Deep vein thrombosis: proximal: graded compression stockings decreased post-thrombotic syndrome.

Clinical bottom line (level 1b)

  1. Patients with a first episode of proximal deep vein thrombosis who wore graded compression stockings for two years, were less likely to have mild-to-moderate post-thrombotic syndrome than those with no stockings (NNT = 4 at 5 years) .
  2. Patients wearing stockings were also less likely to have severe post-thrombotic syndrome (NNT = 8 at 5 years) .
Brandjes et al: Lancet 1997; 349 (9054): 759-762
Expires January 2003

The study

Unblinded concealed randomised trial with intention-to-treat
Setting: academic medical centre, The Netherlands

194 patients (aged 60y, 56% female) first episode of venogram-proven proximal deep vein thrombosis

Excluded if
  • life expectancy of <6 months
  • paralysis of leg
  • bilateral thrombosis
  • leg ulcers or extensive varicose
  • current use of compression stockings


    • Note:
  • Patients were randomised in groups of eight.


    • Control Group: (n = 98, 98 analysed): no stockings
    Experimental Group: (n = 96, 96 analysed): made-to-measure graded compression elastic stockings (40 mmHg at ankle, 36 mmHg at lower calf, 21 mmHg at upper calf). Stockings were applied 2-3 weeks after the first proximal-vein thrombosis, and the stockings were replaced every six months. Patients only wore the stockings during the day, and for at least two years.
    All patients initially received heparin treatment in hospital for at least five days after hospital discharge, coumadin was continued on an outpatient basis for three months.
    97% followed for 6 years
    Outcome notes:
    • mild-to-moderate post-thrombotic syndrome : score of 3 or more on standard scoring system plus one clinical sign
    • severe post-thrombotic syndrome : score of 4 or more

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    mild-to-moderate post-thrombotic syndrome 5 years 46
    (46.9%)    		 19
    (19.8%)    		 58%
    (34% to 73%)    		 27.2%
    (14.5% to 39.8%)    		 4
    (3 to 7)
    severe post-thrombotic syndrome 5 years 23
    (23.5%)    		 11
    (11.5%)    		 51%
    (5% to 75%)    		 12.0%
    (1.48% to 22.6%)    		 8
    (4 to 68)

  • Most cases of post-thrombotic syndrome occurred within 24 months of the acute thrombotic event.

    • Citation

    1. Brandjes DP, Buller HR, Heijboer H, et al: Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349 (9054): 759-762
    Contributor: Clare Wotton, Bob Phillips and Musab Hayatli, January 2001
    Reviewer:

    Clinical Question.
    Patient first episode of proximal DVT
    Intervention or Exposure compression stockings
    Comparison no stockings
    Outcome post-thrombotic syndrome