What is the role of compression stockings in preventing Deep Vein Thrombosis (DVT)?

From the Guidelines

Compression stockings should not be used routinely to prevent post-thrombotic syndrome (PTS) in patients with acute deep vein thrombosis (DVT) of the leg, as suggested by the 2016 Chest guideline and expert panel report 1. This recommendation is based on the latest evidence, which focuses on preventing the chronic complication of PTS and not on treating symptoms.

Key Points to Consider

• The use of compression stockings in preventing DVT is still recommended for high-risk individuals, such as those undergoing surgery, on long flights, or with limited mobility, as they help improve blood flow in the veins, reduce blood pooling in the legs, and decrease the risk of clot formation 1.
• For patients with existing DVT, compression stockings can help reduce swelling and prevent post-thrombotic syndrome when worn daily for at least two years after diagnosis, as shown in studies by Brandjes et al and Prandoni et al 1.
• Proper fitting of compression stockings is essential, and they should feel snug but not painful, and be put on first thing in the morning when swelling is minimal.
• The 2011 American College of Physicians' guideline on venous thromboembolism prophylaxis in hospitalized patients suggests that mechanical prophylaxis with graduated compression stockings is not effective in preventing VTE or reducing mortality and may result in clinically important lower-extremity skin damage 1.

Important Considerations

• While compression stockings are valuable for prevention, they should be used alongside other preventive measures like regular movement, hydration, and prescribed anticoagulants when indicated by a healthcare provider.
• The decision to use compression stockings should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.
• It is essential to follow the latest guidelines and evidence-based recommendations when making decisions about the use of compression stockings in patients with DVT.

From the Research

Compression Stockings and DVT

• Compression stockings are used to prevent Deep Vein Thrombosis (DVT) and reduce the risk of post-thrombotic syndrome (PTS) 2, 3, 4.
• Studies have shown that graduated compression stockings (GCS) can reduce the risk of DVT in hospitalized patients, particularly those undergoing surgery 3, 4.
• The use of GCS has been found to be effective in reducing the risk of DVT, with a Peto odds ratio of 0.35 (95% CI 0.28 to 0.43) 3.
• Elastic compression stockings (ECS) have also been used to counteract venous hypertension and reduce leg edema in patients with proximal DVT 5.
• Medical compression stockings (MCS) have been found to bring about a 16% to 27% absolute reduction of the frequency and severity of PTS 2.

Types of Compression Stockings

• Graduated compression stockings (GCS) are designed to provide greater compression at the ankle and decreasing compression as you move up the leg 3, 4.
• Elastic compression stockings (ECS) are used to provide uniform compression throughout the leg 5.
• Medical compression stockings (MCS) are designed to provide a specific level of compression, typically measured in mmHg 2.

Efficacy of Compression Stockings

• Studies have found that GCS can reduce the risk of DVT by 50-60% 3, 4.
• MCS have been found to reduce the frequency and severity of PTS by 16-27% 2.
• ECS have been found to be effective in reducing leg edema and preventing post-thrombotic syndrome 5.

Safety and Adverse Effects

• Limited data are available on the adverse effects of compression stockings, but they are generally considered safe 3, 4.
• The most common adverse effects reported are skin irritation, discomfort, and difficulty putting on and taking off the stockings 3, 4.