Authors' objectives: Approximately half of adults diagnosed with deep vein thrombosis will develop the post-thrombotic syndrome leading to chronic symptoms – including leg pain, oedema, venous ectasia and, in 5% of cases, venous ulceration. Risk factors include older age, obesity, a history of blood clots, cancer and heart failure. Despite adequate anticoagulation, post-thrombotic syndrome remains a chronic health condition with significant financial burden for patients and health services. The effectiveness of compression stockings in preventing post-thrombotic syndrome is unclear and whether the risks and costs associated with compression stockings are justified.

Authors' results and conclusions: The trial closed early due to poor recruitment during the COVID-19 pandemic; and, of the planned sample size of 864, 152 participants were randomised. Post-thrombotic syndrome occurred in 51% of the control arm and in 30% of the intervention arm at last follow-up. No serious adverse events relating to stockings were recorded. Stocking adherence was a mean of 6 days (standard deviation 2) per week. The sample size was not reached, which precluded any formal statistical analysis. Although a difference in the incidence of post-thrombotic syndrome was demonstrated, the effect size could not be determined. There is interest in understanding optimal strategies for the prevention of post-thrombotic syndrome in these patients and a re-run of this trial should occur.

Authors' methods: The Compression Hosiery to Avoid Post-Thrombotic Syndrome study was a multicentre, pragmatic, assessor-blind, randomised controlled trial of adults with a first proximal deep vein thrombosis. Secondary care National Health Service hospitals in the United Kingdom. Patients ≥ 18 years, with imaging-confirmed, symptomatic presentation of first deep vein thrombosis in the lower limb (popliteal, femoral, iliac or combination), ≤ 3 weeks from diagnosis. Participants were randomised 1 : 1 to standard care (anticoagulation as per local guidelines) or intervention (anticoagulation as per local guidelines and regular use of a graduated compression stocking). The main limitation was its early termination. As a result, it did not reach the required sample size to draw any adequately powered conclusions. The analyses are descriptive and therefore we cannot determine whether there were any differences between trial arms.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/NIHR135971

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hta/THYD9865

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/THYD9865

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk