Are anti-embolic stockings (AES) a good intervention for Deep Vein Thrombosis (DVT), and for how many hours a day should they be worn?

From the Guidelines

Anti-embolic stockings (AES) are not a recommended intervention for preventing Deep Vein Thrombosis (DVT) due to their lack of effectiveness in preventing VTE or reducing mortality, and the potential for clinically important lower-extremity skin damage. According to the American College of Physicians guideline on venous thromboembolism prophylaxis in hospitalized patients 1, mechanical prophylaxis with graduated compression stockings was not effective in preventing VTE or reducing mortality. The guideline strongly recommends against the use of mechanical prophylaxis with graduated compression stockings for prevention of venous thromboembolism.

Instead, heparin or related drugs are recommended for patients in whom heparin can be used, and intermittent pneumatic compression may be a reasonable option for patients at high risk for bleeding events or in whom heparin is contraindicated. The Canadian stroke best practice recommendations also advise against the use of anti-embolism stockings alone for post-stroke venous thromboembolism prophylaxis 1. The American College of Chest Physicians evidence-based clinical practice guidelines suggest that proper fit and adherence with elastic stockings are necessary to ensure efficacy, but do not recommend their use as the sole means of prophylaxis 1.

In terms of the duration of wear, there is no recommendation for the use of AES, given their lack of effectiveness. However, if intermittent pneumatic compression devices (IPC) are used, they should be applied as soon as possible and within the first 24 hours after admission, and discontinued when the patient becomes independently mobile, at discharge from hospital, if the patient develops any adverse effects, or by 30 days (whichever comes first) 1.

Key points to consider:

• AES are not effective in preventing VTE or reducing mortality
• Heparin or related drugs are recommended for patients in whom heparin can be used
• Intermittent pneumatic compression may be a reasonable option for patients at high risk for bleeding events or in whom heparin is contraindicated
• Proper fit and adherence with elastic stockings are necessary to ensure efficacy, but they should not be used as the sole means of prophylaxis
• IPC devices should be applied as soon as possible and within the first 24 hours after admission, and discontinued when the patient becomes independently mobile, at discharge from hospital, if the patient develops any adverse effects, or by 30 days (whichever comes first) 1.

From the Research

Effectiveness of Anti-Embolic Stockings (AES) for Deep Vein Thrombosis (DVT)

• There is high-quality evidence that graduated compression stockings (GCS) are effective in reducing the risk of DVT in hospitalised patients who have undergone general and orthopaedic surgery, with or without other methods of background thromboprophylaxis, where clinically appropriate 2.
• The use of GCS alone, or GCS used on a background of any other DVT prophylactic method, has been shown to decrease the risk of DVT in various groups of hospitalised patients 2, 3.
• GCS are effective in diminishing the risk of DVT in hospitalised patients, and data examination also suggests that GCS on a background of another method of prophylaxis is more effective than GCS on its own 3.

Duration of Wear

• The duration of wear for GCS is typically until discharge or until the participants are fully mobile 2, 3.
• Current guidelines suggest use of graduated elastic compression stockings with a pressure of 30-40 mm Hg at the ankle for 2 years following the diagnosis of deep vein thrombosis (DVT) to prevent post-thrombotic syndrome (PTS) 4.
• However, the optimal duration of wear for AES to prevent DVT is not explicitly stated in the provided studies.

Special Considerations

• The effectiveness of GCS in medical patients is less clear, with limited data available to accurately assess the incidence of adverse effects and complications with the use of GCS 2, 5.
• The use of GCS in patients with acute stroke is also uncertain, with some studies suggesting that they may not be effective in preventing VTE in this population 5.