|
The Cochrane library
holds a protocol for a systematic review on Compression stockings for
preventing deep vein thrombosis in airline passengers. The protocol which is
due to be published in 2004, will assess the "effects of wearing compression
stockings for preventing deep vein thrombosis versus not wearing compression
stockings by people traveling on long-haul flights. For the purposes of
this review, long-haul flights are defined as flights of at least four hours
duration".(1)
A prospective crossover trial carried out in 1999 compared
the effects of two different compression RTW lightweight gradient
compression stockings (8-15 mmHg and 15-20 mmHg) on the venous symptoms of
19 flight attendants. The flight attendants rated their symptoms on a
visual analog scale. "During the initial phase, participants wore no
compression for 2 weeks. They then wore 8-15 mmHg and 15-20 mmHg gradient
compression support hose while flying over a 4-week period. Symptoms before
and after wearing the gradient compression stockings were compared and
statistically analyzed. Wearing of 8-15 mmHg gradient hose resulted
in statistically significant improvement of discomfort (P < 0.01). Swelling,
fatigue, aching, and tightness of the leg were all improved to a
statistically significant degree (P < 0.01). For 15-20 mmHg gradient
hosiery, symptoms were improved to a statistically significant or almost
significant level. The difference between the 8-15 mmHg and 15-20 mmHg
compression was not statistically significant. Use of lightweight
(low compression) RTW gradient compression hosiery is very effective in
improving symptoms of discomfort (P < 0.01), swelling (almost P < 0. 05),
fatigue (P < 0.05), aching (P < 0.01), as well as leg tightness. Improvement
of symptoms is statistically significant compared to no compression when
hosiery was worn regularly during waking hours for 4 weeks". (2)
A recent randomized trial studied the prophylaxis of edema with specific
travel stockings in two separate studies involving flights lasting7 hours
and 10-12 hours. In part one "subjects at low-medium risk for DVT were
contacted; 55 subjects were excluded for several nonmedical, travel-related
problems or inconvenient evaluation time; the remaining 211 were randomized
into 2 groups to evaluate prophylaxis with elastic stockings in 7-8-hour,
long-haul flights. The control group had no prophylaxis; the treatment group
used below-knee, Sigvaris Traveno elastic stockings (Ganzoni, Switzerland,
producing 12-18 mm Hg of pressure at the ankle). Color duplex scanning was
used to evaluate the possible presence of DVT; edema/swelling were evaluated
with a composite score including the presence of edema (with an edema
tester), variations in ankle circumference and leg volumetry, subjective
swelling, and discomfort (scale ranging from 0 to 10). Results: Of the 103
included subjects in the stockings group and 108 in the control group (total
211), 195 subjects completed the study. Dropouts (16) were due to low
compliance or traveling and connection problems. Age, sex distribution, and
risk factors distributions were comparable in the 2 groups. Stockings Group:
Of 97 subjects none had DVT or superficial thromboses. Control Group: Of 98
subjects none had thrombosis. The level of edema at inclusion was comparable
in the 2 groups of subjects. After flights there was an average score of 6.4
(1.3) in the control group, while in the stockings group the score was on
average 2.4 (SD 1), 2.6 times lower than in the control group (p < 0.05). In
the control group 83% of the subjects had an evident increase in ankle
circumference and volume that was visible at inspection and associated with
discomfort. The control of edema with stockings was clear, considering both
parametric data (circumference and volume) and nonparametric (analogue scale
lines) measurements. Part II. In this part of the study 200 subjects at
low-medium risk for DVT were contacted; 35 subjects were excluded for
several nonmedical, travel-related problems or inconvenient evaluation time;
the remaining 165 were randomized into 2 groups to evaluate prevention in
flights lasting between 11 and 12 hours. The control group had no
prophylaxis; the treatment group used Traveno stockings. Of the 83 included
subjects in the stockings group and 82 in the control group (total 165), 146
subjects completed the study. Dropouts were due to low compliance or
connection problems. Age/sex distribution were comparable. Of 75 subjects
completing the study in the stockings group and 71 in the control group,
none had thrombosis. The average level of edema at inclusion was comparable
in the 2 groups (1.1). After the flight there was a score of 8.9 (2) in
controls; in the stockings group the score was 2.56 (1.3) (p < 0.05). The
control of edema and swelling with stockings even after 11 hours of flight
was clear, considering both parametric (circumference, volume) and
nonparametric (analogue scale lines) measurements. The tolerability of the
stockings was very good and there were no complaints or side effects. In
conclusion Sigvaris Traveno stockings are very effective in controlling
edema in long-haul flights". (3)
- Clarke M, Fischer M, Hopewell S, Juszczak E, Eisinga A. Compression
stockings for preventing deep vein thrombosis in airline passengers
(Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2003.
Oxford: Update Software
- Weiss RA, Duffy D. Clinical benefits of lightweight compression:
reduction of venous-related symptoms by ready-to-wear lightweight gradient
compression hosiery. Dermatologic Surgery 1999 25 (9) 701-704
- Cesarone MR, Belcaro G, Nicolaides AN et al. The
LONFLIT4-Concorde--SigvarisTraveno stockings in long flights (EcoTras)
study: a randomized trial. Angiology 2003 54 (1) 1-9
|
