• Dtsch Arztebl Int · Mar 2024

    Review Meta Analysis

    Compression Therapy in the Treatment of Acute Deep Venous Thrombosis of the Lower Limb and for the Prevention of Post-Thrombotic Syndrome—a Review Based on a Structured Literature Search.

    • Dorothea Thieme, Birgit Linnemann, Katja Mühlberg, Thomas Noppeney, Maria Kreutz, and Marcus Thieme.
    • OTH Regensburg, Social and Health Care Sciences, Regensburg, Germany; University Medical Center of the Johannes Gutenberg-University Mainz, Department of Cardiology, Cardiology III - Angiology, Mainz, Germany; University Hospital Leipzig, Department for Angiology, Leipzig, Germany; University Hospital Regensburg, Department for Vascular Surgery, Regensburg, Germany; Regiomed-Vascular Cente, Department of Angiology, Cardiology, Diabetology, Sonneberg, Germany; University Hospital Jena, Department of Interna Medicine I, Angiology, Jena, Germany.
    • Dtsch Arztebl Int. 2024 Mar 22; 121 (6): 188194188-194.

    BackgroundAfter an acute deep venous thrombosis (DVT) of the lower limb, 20% to 63% of patients develop post-thrombotic syndrome (PTS). In this review, we address the efficacy of compression therapy in the treatment of acute DVT of the lower limb, and for the prevention of PTS.Methods12 randomized controlled trials (RCTs) and one meta-analysis, with a total of 3751 patients, were identified in a structured literature search.ResultsTwo RCTs showed that adding compression therapy to drug treatment in the first 9 days of the acute phase of lower limb DVT led to more rapid pain relief (p<0.050) and less swelling (remaining difference in circumference, 1 cm versus 3 cm, p<0.050). As for the prevention of PTS, four RCTs showed a short-term benefit or no benefit of compression therapy. In three further RCTs, medical compression stockings (MCS) brought about a 16% to 27% absolute reduction of the frequency and severity of PTS (47% vs. 20 %, p<0.001; 40% vs. 21% (95% confidence intervals [29.9; 50.1] and [12.7; 29.5], respectively; and 58% vs. 42%, relative risk [RR] 0.73 [0,55; 0.96]). The benefit of MCS was also confirmed in a recent meta-analysis (RR 0.66 [0.44; 0.99], I2 = 88%). Thigh-length MCS were not superior to knee-length MCS for the prevention of PTS (33% vs. 36%, hazard ratio [HR] 0.93 [0.62; 1.41]). Individual, symptomoriented tailoring of the duration of treatment was not inferior to a fixed treatment duration of 24 months (29% vs. 28%; odds ratio [OR] 1.06 [0.78;1.44]).ConclusionCompression therapy relieves symptoms in acute DVT and lessens the frequency and severity of PTS. It is therefore recommended as standard treatment.

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