Risks and contraindications of medical compression treatment
A critical reappraisal. An international consensus statement
Risks and contraindications of medical compression treatment- A critical reappraisal. An international consensus statement
This important paper provides us with up to date information on risks and contraindications of medical compression. In particular the section on the use of compression after deep or superficial venous thrombosis is relevant for all health professionals working in the area of chronic oedema.
It states:
Deep and superficial vein thrombosis
The avoidance of compression in patients with established DVT or SVT appears to be based only on theoretical grounds, as compression might promote the dislodgement of clots and cause pulmonary embolism (PE). There are no data supportive of this theory. Routine lung scans in patients with DVT not treated with compression treatment have demonstrated that PE is found in more than 50% of patients with DVT, thus demonstrating that DVT is a thromboembolic disease. Most of these pulmonary emboli are clinically silent, with the incidence of PE depending on the location of the thrombus.
In a cohort of patients with acute DVT treated with either low-molecular-weight heparin (LMWH) plus compression and walking or LMWH plus bed rest, new PEs (majority asymptomatic) occurred in n <7.4% of patients in both groups. Three randomised controlled trials (RCTs) also demonstrated that early mobilisation does not increase the frequency of PE compared with bed rest in patients with DVT treated with anticoagulation. The situation is similar in patients with SVT, as approximately 34% of patients with acute-phase SVT have predominantly asymptomatic PE. In an RCT of patients with isolated SVT, patients treated with LMWH plus compression stockings demonstrated faster thrombus regression and no increased risk of PE compared with LMWH alone, but did not show any improvement of pain compared with no compression. Following a European tradition, compression in acute SVT or DVT belongs to the standard treatment of these diseases, because firm compression leads to an immediate reduction of pain and swelling in patients with acute DVT.39–41,67–69 There are no data suggesting that compression of veins filled with clots may lead to an increased risk of PE or post-thrombotic syndrome (PTS). Recommendation 18. We recommend considering that, in contrast to previous concepts, compression is not contraindicated in acute thrombotic events, but results in favourable clinical outcomes when applied with caution. In the hands of experts, proper compression leads to an immediate improvement of pain and oedema.
