Below-knee elastic compression stockings to prevent the post-thrombotic syndrome - A randomized, controlled trial
Below-knee elastic compression stockings to prevent the post-thrombotic syndrome - A randomized, controlled trial
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DOI：
10.7326/0003-4819-141-4-200408170-00004
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发表时间：
2004-08-17
影响因子：
39.2
通讯作者：
Girolami, A
中科院分区：
文献类型：
--
作者：
Prandoni, P;Lensing, AWA;Girolami, A
背景资料：由于只有有限的证据表明弹力袜可以预防有症状的深静脉血栓形成（DVT）患者的血栓后综合征，因此弹力袜没有被广泛使用。目的：评价弹力袜预防近端DVT患者血栓后综合征的疗效。设计：随机对照临床试验。地点：大学医院。患者：连续180例首次发作的症状性近端DVT患者接受常规抗凝治疗。干预措施：出院前，患者被随机分配到穿或不穿膝下压缩弹性袜（30至40毫米汞柱的脚踝）2年。随访进行了长达5 years.Measurements：血栓后综合征的存在和严重程度进行了评分，通过使用一个标准化scale.Results：血栓后后遗症开发44的90个对照组（严重的10）和23的90例穿着弹力袜（严重的3）。除1起事件外，所有事件均发生在前2年。对照组血栓后综合征的累积发生率为40.0%（95% CI，29.9%-50.1%）vs 21.1%（Cl，12.7%-29.5%）6个月后，46.7% 1年后为49.1%（Cl，36.4%至57.0%）与22.2%（Cl，13.8%至30.7%），2年后为49.1%（Cl，38.7%至59.4%）与24.5%（Cl，15.6%至33.4%）。调整基线特征后，血栓后综合征的风险比在弹力袜组与对照组相比为0.49（CI，0.29至0.84; P = 0.011）。局限性：这项研究缺乏一个双盲design.Conclusions：血栓后后遗症发展近端DVT的患者几乎有一半。膝盖以下的压缩弹性袜减少了约50%的这一比率。
Background: Because only limited evidence suggests that elastic stockings prevent the post-thrombotic syndrome in patients with symptomatic deep venous thrombosis (DVT), these stockings are not widely used.Objective: To evaluate the efficacy of compression elastic stockings for prevention of the post-thrombotic syndrome in patients with proximal DVT.Design: Randomized, controlled clinical trial.Setting: University hospital.Patients: 180 consecutive patients with a first episode of symptomatic proximal DVT who received conventional anticoagulant treatment.Interventions: Before discharge, patients were randomly assigned to wear or not wear below-knee compression elastic stockings (30 to 40 mm Hg at the ankle) for 2 years. Follow-up was performed for up to 5 years.Measurements: The presence and severity of the post-thrombotic syndrome were scored by using a standardized scale.Results: Post-thrombotic sequelae developed in 44 of 90 controls (severe in 10) and in 23 of 90 patients wearing elastic stockings (severe in 3). All but 1 event developed in the first 2 years. The cumulative incidence of the post-thrombotic syndrome in the control group versus the elastic stockings group was 40.0% (95% Cl, 29.9% to 50.1%) versus 21.1% (Cl, 12.7% to 29.5%) after 6 months, 46.7% (Cl, 36.4% to 57.0%) versus 22.2% (Cl, 13.8% to 30.7%) after 1 year, and 49.1% (Cl, 38.7% to 59.4%) versus 24.5% (Cl, 15.6% to 33.4%) after 2 years. After adjustment for baseline characteristics, the hazard ratio for the post-thrombotic syndrome in the elastic stockings group compared with controls was 0.49 (Cl, 0.29 to 0.84; P = 0.011).Limitations: This study lacked a double-blind design.Conclusions: Post-thrombotic sequelae develop in almost half of patients with proximal DVT. Below-knee compression elastic stockings reduce this rate by approximately 50%.