Compression Therapy in Acute Deep Venous Thrombosis of the Lower Limb and for the Prevention of Post-Thrombotic Syndrome.

BACKGROUND: After an acute deep venous thrombosis (DVT) of the lower limb, 20% to 63% of patients develop post-thrombotic syndrome (PTS). In this review, we address the efficacy of compression therapy in the treatment of acute DVT of the lower limb, and for the prevention of PTS. METHODS: 12 randomized controlled trials (RCTs) and one meta-analysis, with a total of 3751 patients, were identified in a structured literature search. RESULTS: Two RCTs showed that adding compression therapy to drug treatment in the first 9 days of the acute phase of lower limb DVT led to more rapid pain relief (p<0.050) and less swelling (remaining difference in circumference, 1 cm versus 3 cm, p<0.050). As for the prevention of PTS, four RCTs showed a short-term benefit or no benefit of compression therapy. In three further RCTs, medical compression stockings (MCS) brought about a 16% to 27% absolute reduction of the frequency and severity of PTS (47% vs. 20 %, p<0.001; 40% vs. 21% (95% confidence intervals [29.9; 50.1] and [12.7; 29.5], respectively; and 58% vs. 42%, relative risk [RR] 0.73 [0,55; 0.96]). The benefit of MCS was also confirmed in a recent meta-analysis (RR 0.66 [0.44; 0.99], I2 = 88%). Thigh-length MCS were not superior to knee-length MCS for the prevention of PTS (33% vs. 36%, hazard ratio [HR] 0.93 [0.62; 1.41]). Individual, symptomoriented tailoring of the duration of treatment was not inferior to a fixed treatment duration of 24 months (29% vs. 28%; odds ratio [OR] 1.06 [0.78;1.44]). CONCLUSION: Compression therapy relieves symptoms in acute DVT and lessens the frequency and severity of PTS. It is therefore recommended as standard treatment.

[Survey of nurses about compression therapy of acute deep venous thrombosis. Field study in Saxony-Anhalt]. / Befragung Pflegender zur Kompressionstherapie der akuten tiefen Beinvenenthrombose. Feldstudie in Sachsen-Anhalt.

BACKGROUND: In clinical practice, the compression therapy is an established method for the treatment of acute deep vein thrombosis (DVT). The aim of this study was to clarify the extent to which current guidelines and results of studies done in the field for the treatment of acute DVT--particularly compression therapy--are implemented in clinical practice. METHOD: All hospitals in Saxony-Anhalt using primary diagnosis and therapy for DVT (n = 34) were informed about a survey in 2007 and the nursing staff of angiology and internistical wards in these hospitals was asked to take part. The collection of data was done with the help of a questionnaire that had been designed and tested for its validity in a specialised hospital. 510 questionnaires were distributed. The response rate of questionnaires was 69 percent. RESULTS: 79 percent of the nursing staff of internistical wards in Saxony-Anhalt and 94 percent of the nursing staff of angiology wards said that patients with acute DVT have initially received a compression bandage. Significant deficits were visible in transferring the knowledge of evidence-based medicine and nursing regarding techniques of compression bandage. The recommended Fischer-Bandage was only put on in exceptional cases in internistical wards (3 percent) and Angiology (2 percent). Compression stockings were not a suitable method into the treatment of acute deep vein thrombosis of Angiology. 21 percent of the nursing staff of internistical wards said that they have initially applied compression stockings. CONCLUSION: The treatment of acute DVT is important in clinical practice. The compression bandage should be effectively put on the leg. The quality of care and long-term compliance of the patients could be increased this way, leading to prevention of post thrombotic syndrome (PTS) and reduction the duration of patients stay in the clinics.

[Knowledge of nurses about compression therapy. Survey about treatment of acute deep venous thrombosis]. / Das Wissen Pflegender zur Kompressionstherapie. Studie zur Therapie der akuten tiefen Beinvenenthrombose.

Compression therapy is an established method to treat acute deep vein thrombosis (DVT) in clinical practice. The aim ofthis study was to clarify the extent to which current guidelines for the treatment of acute DVT and results of the studies done in this field, particularly in terms of compression therapy, are considered in training courses for nursing staff and patients. All hospitals in Saxony-Anhalt using primary diagnosis and therapy for DVT (n=34) had been informed about a survey in summer 2007 and the nursing staff of angiology and internal wards in these hospitals were asked to take part in the survey. Data was collected with the help of a questionnaire that had been designed and tested for its validity in a specialised hospital. 510 questionnaires were distributed (15/ hospital). The response rate of questionnaires was 69 percent. The acute DVT is part of the nursing training. 92.3 percent of the nursing staff said that they have discussed DVT and 91.5 percent said that they have learned different techniques of compression bandage. 89,2 percent of the nursing staff indicated that they practiced applying compression bandages under the guidance of a teacher. Significant deficits were visible in transferring the knowledge of evidence-based medicine and nursing. The recommended Fischer-Bandage was only taught exceptionally in theory (1.7 percent) and practice (1.9 percent). 47.1 percent of the nursing staff took part in continued training for compression therapy. Patient trainings were only carried out in 18.1 percent. The treatment of acute DVT plays an important role in the nursing training. The compression bandage that is recommended in guidelines and studies should be effectively taught and implemented in nursing education and training of patients.