Non-pharmaceutical measures for prevention of post-thrombotic syndrome

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Abstract
Post‐thrombotic syndrome (PTS) is a long‐term complication of deep vein thrombosis (DVT) characterised by chronic pain, swelling and skin changes in the affected limb. One in every three people with DVT will develop post‐thrombotic complications within five years. To determine the relative effectiveness of, and the rate of complications using, non‐pharmaceutical interventions in people with DVT in the prevention of PTS. We searched the Cochrane Peripheral Vascular Diseases Group Specialised Trials register (last searched November 2005), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 4, 2005). In addition, handsearching of non‐listed journals and personal communications with researchers was undertaken. Randomised controlled trials (RCTs) of non‐pharmaceutical interventions, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS. There were no restrictions on date or language. One author (DNK) identified and assessed titles and abstracts for relevance. This was verified independently by a second author (RS). Data extraction was undertaken independently by two authors (DNK, RS), using data extraction sheets. Three RCTs that evaluated compression therapy were identified. Two studies compared elastic compression stockings with a pressure of 30‐40 mm Hg at the ankle with no intervention applied directly after an episode of DVT. The other small study compared elastic compression stockings (pressure 20‐30 mm Hg) with stockings that were one to two sizes too large in people one year after DVT. Overall, in the treatment group at two years, the use of elastic compression stockings was associated with a highly statistically significant reduction in the incidence of PTS with odds ratio (OR) 0.31 (95% confidence interval (CI) 0.20 to 0.48). In addition, the incidence of severe PTS was reduced from OR 0.39 (95% CI 0.20 to 0.76). In another RCT that considered the first nine days post DVT, no difference in the incidence of pulmonary embolism and size of thrombus in the femoral vein was found. A statistically significant reduction (P < 0.05) was found in pain, swelling and clinical scores, favouring the compression group. There is substantial evidence that elastic compression stockings reduce the occurrence of PTS after DVT. No serious adverse effects were mentioned in the studies. Hence, elastic compression stockings should be added to the treatment of DVT to prevent the development of post‐thrombotic syndrome. 使用非藥理性的方法來預防栓塞後症候群 栓塞後症候群(postthrombotic syndrome，PTS)是一種深部靜脈栓塞的長期性併發症，其主要症狀為，在受到影響的肢體產生慢性疼痛、腫脹和皮膚的變化，每三個具有深部靜脈栓塞的患者中便會有一人會在五年內出現栓塞後症候群。 對於深部靜脈栓塞患者，確認使用非藥物性介入治療對於預防栓塞後症候群的相對功效和併發症的機率。 我們搜尋 Cochrane Peripheral Vascular Diseases Group Specialised Trials register (最後一次搜尋為 11月 2005年)及Cochrane Central Register of Controlled Trials (CENTRAL) (最後一次搜尋為 Issue 4, 2005年)。此外，還以人工搜尋未列在其中的期刊，並且與研究人員直接溝通討論。 對於臨床上確認深部靜脈栓塞患者，對於使用非藥物性介入治療(例如包紮繃帶或使用彈性襪)之功效的隨機性對照試驗，主要評估之預後為栓塞後症候群的發生率，對於試驗之選擇並沒有日期和語言的限制，有1個作者(DNK)負責確認和評估相關的標題和摘要，並由第二名作者(RS)獨立進行驗證。 由兩個作者獨立利用資料萃取表單來進行資料萃取的作業。 有3個評估加壓療法的隨機性對照試驗被確認。其中的2個研究是在深部靜脈栓塞後，比較直接在腳踝施加30 – 40毫米汞柱壓力的彈性壓力襪和不介入治療的效果。還有一個小型試驗是在患者出現深部靜脈栓塞後一年內，比較使用彈性襪(20 – 30毫米汞柱壓力)和使用一至兩倍大之襪子的效果。整體來說，治療組在2年後，使用彈性加壓襪在統計學上將會明顯的降低栓塞後症候群的發生率，其OR值為0.31(95%CI值為0.20至0.48)。此外，嚴重的栓塞後症候群的發生率也會降低，OR值為0.39(95%CI值為0.20至0.76)。在另外一個隨機性對照試驗中，考量到發生深部靜脈栓塞後的前九天，對於肺動脈栓塞的發生和股靜脈栓塞之規模來說並沒有差異。在接受壓力治療的組別中，疼痛感、腫脹和臨床評分結果上都有顯著的降低(P值小於0.05)。 有確切的證據顯示彈性壓力襪會降低深部靜脈栓塞後的栓塞後症候群發生率，在這些研究中並沒有提到嚴重的不良事件，所以應該要將彈性壓力襪加入深部靜脈栓塞的治療中以預防栓塞後症候群的發生。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 有深部靜脈栓塞的患者，可以藉由穿著彈性壓力襪可明顯降低栓塞後症候群發生的機率。當流動於靜脈的血流被血塊阻塞時便會產生深部靜脈栓塞現象，有深部靜脈栓塞的患者通常會在腿部產生慢性疼痛、腫脹和皮膚變化，也就是所謂栓塞後症候群的症狀。有人嘗試使用彈性壓力襪來減少腫脹和改善腿部靜脈的血流狀況，本回顧發現當患有深部靜脈栓塞的病患穿著彈性壓力襪時較不容易引發栓塞後症候群。也沒有發現有不良反應，但是如果病患的動脈血流補給不足時則可能會造成症狀的惡化。