “always” or “frequently” prescribe ECS for PTS prevention following DVT, and only 26% “always or “frequently” evaluate patients for the development of PTS after DVT. The primary barrier that reportedly prevents providers from performing these functions more frequently is the lack of personal knowledge or expertise to discuss or diagnose PTS. The majority of providers surveyed report they have not received prior education about PTS. Patient survey: Patients at each institution completed a different survey, each exploring different aspects of PTS knowledge. At the University of Utah (n=106 completed surveys), 54% of patients surveyed reported they had never heard of PTS. Only 50% chose the correct answer when asked to identify signs and symptoms of PTS (leg pain and swelling), and only 25% correctly identified a risk factor for PTS (blood clot above the knee). The majority of patients correctly identified appropriate leg elevation technique (67%), and the fact that lower extremities do not always return to normal following DVT (82%). When asked about a possible treatment for PTS, 66% of patients correctly chose ECS, but only 44% correctly chose ECS as also a possible PTS preventive therapy. At Jewish General Hospital (n=60 completed surveys), only 38% of patients reported receiving PTS education, and this was done primarily in the form of verbal teaching by the physician or vascular lab staff. Additionally, 38% of patients reported they were prescribed ECS following DVT, and the majority of those patients did go on to purchase the stockings and wear them regularly. Conclusion:The results of our survey establish that there is tremendous potential to impact and improve both health care provider and patient knowledge of PTS. We found that the majority of providers underestimate the incidence of PTS, which is underscored by the fact that only 1/3 of providers routinely discuss the risk of PTS with DVT patients, and only 1/4 routinely prescribe ECS and/or assess DVT patients for the development of PTS. The gaps in provider knowledge correlate with those in DVT patients surveyed. Most patients have never heard of PTS, and therefore are largely unaware of PTS risk factors, signs and symptoms, and possible preventive methods. These data will be used in the second phase of our quality improvement project to inform the development of educational materials and tools specifically tailored to the learning needs of patients and health care providers. Disclosures:No relevant conflicts of interest to declare.

How I treat postthrombotic syndrome

AbstractPostthrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT) that reduces quality of life and has important socioeconomic consequences. More than one-third of patients with DVT will develop PTS, and 5% to 10% of patients will develop severe PTS, which may manifest as venous ulceration. The principal risk factors for PTS are persistent leg symptoms 1 month after the acute episode of DVT, extensive DVT, recurrent ipsilateral DVT, obesity, and older age. Daily use of elastic compression stockings (ECSs) for 2 years after proximal DVT appears to reduce the risk of PTS; however, there is uncertainty about optimal duration of use and compression strength of ECSs and the magnitude of their effect. The cornerstone of managing PTS is compression therapy, primarily using ECSs. Venoactive medications such as aescin and rutoside may provide short-term relief of PTS symptoms. The likelihood of developing PTS after DVT should be discussed with patients, and symptoms and signs of PTS should be monitored during clinical follow-up. Further studies to elucidate the pathophysiology of PTS, to identify clinical and biologic risk factors, and to test new preventive and therapeutic approaches to PTS are needed to ultimately improve the long-term prognosis of patients with DVT.

Contemporary Issues in the Prevention and Management of Postthrombotic Syndrome

To provide an evidence-based review and clinical summary of postthrombotic syndrome (PTS). A literature review was performed via MEDLINE (1950-July 1, 2009) and International Pharmaceutical Abstracts (1970-June 2009) searches using the terms post-thrombotic syndrome, post-phlebitic syndrome, deep vein thrombosis, and compression stockings. PTS is best characterized as a chronic syndrome of clinical signs and symptoms including pain, swelling, parasthesias, and ulceration in the affected limb following deep vein thrombosis (DVT). It occurs in up to half of patients with symptomatic DVT, usually within the first 2 years. Although the pathophysiology of PTS is not well understood, a thrombus may cause venous hypertension and valvular incompetence resulting in edema, tissue hypoxia, and in severe cases, ulceration. Risk factors for PTS include recurrent ipsilateral DVT, obesity, and poor quality of anticoagulant therapy. PTS diagnosis is based on the presence of typical signs and symptoms and may be made using one of several clinical scoring systems. Prevention of PTS should focus on DVT prevention and the use of elastic compression stockings following DVT, while fibrinolysis remains under investigation as an effective method for PTS prevention. The treatment of PTS may include either pharmacologic or mechanical modalities, although none of these regimens has been rigorously tested. Pharmacists have the opportunity to provide more comprehensive antithrombotic management by educating patients and providers on PTS, recommending appropriate preventive therapy, assisting patients in obtaining and adhering to this therapy, and assisting providers with the management of PTS. Providers should be proactive in preventing PTS, with pharmacists taking an active role in optimal DVT prevention, identifying patients at risk for PTS, and counseling and directing preventive therapies.

Is the wearing of elastic stockings for half a day as effective as wearing them for the entire day?

Background There is good evidence for the use of compression for some clinical indications but little is known about dosimetry in compression. Objective The aim of this work was to evaluate whether or not the use of compression stockings during part of the day would help in the reduction of evening oedema in patients with clinical, epidemiological, anatomical and physiopathological (CEAP) classifications C0 and C1. Methods The effects of elastic compression stockings on volumetric variations during the working day were evaluated for the legs of two men and 18 women (40 legs). The inclusion criterion was classification as C0 (10 legs) or C1 (30 legs) according to the CEAP criteria. Participants used three-quarter-length elastic compression stockings (20-30 mmHg) on three consecutive days for the entire day or only for the morning or they did not use the stockings at all. Volumetry using the water displacement technique was performed in the morning and in the evening. When the patients wore the stockings only during the morning, volumetry was also performed at 13:00 h. Results Significant increases in volume were observed for both legs when stockings were not used compared with the use of stockings in the morning only. After removing the stockings, both legs had significant increases in volume in the afternoon. However, use for half the day was better than not using the stockings at all. Conclusions The use of elastic compression stockings can reduce volumetric variations during working hours, with the use of stockings for the entire day being better than for just half the day.

The use of elastic compression stockings for post‐thrombotic syndrome in a child

Post-thrombotic syndrome (PTS) is a potential complication following deep vein thrombosis (DVT) in children. Guidelines for management of PTS in children are non-existent. The absence of guidelines may limit the use of elastic compression stockings (ECS), offered for prevention and treatment of PTS in adults. We report the case of a 6-year-old, who developed PTS following a presumed line-related lower limb DVT, with dramatic improvement in functional status with ECS use. The presented case highlights the subtle nature of symptoms, potential benefits and limitations of ECS use for PTS, and current lack of evidence in children.

Risk factors for post-thrombotic syndrome in patients with a first deep venous thrombosis.

Post-thrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT). To determine the risk of PTS after DVT and to assess risk factors for PTS. Patients were recruited from the Multiple Environmental and Genetic Assessment (MEGA) study of risk factors for venous thrombosis. Consecutive patients who suffered a first DVT of the leg were included in a follow-up study. All patients completed a questionnaire and DNA was obtained. PTS was ascertained in a structured interview using a clinical classification score. The 1-year cumulative incidence of PTS was 25% and 7% for severe PTS. Elastic compression stockings were prescribed in 1412 (85%) patients. The majority used their stockings every day. Women were at an increased risk compared with men [risk ratio (RR) 1.5, 95% confidence interval (CI) 1.3-1.8]. Similarly, obese patients had a 1.5-fold increased risk of PTS compared with normal weight patients (RR 1.5, 95% CI 1.2-1.9), with a 1-year cumulative incidence of 34% compared with 22%. Patients who already had varicose veins had an increased risk (RR 1.5, 95% CI 1.2-1.8) of PTS. DVT in the femoral and iliac vein was associated with a 1.3-fold increased risk of PTS compared with popliteal vein thrombosis (RR 1.3, 95% CI 1.1-1.6). Patients over 60 years were less likely to develop PTS than patients below the age of 30 (RR 0.6, 95% CI 0.4-0.9). Malignancy, surgery, minor injury, plaster cast, pregnancy or hormone use did not influence the risk of PTS neither did factor (F)V Leiden nor the prothrombin 20210A mutation. PTS is a frequent complication of DVT, despite the widespread use of elastic compression stockings. Women, obese patients, patients with proximal DVT and those with varicose veins have an increased risk of PTS, whereas the elderly appeared to have a decreased risk.