Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial

Jean-Philippe Galanaud, Céline Genty-Vermorel, Carole Rolland, Alexa Comte, Pierre Ouvry, Isabelle Bertaina, François Verrière, Jean-Luc Bosson, Jean-Philippe Galanaud, Céline Genty-Vermorel, Carole Rolland, Alexa Comte, Pierre Ouvry, Isabelle Bertaina, François Verrière, Jean-Luc Bosson

Abstract

Postthrombotic syndrome (PTS) is a burdensome and costly complication of deep vein thrombosis (DVT) that develops in 20%-40% of patients within 2 years after proximal DVT. In the absence of effective curative treatment, management of PTS relies on its prevention after DVT. The effectiveness of elastic compression stockings (ECS) to prevent PTS is uncertain. We present an overview of published studies assessing the efficacy of ECS to prevent PTS and present the protocol for the CELEST clinical trial. While previous open-label randomized trials have reported a 50% risk reduction in PTS in patients treated with >30 mm Hg ankle pressure ECS, a large double-blind trial reported no effect of ECS. We discuss the main potential limitations of these trials, including a placebo effect and suboptimal compliance to ECS. We present the protocol of the CELEST double-blind randomized trial comparing 2 years of high strength (ankle pressure 35 mm Hg) versus lower strength (ankle pressure 25 mm Hg) ECS in the prevention of PTS after a first acute symptomatic, unilateral, proximal DVT. The use of lower-strength ECS than that used in previous studies should favor compliance. CELEST may provide important evidence about the efficacy of ECS in the prevention of PTS after DVT. The results will be interpreted in the light of results from recent clinical trials assessing ECS for PTS prevention that reported that the duration of ECS use should be tailored to the individual, if ECS are efficacious in the prevention of PTS.

Keywords: clinical trial; compression stockings; deep vein thrombosis; postthrombotic syndrome; venous thrombosis.

© 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).

Figures

Figure 1
Figure 1
CELEST study flow diagram. ABI, ankle brachial index; CEAP, Clinical Etiological Anatomical Pathophysiological classification; DVT, deep vein thrombosis; ECS, elastic compression stockings; F/U, follow‐up; IVC, inferior vena cava; PE, pulmonary embolism; PTS, postthrombotic syndrome; QOL, quality of life; SAE, serious adverse event; US, ultrasound

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