British Society for Haematology. Listening. Learning. Leading British Society for Haematology. Listening. Learning. Leading
27 September 2018

People with deep-vein thrombosis (DVT) should start compression therapy within 24 hours of diagnosis to help reduce the risk of developing potentially debilitating complications, according to a new Dutch analysis.

In the largest study yet to track outcomes from compression therapy in the acute phase of DVT, researchers examined whether or not immediate compression therapy could prevent residual vein occlusion, and what effect that had on the incidence of post‑thrombotic syndrome.

DVT affects 1 in 1,000 people in the UK every year and occurs when a blood clot forms in the deep veins, typically in the leg. Residual vein occlusion – where a clot remains in the vein – is one factor which might contribute to the development of post-thrombotic syndrome, a long-term complication which occurs in roughly a third of people who develop DVT. Post-thrombotic syndrome can have a significant impact on quality of life, with symptoms including pain, swelling, and changes to the skin in the affected leg.

The researchers analysed the results of an existing study of nearly 600 patients diagnosed with proximal (upper leg) DVT in the Netherlands. They found that patients who received immediate compression therapy saw an absolute reduction of 20% in their risk of developing residual vein occlusion (46.3% in those receiving immediate compression, compared to 66.7% without).

Those patients who didn’t develop residual vein occlusion saw an absolute reduction of 8% in their risk of post‑thrombotic syndrome at two years (46.0% of patients without residual vein occlusion developed post‑thrombotic syndrome, compared to 54.0% of those with residual vein occlusion).

Compression therapy was administered using multilayered bandaging or compression hosiery until oedema was reabsorbed, at which time all patients wore fitted compression stockings. In addition to compression, patients also received anticoagulants.

 “We found little reason for those treating DVT not to use compression therapy as a prevention measure against future complications,” said senior study author Dr Arina ten Cate-Hoek of Maastricht University in the Netherlands, whose findings are published in the journal Blood.

Compression therapy was not associated with any adverse side effects. However, compression therapy appeared to show no benefit to patients with a blood clot in the common femoral vein in the upper leg, which is consistent with previous studies.

Dr ten Cate-Hoek says that compression therapy is thought to improve blood flow by reducing the diameter of veins.

“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,” she said.

 “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.”


Source: Amin, E.E., Bistervels, I.M., Meijer, K., Tick, L.W., Middeldorp, S., Mostard, G., van de Poel, M., Serné, E.H., Otten, H.M., Klappe, E.M., Joore, M.A., ten Cate, H., ten Wolde, M., and ten Cate-Hoek, A.J. (2018) “Residual vein occlusion in relation to immediate compression and postthrombotic syndrome in deep vein thrombosis”, Blood, available at doi: 10.1182/blood-2018-03-836783

 

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