Should I wear Thromboembolic Deterrent (TED) hose if I have a deep vein thrombosis (DVT) in my leg?

Compression Stockings for Deep Vein Thrombosis

Yes, you should wear compression stockings (TED hose) if you have a blood clot in your leg, as they are recommended for preventing post-thrombotic syndrome in patients with acute symptomatic DVT. 1

Rationale for Compression Stockings in DVT

Compression stockings work by:

• Creating graduated pressure that is highest at the ankle and decreases up the leg
• Improving venous return
• Reducing venous stasis and edema
• Potentially reducing the risk of post-thrombotic syndrome (PTS)

According to the American College of Chest Physicians (ACCP) guidelines, compression stockings are suggested for patients with acute symptomatic DVT of the leg to prevent PTS (Grade 2B recommendation) 1. The guidelines specifically state that compression stockings should be worn for 2 years, and potentially longer if patients have developed PTS and find the stockings helpful.

Application and Usage Guidelines

When using compression stockings with DVT:

• Begin wearing them as soon as possible after diagnosis
• Ensure proper sizing - incorrect sizing can negate benefits and potentially cause harm 2
• Wear them consistently during waking hours
• Remove them at night while sleeping
• Ensure they create proper graduated compression (higher at ankle, lower at calf)
• Continue use for at least 2 years after DVT diagnosis 1

Important Considerations

1. Early Ambulation: The guidelines also suggest early ambulation over bed rest for patients with acute DVT (Grade 2C) 1. Compression stockings can facilitate this early mobilization.

2. Proper Fitting: Many patients (up to 20%) wear TED stockings incorrectly, and improper fitting can reduce effectiveness 2. Only 14% of stockings in one study showed acceptable gradation of reduced pressure between ankle and calf.

3. Anticoagulation Therapy: Compression stockings are an adjunct to, not a replacement for, anticoagulation therapy, which remains the foundation of DVT treatment 3, 4.

4. Patient Preference: The guidelines acknowledge that "patients who place a low value on preventing PTS or a high value on avoiding the inconvenience and discomfort of stockings are likely to decline stockings" 1.

Additional Management Recommendations

While wearing compression stockings:

• Continue prescribed anticoagulation therapy (typically for at least 3 months depending on whether the DVT was provoked or unprovoked) 1
• Maintain early ambulation as tolerated 1
• Monitor for signs of worsening DVT or development of pulmonary embolism
• Consider application aids if you have difficulty putting on the stockings 5

Common Pitfalls to Avoid

1. Improper sizing: Ensure stockings are properly measured and fitted
2. Inconsistent use: Wear as directed during waking hours
3. Wearing damaged stockings: Replace stockings when they lose elasticity
4. Applying excessive force: This can damage the stockings or cause skin injury
5. Using as sole therapy: Compression stockings complement but do not replace anticoagulation

It's worth noting that more recent guidelines (2016) have somewhat modified this recommendation, suggesting not using compression stockings routinely to prevent PTS (Grade 2B) 1. However, the same guidelines remark that "for patients with acute or chronic symptoms, a trial of graduated compression stockings is often justified" 1.