![]() ![]() Men comprised 62.4% of the active group and 57.9% of the placebo group. The average age was 55.4 years in the study group (standard deviation ± 15.3 years) and 54.8 years (SD ± 15.8 years) in the place- bo group. Baseline characteristics, including body mass index (BMI), VTE risk factors, and anticoagulation treatment regimens, were similar between groups. There were 409 patients in the ECS group and 394 in the placebo group. Outcomes were measured objectively using a validated scale (the Villalta scale) for PTS severity and the 36-item Short Form Health Survey (SF-36) and the Venous Insufficiency Epidemiological and Economic Study Quality of Life (VEINES-QOL) questionnaire to measure QOL. 8 Secondary outcomes included severity of PTS, presence of leg ulcers, recurrence of venous thromboembolism (VTE), death, adverse events, venous valvular reflux, and quality of life (QOL). The primary outcome was the cumulative incidence of PTS diagnosed at 6 months or later using Ginsberg's criteria of ipsilateral pain and swelling of at least 1 month's duration. Participants were followed at one, 6, 12, 18, and 24 months. Patients were asked to wear the stocking on the affected leg each day from when they woke until they went to bed. Providers, study personnel and statisticians, and patients were all blinded to treatment allocation. Patients were randomly assigned to wear active (30-40 mm Hg graduated) ECS or identical-looking placebo ECS with <5 mm Hg compression at the ankle for 2 years. ![]() ![]() Patients were excluded if they had received thrombolytics, had arterial claudication, had a life expectancy of <6 months, were unable to put on ECS due to physical disabilities or allergy, or were unable to participate in follow-up visits. Most patients received standard anticoagulation therapy to treat their DVT (5-10 days of heparin and 3-6 months of warfarin). Kahn et al 1 conducted a randomized, placebo-controlled trial of active vs placebo ECS in patients from 24 centers in the United States and Canada who'd had an ultrasound-confirmed proximal DVT (in the popliteal or more proximal deep leg vein) within the previous 14 days. STUDY SUMMARY: RCT sets aside a common practice 6,7 However, these were small, single-center studies, and they were not placebo-controlled. Prior studies suggested that using ECS can cut the incidence of PTS in half. These stockings are expensive and uncomfortable. Patients are frequently encouraged to wear ECS after DVT to reduce the incidence of PTS by reducing venous hypertension and reflux. 3 Because current PTS treatments are not very effective, prevention is essential. 2 It occurs in 25% to 50% of patients after DVT. Its clinical features range from minor limb swelling to severe edema and pain, irreversible skin changes, and leg ulcerations. PTS can be a frustrating, debilitating condition. ![]() He is asking about using elastic compression stockings (ECS). He has read about post-thrombotic syndrome (PTS) online and is very concerned about this possible side effect. He was prescribed warfarin, 5 mg/d, with enoxaparin bridging, 120 mg/d. A 56-year-old man comes to your clinic 3 days after receiving a diagnosis of lower extremity deep vein thrombosis (DVT). ![]()
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