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Compression hosiery preferred option for acute deep vein thrombosis

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August 6, 2018

Compression hosiery improved quality of life and appeared cost-effective for the acute phase between diagnosis of deep vein thrombosis and application of elastic compression stockings, according to results of a substudy of the IDEAL DVT study.

Although multilayer bandaging appeared slightly more effective than hosiery, it cost significantly more and did not improve quality of life.

“Deep vein thrombosis is a potential debilitating and life-threatening disease, with an annual incidence of one to two per 1,000 people,” Elham E. Amin, PhD student at Maastricht University in the Netherlands, and colleagues wrote. “Complaints related to DVT can vary from mild to severe, with DVT recurrence and pulmonary embolism being the most severe consequences.”

Post-thrombotic syndrome — characterized by pain, cramps, edema and venous ulcers — is a long-term, irreversible complication that develops among 20% to 50% of patients within 2 years of DVT diagnosis.

“The main, although disputed, form of preventive therapy for post-thrombotic syndrome is the use of elastic compression stockings (class III, ankle pressure of 40 mmHg) for a period of up to 2 years following DVT,” the researchers wrote.

Generally, compression stockings are applied as soon as leg edema is resolved, which may take 2 to 6 weeks. However, there is no consensus on the preferred treatment — either multilayer compression bandages, thigh-high compression hosiery or no compression — for the time between DVT diagnosis and elastic compression stockings application.

Amin and colleagues analyzed 865 patients (mean age, 57.2 years; 58.2% men) from the Netherlands and Italy with proximal DVT who received compression (n = 668) — via multilayer bandaging (n = 415) or hosiery (n = 253) — or no compression (n = 188). Sixteen patients in the multilayer bandaging group required compression hosiery because of leg complaints.

Health-related quality of life — measured using the EQ-5D, the Short Form Health Survey

version 2, and the disease-specific Venous Insufficiency Epidemiological and Economic Study (VEINESQoL) — and costs served as study measures. Researchers also measured the impact of compression on the Villalta score, for which a score of at least 5 measured 6 months after DVT indicates the presence of post-thrombotic syndrome.

At 3 months, patients who underwent compression had lower overall objective Villalta scores compared with the no compression group (1.52 vs. 2.21; P < .001). Researchers attributed the differences to irreversible skin signs — induration, hyperpigmentation and venectasia — and pain on calf compression.

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However, subjective and total Villata scores appeared similar across groups.

Researchers observed no statistically significant differences in health-related quality of life for all compression vs. no compression.

However, those who used hosiery had significantly higher scores than the bandaging group in the acute phase on the EQ-5D (0.86 vs. 0.81; P = .015) and VEINES-QOL (0.66 vs. 0.62; P = .03). Researchers only observed these differences at 1 month; the differences did not appear statistically significant at 3 months.

Mean health care costs appeared highest among patients who underwent compression via bandaging at 417.08 (95% CI, 354.1-489.3) compared with 114.25 (95% CI, 92.5-198.43) for those who underwent compression via hosiery and 105.86 (95% CI, 34.63-199.3) for those who underwent no compression.

“The differences in costs across groups were mainly attributable to costs related to compression

material use and home care nursing demands, which were both highest in the bandaging group and lowest in the no compression group,” the researchers wrote.

The main limitation of the study is the lack of randomization between compression via hosiery, compression via bandaging and no compression.

“Multilayer bandaging is, overall, slightly more effective than compression hosiery, but without the gain in health-related quality of life, and at a significantly higher cost,” the researchers wrote. “Compression hosiery is a relatively cheap, easy to use and safe alternative to multilayer bandaging in all patients. Therefore, from both a patient perspective and an economic perspective, compression hosiery would be the preferred choice when initial compression is applied in unselected patients.”– by Cassie Homer

Disclosures: The researchers report no relevant financial disclosures.