When should a patient start wearing compression hose after being diagnosed with deep vein thrombosis (DVT)?

From the Guidelines

Patients should start wearing compression hose within 1 month of diagnosis of proximal deep vein thrombosis (DVT) to prevent postthrombotic syndrome, as recommended by the American College of Physicians and the American Academy of Family Physicians 1. The evidence demonstrated a marked reduction in the incidence and severity of postthrombotic syndrome among patients wearing compression stockings, either over-the-counter stockings or custom-fit stockings, if use was initiated within 1 month diagnosis of proximal DVT. Some key points to consider when prescribing compression hose include:

• Graduated compression stockings providing 30-40 mmHg of pressure at the ankle are recommended
• These should be worn daily, put on first thing in the morning before getting out of bed, and worn throughout the day until bedtime
• Patients should continue wearing compression hose for at least 1 year after DVT diagnosis to reduce the risk of post-thrombotic syndrome
• Compression stockings work by applying external pressure that helps blood flow back to the heart, reducing venous pressure and preventing blood from pooling in the legs
• Patients should be measured properly for correct fit, replace stockings every 3-6 months as they lose elasticity, and should remove them only for bathing and sleeping. The highest quality study, which is also the most recent, supports the use of compression stockings to prevent postthrombotic syndrome, and this should be the guiding principle for clinical decision-making 1.

From the Research

Timing of Compression Hose Initiation

• The optimal timing for initiating compression therapy in patients with deep vein thrombosis (DVT) is still a matter of debate 2.
• A survey of French Vascular Medicine physicians found that 94.3% of respondents systematically prescribed compression therapy at diagnosis, with 57.3% using elastic compression stockings (ECS) and 42.7% using bandages 3.
• A worldwide survey found that 81.4% of respondents start compression immediately after diagnosis, with the main reasons being reduction of pain and swelling, and prevention of post-thrombotic syndrome (PTS) 4.

Compression Therapy Initiation

• There is no consensus on the optimal timing for initiation of compression therapy, with some studies suggesting that early compression may be beneficial, while others have found conflicting results 2, 3.
• The majority of physicians (85.9%) modulate the duration of compression therapy according to the results of follow-up compression ultrasonographic explorations 3.
• A study found that adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone 5.

Clinical Practice

• Compression therapy is routinely used in proximal DVT in all regions, with 82.8% of respondents using it as part of their treatment protocol 4.
• A randomized controlled study found that anticoagulant therapy had no effect on DVT progression in actively mobilized patients wearing graduated compressing stockings when compared to a non-anticoagulant treated group receiving analgetic therapy with phenylbutazone 6.
• The use of compression therapy in clinical practice is widespread, but the optimal timing, duration, and strength of compression are still matters of debate 2, 3, 4.