Post-thrombotic syndrome, a serious complication of deep vein thrombosis, affects many patients and is prevented by the use of elastic compression therapy. What remains unknown, however, is the optimal time for which a patient should wear compression stockings. At yesterday’s Late Breaking Abstract Session, Arina ten Cate-Hoek, M.D., Ph.D. presented results from the IDEAL DVT study.
- Patients were randomized into two groups: individualized duration (after an initial 6-month period) of therapy and standard duration of therapy of 24 months.
- Individualized therapy shortened the duration of therapy and was non-inferior to standard duration of therapy.
- Quality of life and adherence with the use of the compression stockings was similar in the two groups.
Post-thrombotic syndrome (PTS) is a serious complication of deep vein thrombosis (DVT) of the lower limb that affects 20% to 50% of patients post DVT. Elastic compression therapy (ECT) has been the cornerstone for the prevention of PTS for decades. It is uncertain who benefits from this therapy, and what the optimal duration of therapy should be.
The goal of the IDEAL DVT study was to evaluate whether tailoring the duration of ECT based on signs and symptoms was non-inferior to standard ECT. In this multicenter, single-blinded, allocation concealed, non-inferiority trial, patients with acute objectively-documented proximal DVT were assessed. They were randomized to either individualized duration of ECT (based on Villalta scores) following an initial therapeutic period of 6 months or to the standard duration of therapy of 24 months. Signs and symptoms of PTS, quality of life, and adherence were assessed. The primary endpoint was the proportion of patients with PTS at 24 months.
There were 864 patients enrolled in this study. The cumulative incidence of PTS after 24 months was 28.9% in the individualized treatment group and 27.8% in standard treatment group (absolute difference of 1.1%). It was concluded that individualized, shortened duration ECS treatment is non-inferior to the standard duration of treatment of 24 months.
The main advantage of individualized treatment duration is the efficiency of this strategy. Over 50% of patients stopped ECT at 6 months and another 10% stopped at 12 months. Adherence was similar in both groups (>90% after 3 months and 80% at the last follow-up visit). Quality of life scores were similar in both treatment groups.
In summary, individualized therapy with elastic compression stockings for the prevention of PTS shortened the duration of therapy for many patients and was non-inferior to the standard duration of therapy with regards to the risk of developing PTS. This individualized strategy is expected to result in considerable cost savings.