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Immediate compression offers 'clear benefit' following blood clot
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Patients with deep vein thrombosis who underwent immediate compression therapy had significantly lower rates of residual vein obstruction and post-thrombotic syndrome than those who received no compression, according a multicenter prospective study.
“Post-thrombotic syndrome is the most frequent complication of DVT, affecting 20% to 50% of patients 1 to 2 years after DVT,” Elham E. Amin, PhD, a student at Maastricht University in the Netherlands, and colleagues wrote. “It is a chronic condition that is characterized by mild to severe symptoms and signs of venous insufficiency ranging from pain, sensation of leg heaviness, discomfort, pretibial edema, skin induration and hyperpigmentation to venous ulceration in the most severe cases.”
There has been debate among clinicians about compression as preventive therapy, and its effect on residual vein obstruction and on recurrence is “not unequivocally clear,” according to researchers.
To assess this association, Amin and colleagues prospectively studied 592 patients (mean age, 57 years; 57.8% men; mean BMI, 28.2 kg/m2) with confirmed proximal DVT as a prespecified substudy of the randomized controlled IDEAL DVT study. Researchers randomly assigned patients no compression (n = 72), acute compression with multilayer bandaging (n = 369) or compression hosiery (n = 151) within 24 hours of DVT diagnosis.
All patients received anticoagulants.
“Although the use of compression stockings after DVT is routine across much of Europe, it is less common in the United States, where guidelines emphasize compression primarily for patients who complain of ongoing symptoms,” study author Arina J. ten Cate-Hoek, MD PhD Msc, physician, clinical epidemiologist and medical director of thrombosis at Maastricht University, said in a press release.
Researchers used compression ultrasonography to detect residual vein obstruction and recurrent DVT. Incidence of post-thrombotic syndrome was defined as Villalta score of 5 or greater at 6 months and 24 months.
Average time from diagnosis to compression ultrasonography was 5.3 months.
In total, 289 of the 592 patients (48.8%) in the study had residual vein obstruction at ultrasound.
Those who received immediate compression had a lower rate of residual vein obstruction than those who did not receive compression (46.3% vs. 66.7%; OR = 0.46; 95% CI, 0.27-0.8).
At 24 months, post-thrombotic syndrome occurred more frequently among patients with residual vein obstruction than among those without it (54% vs. 46%; OR = 0.65; 95% CI, 0.46-0.92).
“We found little reason for those treating DVT not to use compression therapy as a prevention measure against future complications,” ten Cate-Hoek said in the release.
Recurrent venous thrombosis did not appear associated with residual vein obstruction (OR = 0.82; 95% CI, 0.61-1.12).
“I think we can infer from our findings that this improved blood flow certainly helps prevent complications like residual vein occlusion and post-thrombotic syndrome after DVT,” ten Cate-Hoek said in the release. “Given these outcomes, and that compression stockings are fairly easy to self-administer, relatively inexpensive and minimally intrusive, compression therapy offers a clear benefit for all patients with DVT.”
The limitations of the study included the use of data from a larger randomized study and that some patients were anticoagulated with agents that may increase their risk for post-thrombotic syndrome.
“We suggest that in addition to adequate anticoagulation therapy, immediate compression therapy — either with multilayer bandaging or with compression hosiery — should be implemented in daily clinical practice and that the application of early compression therapy in patients with acute DVT should be irrespective of symptomatology in order to optimize the prevention of post-thrombotic syndrome,” the researchers wrote. – by Cassie Homer
Disclosures: The authors report no relevant financial disclosures.
Perspective
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The most important takeaway with this study is there is no harm in starting compression therapy as soon as possible. There may actually be some benefit with regard to lowering risk for developing post-thrombotic symptoms.
I was not surprised by the study results, but this does refute old ideas that interventions such as physical activity, mobility and compression therapy are “dangerous” in the acute period. The findings may influence practice. The benefit reported was not large, but it was significant and post-thrombotic symptoms can be quite debilitating to patients. It is nice to see a well-designed clinical trial addressing this important issue.
It’s important to note that residual vein occlusion is a biomarker and not necessarily an important outcome from the perspective of clinically relevant outcomes. Therefore, the 20% reduction in residual vein occlusion is not as important as the 8% reduction in post-thrombotic symptoms. These are more relevant to patients and more important risk factors for recurrent thrombosis. Thus, the impact of the clinical intervention is relatively modest, but still important.
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