Wearing Compression Socks with a DVT
Compression stockings should not be routinely used in patients with acute DVT, but may be used for symptomatic relief if the patient finds them comfortable. 1
Current Guidelines on Compression Stockings and DVT
The most recent guidelines from major medical societies have shifted away from routine recommendation of compression stockings for DVT patients:
- The American Society of Hematology (2020) suggests against routine use of compression stockings for patients with DVT, regardless of their risk for post-thrombotic syndrome (PTS) 1
- The CHEST guidelines (2016) also suggest not using compression stockings routinely to prevent PTS in patients with acute DVT 1
This represents a significant change from older guidelines that recommended routine use of compression stockings for 1-2 years after DVT diagnosis.
Benefits vs. Risks of Compression Stockings with DVT
Potential Benefits:
- May provide symptomatic relief of pain and swelling in the acute phase 1, 2
- Historically thought to prevent PTS, though recent high-quality evidence contradicts this 1
Potential Risks/Considerations:
- Discomfort and difficulty applying stockings
- Skin breakdown or allergic reactions in some patients
- Cost burden for maintaining stockings long-term
- Contraindicated in severe peripheral arterial disease 2
Evidence Evolution
The recommendation against routine use stems primarily from newer, high-quality evidence:
- Older studies suggested compression stockings could reduce PTS by up to 50% 3
- However, the SOX trial (a large, randomized controlled trial with proper blinding) found no benefit of compression stockings in preventing PTS 1, 2
- When only considering studies with low risk of bias, compression stockings showed no significant reduction in PTS or recurrent DVT 1
When to Consider Using Compression Stockings
Despite not being routinely recommended, compression stockings may still be appropriate in specific situations:
- For symptomatic relief of acute DVT symptoms (pain, swelling) 1, 2
- For patients who find them comfortable and report symptom improvement
- For management of established PTS symptoms
Practical Recommendations if Using Compression Stockings
If you choose to use compression stockings for symptom relief:
- Moderate to high compression (20-30 mmHg or 30-40 mmHg) is typically recommended 2
- Knee-high stockings are generally as effective as thigh-high stockings and easier to use 2, 4
- Proper fitting is essential - measurements should be taken in the morning when swelling is minimal 2
- Apply stockings early in the day when edema is minimal
Important Considerations
- Compression stockings are not a substitute for anticoagulation therapy, which remains the cornerstone of DVT treatment 1
- The decision to use compression stockings should consider patient comfort, ability to apply them, and cost
- Patients with severe peripheral arterial disease should avoid compression stockings 2
In summary, while compression stockings are not routinely recommended for DVT patients to prevent PTS, they may be used for symptomatic relief if the patient finds them helpful and comfortable.