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Do we need a second “SOX” trial to evaluate the role of stockings in the prevention of PTS? Alun H Davies Professor of Vascular Surgery Imperial College London

Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings

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Page 1: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings

Do we need a second “SOX” trial to evaluate

the role of stockings in the prevention of

PTS?

Alun H Davies

Professor of Vascular Surgery

Imperial College London

Page 2: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings

Introduction

• Lower limb pain, oedema, skin discolouration or ulceration occur

in upto 50% of patients post DVT

• PTS is the clinical manifestation of sustained ambulatory venous

hypertension from deep venous scarring, valve incompetence or

both

• Economic losses occur from nursing time for bandages and loss

of working days for patients

Page 3: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings

Current standard of care

Grade 1A evidence

Page 4: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 5: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 6: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 7: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 8: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 9: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 10: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings

Risk of bias

Page 11: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings

Higher baseline risk of PTS and increased benefit of

GCS?

Page 12: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings

Higher baseline risk of PTS and increased benefit of

GCS?

Page 13: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 14: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 15: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 16: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
Page 17: Do we need a second “SOX” trial to evaluatecacvsarchives.org/archivesite/2017/pdf/presentations...The Global Leader in Clinical Chest Medicine Routine use of compression stockings
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Discussion

No consistent effect of GCS was noted

Trials were methodologically and statistically very

different

The lower compliance and lower baseline risk of PTS in

SOX may partly account for the lack of benefit for GCS

A large trial is needed to confirm or refute the findings of

SOX