BACKGROUND: Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic pain, swelling and skin changes in the affected limb. One in every three people with DVT will develop post-thrombotic complications within five years. OBJECTIVES: To determine the relative effectiveness of, and the rate of complications using, non-pharmaceutical interventions in people with DVT in the prevention of PTS. SEARCH STRATEGY: We searched the Cochrane Peripheral Vascular Diseases Group Specialised Trials register (last searched November 2005), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched issue 4, 2005). In addition, handsearching of non-listed journals and personal communications with researchers was undertaken. SELECTION CRITERIA: Randomised controlled trials (RCTs) of non-pharmaceutical interventions, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS. There were no restrictions on date or language. One author (DNK) identified and assessed titles and abstracts for relevance. This was verified independently by a second author (RS). DATA COLLECTION AND ANALYSIS: Data extraction was undertaken independently by two authors (DNK, RS), using data extraction sheets. MAIN RESULTS: Three RCTs that evaluated compression therapy were identified. Two studies compared elastic compression stockings with a pressure of 30 to 40 mmHg at the ankle with no intervention applied directly after an episode of DVT. The other small study compared elastic compression stockings (pressure 20 to 30 mmHg) with stockings that were one to two sizes too large in people one year after DVT. Overall, in the treatment group at two years, the use of elastic compression stockings was associated with a highly statistically significant reduction in the incidence of PTS with odds ratio (OR) 0.31 (95% confidence interval (CI) 0.20 to 0.48). In addition, the incidence of severe PTS was reduced from OR 0.39 (95% CI 0.20 to 0.76). In another RCT that considered the first nine days post DVT, no difference in the incidence of pulmonary embolism and size of thrombus in the femoral vein was found. A statistically significant reduction (p < 0.05) was found in pain, swelling and clinical scores, favouring the compression group. AUTHORS' CONCLUSIONS: There is substantial evidence that elastic compression stockings reduce the occurrence of PTS after DVT. No serious adverse effects were mentioned in the studies. Hence, elastic compression stockings should be added to the treatment of DVT to prevent the development of post-thrombotic syndrome.

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