***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective The purpose of this r and omized study was to evaluate the influence of immediate multilayer compression b and ages before application of elastic stockings in the acute phase of deep-vein thrombosis ( DVT ) on development of the post-thrombotic syndrome ( PTS ) . Methods Sixty-nine patients with acute symptomatic DVT were r and omized to immediate b and aging ( n = 34 ) or no b and aging ( n = 35 ) . After reduction of edema sized-to-fit elastic stockings were applied in all patients after 7–14 days . Follow-up visits and non-invasive examinations were planned after 7 , 30 and 90 days and 1 year . Venous outflow resistance ( VOR ) was measured by strain gauge plethysmography . Thrombosis score ( TS ) and reflux were measured by duplex scanning . After one year patients were evaluated for clinical PTS using both the clinical scale of the CEAP classification and the Villalta score . Results Improvement of clinical symptoms and decrease of leg circumference was better on day 7 in the b and aging group , but after 1 and 3 months clinical symptoms had improved equally in both groups . In 7 patients in the no-b and aging group a b and age was applied after all because of persistent edema after 10 days . There were no differences in VOR , TS and reflux . Using the CEAP classification the incidence of PTS was 39 % in patients with b and ages and 42 % in patients without b and ages ( RR 0.91 , 95 % CI 0.50–1.66 ) . Using the Villalta score the incidence of PTS was resp . 29 and 33 % ( RR 0.87 , 95 % CI 0.41–1.8 ) . There was no difference in severity of PTS . Conclusion Immediate multilayer compression b and aging in the acute phase of DVT is effective in reducing edema and complaints in the first week , but has no effect on thrombus regression , valve incompetence and the development of clinical PTS after 1 year BACKGROUND Post-thrombotic syndrome varies from mild oedema to incapacitating swelling with pain and ulceration . We investigated the rate of post-thrombotic syndrome after a first episode of deep-vein thrombosis and assessed the preventive effect of direct application of a sized-to-fit grade d compression stocking . METHODS Patients with a first episode of venogram-proven proximal deep-vein thrombosis were r and omly assigned no stockings ( the control group ) or made-to-measure grade d compression elastic stockings for at least 2 years . Post-thrombotic syndrome was assessed with a st and ard scoring system that combined clinical characteristics and objective leg measurements . Patients were assessed every 3 months during the first 2 years , and every 6 months thereafter for at least 5 years . The cumulative incidence of mild-to-moderate post-thrombotic syndrome was the primary outcome measure . FINDINGS Of the 315 consecutive out patients considered for inclusion , 44 were excluded and 77 did not consent to take part . 194 patients were r and omly assigned compression stockings ( n = 96 ) or no stockings ( n = 98 ) . The median follow-up was 76 months ( range 60 - 96 ) in both groups . Mild-to-moderate post-thrombotic syndrome ( score > or = 3 plus one clinical sign ) occurred in 19 ( 20 % ) patients in the stocking group and in 46 ( 47 % ) control-group patients ( p < 0.001 ) . 11 ( 11 % ) patients in the stocking group developed severe post-thrombotic syndrome ( score > or = 4 ) , compared with 23 ( 23 % ) patients in the control group ( p < 0.001 ) . In both groups , most cases of post-thrombotic syndrome occurred within 24 months of the acute thrombotic event . INTERPRETATION About 60 % of patients with a first episode of proximal deep-vein thrombosis develop post-thrombotic syndrome within 2 years . A sized-to-fit compression stocking reduced this rate by about 50 % BACKGROUND Graduated elastic compression ( GEC ) stockings have been demonstrated to reduce the morbidity associated with post-thrombotic syndrome . The ideal length or compression strength required to achieve this is speculative and related to physician preference and patient compliance . The aim of this study was to evaluate the hemodynamic performance of four different stockings and determine the patient 's preference . METHODS Thirty-four consecutive patients ( 40 legs , 34 male ) with post-thrombotic syndrome were tested with four different stockings ( Mediven plus open toe , Bayreuth , Germany ) of their size in r and om order : class 1 ( 18 - 21 mm Hg ) and class II ( 23 - 32 mm Hg ) , below-knee ( BK ) and above-knee thigh-length ( AK ) . The median age , Venous Clinical Severity Score , Venous Segmental Disease Score , and Villalta scale were 62 years ( range , 31 - 81 years ) , 8 ( range , 1 - 21 ) , 5 ( range , 2 - 10 ) , and 10 ( range , 2 - 22 ) , respectively . The C of C0 - 6EsAs , d , pPr , o was C0 = 2 , C2 = 1 , C3 = 3 , C4a = 12 , C4b = 7 , C5 = 12 , C6 = 3 . Obstruction and reflux was observed on duplex in 47.5 % legs , with deep venous reflux alone in 45 % . Air plethysmography was used to measure the venous filling index ( VFI ) , venous volume , and time to fill 90 % of the venous volume . Direct pressure measurements were obtained while lying and st and ing using the PicoPress device ( Microlab Elettronica , Nicolò , Italy ) . The pressure sensor was placed underneath the test stocking 5 cm above and 2 cm posterior to the medial malleolus . At the end of the study session , patients stated their preferred stocking based on comfort . RESULTS The VFI , venous volume , and time to fill 90 % of the venous volume improved significantly with all types of stocking versus no compression . In class I , the VFI ( mL/s ) improved from a median of 4.9 ( range , 1.7 - 16.3 ) without compression to 3.7 ( range , 0 - 14 ) BK ( 24.5 % ) and 3.6 ( range , 0.6 - 14.5 ) AK ( 26.5 % ) . With class II , the corresponding improvement was to 4.0 ( range , 0.3 - 16.2 ) BK ( 18.8 % ) and 3.7 ( range , 0.5 - 14.2 ) AK ( 24.5 % ) . Median stocking pressure ( mm Hg ) as measured with the PicoPress in class I was 23 ( range , 12 - 33 ) lying and 27 ( range , 19 - 39 ) st and ing ( P < .0005 ) and in class II was 28 ( range , 21 - 40 ) lying and 32 ( range , 23 - 46 ) st and ing ( P < .0005 ) . There was a significant but weak correlation ( Spearman ) between stocking interface pressure measured directly with the PicoPress and the VFI improvement ( baseline VFI-compression VFI ) at r = .237 ; P = .005 . Twenty-one patients ( legs ) changed their preference of  compression  and 38 % of these ( 8/21 patients , 9/21 legs ) preferred an AK-GEC stocking . CONCLUSIONS Compression significantly improved all hemodynamic parameters on air plethysmography . However , the hemodynamic benefit did not significantly change with the class or length of stocking . These results support the liberal selection of a GEC stocking based on patient preference Although below-knee compression elastic stockings ( CES ) are effective for the prevention of the postthrombotic syndrome ( PTS ) , a substantial number of patients with deep venous thrombosis still develop PTS . In the present open-label , r and omized clinical trial , we compared thigh-length with below-knee CES for the prevention of PTS . A total of 267 patients with the first episode of proximal deep venous thrombosis were r and omized to wear either thigh-length or below-knee CES for 2 years . After 3 , 6 , 12 , 18 , 24 , and 36 months , they were assessed for PTS manifestations according to the Villalta scale . PTS developed in 44 ( 32.6 % ) of the 135 patients r and omized to thigh-length CES and in 47 ( 35.6 % ) of the 132 allocated to below-knee CES , for an adjusted hazard ratio of 0.93 ( 95 % confidence interval , 0.62 - 1.41 ) . Severe PTS developed in 3 patients in each group . CES-related side effects developed in 55 ( 40.7 % ) of the 135 patients allocated to thigh-length CES and in 36 ( 27.3 % ) of those r and omized to the below-knee group ( P = .017 ) , and led to premature discontinuation of their use in 29 ( 21.5 % ) and 18 ( 13.6 % ) patients , respectively . We conclude that thigh-length CES do not offer a better protection against PTS than below-knee CES and are less well tolerated Objective Post-thrombotic syndrome is a chronic complication of acute deep venous thrombosis in the lower extremity . The role of graduated compression stockings in the prevention of post-thrombotic syndrome has been studied with opinion being divided on the beneficial effects . We aim to answer this question with a r and omized controlled study that uses multiple scoring instruments to assess post-thrombotic syndrome . Methods Sixty-nine consecutive patients with acute deep venous thrombosis diagnosed by duplex ultrasonography were r and omized to treatment with graduated compression stockings or no graduated compression stockings . Venous Clinical Severity Score and Villalta-Pr and oni Score , commonly used scoring systems , were used to appraise post-thrombotic syndrome at 3 , 6 , 12 , 18 , and 24 months following diagnosis of deep venous thrombosis . In both scoring systems , the individual either had post-thrombotic syndrome or no post-thrombotic syndrome . Cumulative incidence was computed using Kaplan – Meier analysis . Relative risk was assessed for age , obesity , varicose veins , and iliofemoral deep venous thrombosis . Results As measured by both Villalta-Pr and oni Score and Venous Clinical Severity Score instruments , the graduated compression stockings group had a lower incidence of post-thrombotic syndrome compared to the control group , but only when one month was used as cut off time for the first diagnosis of post-thrombotic syndrome . When 6 or 12 months were used , there was no difference in the incidence of post-thrombotic syndrome between the two groups . The burden of post-thrombotic syndrome was significantly more when the Villalta-Pr and oni Score instrument ( ∼75 % ) was used as compared to the Venous Clinical Severity Score instrument ( ∼30 % ) at 24 months ’ follow-up . Obesity was the only statistically significant predictor for the development of post-thrombotic syndrome . Conclusion As assessed by both Villalta-Pr and oni Score and Venous Clinical Severity Score instruments , use of graduated compression stockings does not reduce the incidence of post-thrombotic syndrome . There is a significant difference in the incidence post-thrombotic syndrome as detected by Villalta-Pr and oni Score and Venous Clinical Severity Score instruments with incidence of post-thrombotic syndrome dependent on instrument and cut off time interval used to assess post-thrombotic syndrome . However , larger prospect i ve studies are required to confirm these differences Objective To study whether stopping elastic compression stockings ( ECS ) after 12 months is non-inferior to continuing them for 24 months after proximal deep venous thrombosis . Design Multicentre single blind non-inferiority r and omised controlled trial . Setting Outpatient clinics in eight teaching hospitals in the Netherl and s , including one university medical centre . Participants Patients compliant with compression therapy for 12 months after symptomatic , ultrasound proven proximal deep venous thrombosis of the leg . Interventions Continuation or cessation of ECS 12 months after deep venous thrombosis . Main outcome measures The primary outcome was the incidence of post-thrombotic syndrome 24 months after diagnosis of deep venous thrombosis , as assessed by the st and ardised Villalta scale in an intention to treat analysis . The predefined non-inferiority margin was 10 % . The main secondary outcome was quality of life ( VEINES-QOL/Sym ) . Results 518 patients compliant with ECS and free of post-thrombotic syndrome were r and omised one year after diagnosis of deep venous thrombosis to stop or continue ECS therapy for another year . In the stop-ECS group , 51 of 256 patients developed post-thrombotic syndrome , with an incidence of 19.9 % ( 95 % confidence interval 16 % to 24 % ) . In the continue-ECS group , 34 of 262 patients developed post-thrombotic syndrome ( incidence 13. 
    Output:
    
There was very limited evidence available for adverse effects and quality of life ( QoL ) .
There is very limited evidence for adverse effects , patient satisfaction , QoL , and compliance rates .
There is low-certainty evidence favouring use of intermittent pneumatic compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration .
There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to compression device use owing to small studies of short duration .