Tie Hong-Tao, Luo Ming-Zhu, Luo Ming-Jing, Li Ke, Li Qiang, Wu Qing-Chen
From the Department of Cardiothoracic Surgery (H-TT, QL, Q-CW), The First Affiliated Hospital of Chongqing Medical University; Division of Immunology (M-ZL, M-JL), The Children's Hospital of Chongqing Medical University; and Department of Orthopedics Surgery (KL), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2015 Aug;94(31):e1318. doi: 10.1097/MD.0000000000001318.
Although compression therapy has been widely used after deep vein thrombosis (DVT), its efficacy in prevention of postthrombotic syndrome (PTS) remains disputable. We aimed to update the meta-analysis to comprehensively evaluate the effect of compression therapy on the prevention of PTS in adult patients after DVT.PubMed, Embase, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) evaluating the preventive effect of compression therapy on PTS in adult patients after DVT were included. The primary outcome was the incidence of PTS. All meta-analyses were performed using random-effects models regardless of the heterogeneity. Subgroup and sensitivity analysis were also performed to examine the robustness of the pooled effects according to our predesigned plan. Potential publication bias was assessed.Eight RCTs with 1598 patients were included. Overall, compression therapy could significantly reduce the incidence of PTS (estimate 0.68, 95% confidence interval [CI] 0.52-0.90; P = 0.007). However, it was only associated with a reduction in the incidence of mild/moderate PTS (relative risk [RR] 0.66, 95% CI 0.46-0.93; P = 0.019) but not in the incidence of severe PTS (RR 0.64, 95% CI 0.27-1.50; P = 0.31). Additionally, compression therapy failed to reduce the incidence of recurrent venous thromboembolism (RR 0.91, 95% CI 0.65-1.27; P = 0.58), the incidence of ulceration (RR 0.74, 95% CI 0.36-1.53; P = 0.42), or mortality (RR 0.99, 95% CI 0.72-1.37; P = 0.96). No publication bias was observed.Current evidence still supports compression therapy to be a clinical practice for prophylaxis of PTS in adult patients after DVT. However, our findings should be cautiously interpreted because of heterogeneity and hence more large-scale and well-designed RCTs are still warranted.
尽管压迫疗法已在深静脉血栓形成（DVT）后广泛应用，但其在预防血栓形成后综合征（PTS）方面的疗效仍存在争议。我们旨在更新荟萃分析，以全面评估压迫疗法对成年DVT患者预防PTS的效果。系统检索了PubMed、Embase和Cochrane图书馆数据库。纳入评估压迫疗法对成年DVT患者PTS预防效果的随机对照试验（RCT）。主要结局是PTS的发生率。所有荟萃分析均使用随机效应模型，无论异质性如何。还根据预先设计的方案进行了亚组和敏感性分析，以检验合并效应的稳健性。评估潜在的发表偏倚。纳入了8项RCT，共1598例患者。总体而言，压迫疗法可显著降低PTS的发生率（估计值0.68，95%置信区间[CI]0.52 - 0.90；P = 0.007）。然而，它仅与轻度/中度PTS发生率的降低相关（相对危险度[RR]0.66，95%CI 0.46 - 0.93；P = 0.019），而与重度PTS的发生率无关（RR 0.64，95%CI 0.27 - 1.50；P = 0.31）。此外，压迫疗法未能降低复发性静脉血栓栓塞的发生率（RR 0.91，95%CI 0.65 - 1.27；P = 0.58）、溃疡的发生率（RR 0.74，95%CI 0.36 - 1.53；P = 0.42）或死亡率（RR 0.99，95%CI 0.72 - 1.37；P = 0.96）。未观察到发表偏倚。目前的证据仍支持压迫疗法作为成年DVT患者预防PTS的临床实践。然而，由于存在异质性，我们的研究结果应谨慎解读，因此仍需要更多大规模且设计良好的RCT。
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