Individually tailored duration of elastic compression therapy in relation to incidence of the postthrombotic syndrome.

Abstract

We assessed whether individualized shortened duration of elastic compression stocking (ECS) therapy after acute deep venous thrombosis (DVT) is feasible without increasing the incidence of postthrombotic syndrome (PTS). At the outpatient clinic of the Maastricht University Medical Centre, 125 consecutive patients with confirmed proximal DVT were followed for 2 years. Villalta scores were assessed on four consecutive visits; 3, 6, 12, and 24 months after the acute event. Reflux was assessed once by duplex testing. After 6 months, patients with scores <or=4 on the Villalta clinical score and in the absence of reflux were allowed to discontinue ECS therapy. If reflux was present, two consecutive scores <or=4 were needed to discontinue ECS therapy. ECS therapy was discontinued in 17% of patients at 6 months, in 48% at 12 months, and in 50% at 24 months. Reflux on duplex testing was present in 74/101 (73.3%) tested patients and was not associated with the onset of PTS. At the 6-month visit, the cumulative incidence of PTS was 13.3%, at 12 months 17.0%, and at 24 months 21.1%. Varicosities/venous insufficiency (present at baseline) was significantly associated with PTS; hazard ratio 3.2 (1.2-9.1). Patients with a low probability for developing PTS can be identified as early as 6 months after the thrombotic event, and individualized shortened duration of ECS therapy based on Villalta clinical scores may be a safe management option. These findings need to be confirmed in a randomized clinical trial.