Kolbach D, Sandbrink M, Neumann H, Prins M.
Compression therapy for treating stage I and II (Widmer) post-
thrombotic syndrome.
Cochrane Database Syst Rev. 2003;4:CD004177.

Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht,
NETHERLANDS.
BACKGROUND: Post-thrombotic syndrome (PTS) is a long-term
complication of deep vein thrombosis characterised by chronic
complaints, swelling, and skin changes in the affected limb. One
in every three patients with deep vein thrombosis develops post-
thrombotic complications within five years. OBJECTIVES: To
assess the effectiveness of compression therapy in patients with
stage I and II post-thrombotic syndrome according to the
classification of Widmer. Interventions of interest included elastic
compression stockings and mechanical devices, compared with no
intervention and with each other. SEARCH STRATEGY: The
reviewers searched the Cochrane Peripheral Vascular Diseases
Specialised Trials Register (last searched April 2003), and the
Cochrane Central Register of Controlled Trials (CENTRAL) (last
searched Issue 1, 2003). In addition, journals, conference
proceedings and bibliographies were hand searched. Personal
contact with other investigators involved in the clinical area was
sought to get information about missed or unpublished studies.
SELECTION CRITERIA: Trials that evaluated compression
therapy for stage I and II (Widmer) post-thrombotic syndrome.
Primary outcomes were leg ulceration, or deterioration of post-
thrombotic syndrome. There were no restrictions on date or
language. One reviewer (DNK) assessed titles and abstracts for
relevance. This was verified independently by a second reviewer
(MWCS). DATA COLLECTION AND ANALYSIS: Details of
eligible studies were extracted and summarised using data
extraction sheets. Data extraction was undertaken by one reviewer
(DNK) and verified by a second reviewer (MHP). MAIN
RESULTS: Only two trials were identified that addressed physical
treatment of post-thrombotic syndrome. Both trials were initiated
by the same group of investigators. A cross-over study lasting two
months compared low and high pressure with intermittent
compression units for severe post-thrombotic syndrome. This
showed a beneficial effect of higher pressures. The second study,
in patients with mild to moderate post-thrombotic symptoms, showed no effect of elastic compression stockings (30-40 mm Hg at
the ankle region) when compared to 'placebo' stockings that were
one to two sizes too large. REVIEWER'S CONCLUSIONS: There
is some evidence of a beneficial effect of intermittent pneumatic
compression units, but the study was too small and of too short a
duration to draw strong conclusions. Further research is needed in
order to assess whether intermittent pneumatic compression units
give long term reduction and relief of the symptoms caused by
post-thrombotic syndrome, and prevent deterioration and leg
ulceration. The use of elastic compression stockings to treat post-
thrombotic syndrome cannot be supported on the basis of the
currently available data.