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Graduated compression stockings to treat acute leg pain associated with proximal DVT

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: https://doi.org/10.1160/TH14-05-0430
Issue: 2014: 112/6 (Dec) pp. 1077–1327
Pages: 1137-1141

Graduated compression stockings to treat acute leg pain associated with proximal DVT

A randomised controlled trial

S. R. Kahn (1), S. Shapiro (1, 2), T. Ducruet (1), P. S. Wells (3), M. A. Rodger (3, 4), M. J. Kovacs (5), D. Anderson (6, 7), V. Tagalakis (1), D. R. Morrison (1), S. Solymoss (8), M.-J. Miron (9), E. Yeo (10), R. Smith (11), S. Schulman (12, 13), J. Kassis (14), C. Kearon (12), I. Chagnon (15), T. Wong (16), C. Demers (17), R. Hanmiah (18), S. Kaatz (19), R. Selby (20), S. Rathbun (21), S. Desmarais (22), L. Opatrny (23), T. L. Ortel (24), J.-P. Galanaud (25), J. S. Ginsberg (12)

(1) Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada; (2) Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; (3) Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; (4) Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; (5) Division of Hematology, London Health Sciences Centre, London, Ontario, Canada; (6) Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; (7) Capital Health, Halifax, Nova Scotia, Canada; (8) Division of Hematology, Montreal General Hospital, Montreal, Quebec, Canada; (9) Department of Medicine, Hôpital Notre-Dame, Montreal, Quebec, Canada; (10) Division of Hematology, University Health Network, Toronto, Ontario, Canada; (11) Divisions of Cardiology and Thrombosis, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada; (12) Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada; (13) Karolinska Institute, Stockholm, Sweden; (14) Division of Hematology, HôpitalMaisonneuve-Rosemont, Montreal, Quebec, Canada; (15) Department of Medicine, Hôpital du Sacré-Coeur de Montréal/University of Montreal, Montreal, Quebec, Canada; (16) Department of Medicine, St. Boniface General Hospital/University of Manitoba, Winnipeg, Manitoba, Canada; (17) Division of Hematology, CHU de Quebec, Quebec, Quebec, Canada; (18) Division of General Internal Medicine, St. Joseph’s Hospital, Hamilton, Ontario, Canada; (19) Academic Hospital Medicine, Hurley Medical Center, Flint, Michigan, USA; (20) Departments of Medicine and Clinical Pathology, Sunnybrook Health Sciences Centre/University Health Network/University of Toronto, Toronto, Ontario, Canada; (21) Vascular Medicine, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA; (22) Department of Medicine, Hôpital Pierre-Boucher, Longueil, Quebec, Canada; (23) Vice-President Professional Services, St. Mary’s Hospital Center, Montreal, Quebec, Canada; (24) Division of Hematology, Duke University Medical Center, Durham, North Carolina, USA; (25) Internal Medicine, Montpellier University Hospital, Montpellier, France

Keywords

Randomised Controlled Trial, compression, Venous thrombosis, Pain, stockings, placebos, therapeutics

Summary

Acute deep venous thrombosis (DVT) causes leg pain. Elastic compression stockings (ECS) have potential to relieve DVT-related leg pain by diminishing the diameter of distended veins and increasing venous blood flow. It was our objective to determine whether ECS reduce leg pain in patients with acute DVT. We performed a secondary analysis of the SOX Trial, a multicentre randomised placebo controlled trial of active ECS versus placebo ECS to prevent the post-thrombotic syndrome.The study was performed in 24 hospital centres in Canada and the U.S. and included 803 patients with a first episode of acute proximal DVT. Patients were randomised to receive active ECS (knee length, 30–40 mm Hg graduated pressure) or placebo ECS (manufactured to look identical to active ECS, but lacking therapeutic compression). Study outcome was leg pain severity assessed on an 11-point numerical pain rating scale (0, no pain; 10, worst possible pain) at baseline, 14, 30 and 60 days after randomisation. Mean age was 55 years and 60% were male. In active ECS patients (n=409), mean (SD) pain severity at baseline and at 60 days were 5.18 (3.29) and 1.39 (2.19), respectively, and in placebo ECS patients (n=394) were 5.38 (3.29) and 1.13 (1.86), respectively. There were no significant differences in pain scores between groups at any assessment point, and no evidence for subgroup interaction by age, sex or anatomical extent of DVT. Results were similar in an analysis restricted to patients who reported wearing stockings every day. In conclusion, ECS do not reduce leg pain in patients with acute proximal DVT.

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