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Evidence summaries

Compression for Preventing Recurrence of Venous Ulcers

High compression hosiery appears to be more effective in reducing recurrence from venous leg ulceration than no compression and high-compression may be more effective than moderate-compression. Level of evidence: "B"

Compression is recommended for preventing recurrence of venous ulcers.

The recommendation is strong because potential benefits of the intervention clearly exceed plausible harms.

Summary

A Cochrane review [Abstract] 1 included 4 studies with a total of 979 subjects. One study in patients with recently healed venous ulcers (n = 153) compared recurrence rates with high compression hosiery (class 3) and without compression and found that compression significantly reduced ulcer recurrence at 6 months (RR 0.46, 95% CI 0.27 to 0.76).

Two studies compared high (UK class 3) compression hosiery with moderate (UK class 2) compression hosiery. The first study (n=300) found no significant reduction in recurrence at 5 years follow up with high-compression hosiery compared with moderate-compression (RR 0.82, 95% CI 0.61 to 1.12). The second study (n = 338) assessed ulcer recurrence at 3 years follow up and found that high-compression hosiery reduced recurrence compared with moderate-compression (RR 0.57, 95% CI 0.39 to 0.81). Statistically significant heterogeneity precluded meta-analysis of the results from these studies. Patient-reported compliance rates were reported in both trials; there was significantly higher compliance with medium-compression than with high-compression hosiery in one and no significant difference in the second.

A fourth study (n=166) found no statistically significant difference in recurrence between two types of medium (UK class 2) compression hosiery (Medi versus Scholl: RR 0.74, 95% CI 0.45 to 1.2). No trials of compression bandages for preventing ulcer recurrence were identified.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding).

References

  • Nelson EA, Bell-Syer SE. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev 2014;(9):CD002303. [PubMed].

Primary/Secondary Keywords