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Dinanda N Kolbach - One of the best experts on this subject based on the ideXlab platform.

  • Compression Therapy for treating post‐thrombotic syndrome
    The Cochrane database of systematic reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

  • Compression Therapy for treating post thrombotic syndrome
    Cochrane Database of Systematic Reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

  • Compression Therapy for prevention of post thrombotic syndrome
    Cochrane Database of Systematic Reviews, 2017
    Co-Authors: Diebrecht Appelen, Martin H. Prins, Martino Neumann, Eva Van Loo, Dinanda N Kolbach
    Abstract:

    Background 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. Objectives 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). Search methods 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. Selection criteria 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. Data collection and analysis 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. Main results 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. Authors' conclusions 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.

Diebrecht Appelen - One of the best experts on this subject based on the ideXlab platform.

  • Compression Therapy for treating post‐thrombotic syndrome
    The Cochrane database of systematic reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

  • Compression Therapy for treating post thrombotic syndrome
    Cochrane Database of Systematic Reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

  • Compression Therapy for prevention of post thrombotic syndrome
    Cochrane Database of Systematic Reviews, 2017
    Co-Authors: Diebrecht Appelen, Martin H. Prins, Martino Neumann, Eva Van Loo, Dinanda N Kolbach
    Abstract:

    Background 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. Objectives 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). Search methods 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. Selection criteria 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. Data collection and analysis 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. Main results 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. Authors' conclusions 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.

Martin H. Prins - One of the best experts on this subject based on the ideXlab platform.

  • Compression Therapy for treating post‐thrombotic syndrome
    The Cochrane database of systematic reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

  • Compression Therapy for treating post thrombotic syndrome
    Cochrane Database of Systematic Reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

  • Compression Therapy for prevention of post thrombotic syndrome
    Cochrane Database of Systematic Reviews, 2017
    Co-Authors: Diebrecht Appelen, Martin H. Prins, Martino Neumann, Eva Van Loo, Dinanda N Kolbach
    Abstract:

    Background 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. Objectives 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). Search methods 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. Selection criteria 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. Data collection and analysis 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. Main results 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. Authors' conclusions 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.

Martino Neumann - One of the best experts on this subject based on the ideXlab platform.

  • Compression Therapy for treating post‐thrombotic syndrome
    The Cochrane database of systematic reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

  • Compression Therapy for treating post thrombotic syndrome
    Cochrane Database of Systematic Reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

  • Compression Therapy for prevention of post thrombotic syndrome
    Cochrane Database of Systematic Reviews, 2017
    Co-Authors: Diebrecht Appelen, Martin H. Prins, Martino Neumann, Eva Van Loo, Dinanda N Kolbach
    Abstract:

    Background 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. Objectives 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). Search methods 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. Selection criteria 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. Data collection and analysis 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. Main results 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. Authors' conclusions 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.

Sara Azirar - One of the best experts on this subject based on the ideXlab platform.

  • Compression Therapy for treating post‐thrombotic syndrome
    The Cochrane database of systematic reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

  • Compression Therapy for treating post thrombotic syndrome
    Cochrane Database of Systematic Reviews, 2019
    Co-Authors: Sara Azirar, Diebrecht Appelen, Martin H. Prins, Martino Neumann, Adriaan N. P. De Feiter, Dinanda N Kolbach
    Abstract:

    Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and Compression Therapy. There have been limited studies regarding the effectiveness of Compression Therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of Compression Therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. Objectives To assess the effectiveness of Compression Therapy for treatment of post-thrombotic syndrome, including elastic Compression stockings and mechanical devices compared with no intervention, placebo and with each other. Search methods For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. Selection criteria We included trials that evaluated Compression Therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. Data collection and analysis One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. Main results We identified four trials, with 116 participants, investigating the effectiveness of Compression Therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic Compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical Compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing Compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical Compression devices.None of the studies evaluated patient satisfaction. Authors' conclusions There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic Compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to Compression device use owing to small studies of short duration. High-certainty evidence to support the use of Compression Therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether Compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.