2025/01/12 by Ankur Thapar, Rebecca Lawton, Andrew W. Bradbury +7 · 1 voice
Medicine · #Diagnosis and Treatment of Venous Diseases #Tendon Structure and Treatment #Venous Thromboembolism Diagnosis and Management
paper · doi:10.1093/bjs/znaf018
openalex publication_date 2025/01/12 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/29
Deep-vein thrombosis (DVT) occurs in 1 in 1000 persons in the UK annually1. Half of those with lower limb, proximal DVT (involving the popliteal, femoral, or iliac vein, or a combination of these veins) go on to develop chronic pain, swelling, skin changes, and/or skin breakdown secondary to post-thrombotic syndrome (PTS)2. PTS is a lifelong disability affecting men and women of working age3. Patients with PTS may have difficulty walking, standing for prolonged intervals, and maintaining employment4. The severity of PTS increases with age and BMI2. With an older, heavier UK population, the burden of PTS is set to rise. There is controversy over the role of graduated compression stockings (GCS) in preventing PTS. A meta-analysis of RCTs revealed that two early trials showed a large reduction in PTS after GCS use; however, the most recent SOX trial showed no benefit5. The SOX trial randomized 806 patients to receive ‘active’ GCS or placebo GCS, but was criticized for poor patient adherence to GCS, which tended to diminish over follow-up and may have affected efficacy. In the UK, the National Institute for Health and Care Excellence (NICE) recommends against GCS use after DVT6, as does the American College of Chest Physicians7. However, the European Society for Vascular Surgery and the Australia and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism recommend the opposite8,9. The aim of the Compression Hosiery to Avoid Post-thrombotic Syndrome (CHAPS) RCT was to establish whether the use of GCS prevents PTS in patients with proximal DVT.