Individually tailored duration of elastic compression therapy in relation to incidence of the postthrombotic syndrome.

OBJECTIVE: We assessed whether individualized shortened duration of elastic compression stocking (ECS) therapy after acute deep venous thrombosis (DVT) is feasible without increasing the incidence of postthrombotic syndrome (PTS).

METHODS: At the outpatient clinic of the Maastricht University Medical Centre, 125 consecutive patients with confirmed proximal DVT were followed for 2 years. Villalta scores were assessed on four consecutive visits; 3, 6, 12, and 24 months after the acute event. Reflux was assessed once by duplex testing. After 6 months, patients with scores <or=4 on the Villalta clinical score and in the absence of reflux were allowed to discontinue ECS therapy. If reflux was present, two consecutive scores <or=4 were needed to discontinue ECS therapy.

RESULTS: ECS therapy was discontinued in 17% of patients at 6 months, in 48% at 12 months, and in 50% at 24 months. Reflux on duplex testing was present in 74/101 (73.3%) tested patients and was not associated with the onset of PTS. At the 6-month visit, the cumulative incidence of PTS was 13.3%, at 12 months 17.0%, and at 24 months 21.1%. Varicosities/venous insufficiency (present at baseline) was significantly associated with PTS; hazard ratio 3.2 (1.2-9.1).

CONCLUSIONS: Patients with a low probability for developing PTS can be identified as early as 6 months after the thrombotic event, and individualized shortened duration of ECS therapy based on Villalta clinical scores may be a safe management option. These findings need to be confirmed in a randomized clinical trial.