Compression Hosiery to Avoid the Post-Thrombotic Syndrome: a synopsis of the CHAPS RCT

Area of Science:

• Vascular Medicine
• Clinical Trials
• Public Health

Background:

• Post-thrombotic syndrome (PTS) affects half of deep vein thrombosis (DVT) patients, causing chronic leg pain, edema, and ulceration.
• Risk factors for PTS include older age, obesity, prior clots, cancer, and heart failure.
• Current prevention strategies, including compression stockings, have unclear effectiveness and cost-benefit justification.

Purpose of the Study:

• To evaluate the effectiveness of graduated compression stockings in preventing post-thrombotic syndrome (PTS) in adults following a first proximal deep vein thrombosis (DVT).

Main Methods:

• A multicenter, pragmatic, randomized controlled trial comparing standard care (anticoagulation) with intervention (anticoagulation plus compression stockings).
• Participants were adults (≥18 years) with symptomatic, imaging-confirmed DVT within 3 weeks of diagnosis.
• The primary outcome was PTS incidence assessed by Villalta criteria over an 18-month median follow-up.

Main Results:

• The trial was terminated early due to poor recruitment (152/864 participants randomized).
• PTS incidence was 51% in the control group and 30% in the intervention group.
• No serious adverse events related to stockings were reported; adherence was moderate (6 days/week).

Conclusions:

• Despite a potential benefit observed, the study could not provide statistically significant conclusions due to its early termination and insufficient sample size.
• Further research, including a re-run of the trial, is warranted to determine the efficacy of compression stockings in preventing PTS.
• Understanding optimal PTS prevention strategies remains crucial for patient and clinical management.