Can a patient with Deep Vein Thrombosis (DVT) wear compression hose?

Can Patients with DVT Wear Compression Stockings?

Yes, patients with acute DVT in their legs can and should wear compression stockings (30-40 mmHg at the ankle) as adjunctive therapy to anticoagulation. 1, 2

Compression Therapy for Acute DVT

Primary Recommendation

• Compression stockings are suggested for patients with acute symptomatic DVT of the leg, with the understanding that anticoagulation remains the cornerstone of treatment. 1, 2
• The 2012 American College of Chest Physicians (ACCP) guidelines recommend wearing compression stockings for 2 years after acute DVT diagnosis. 1, 2
• Compression therapy should be initiated as soon as possible after DVT diagnosis. 2

Evolving Evidence and Important Caveat

There is an important shift in the evidence base that clinicians must understand:

• The 2020 American Society of Hematology (ASH) guidelines suggest against routine use of compression stockings for prevention of post-thrombotic syndrome (PTS), based on very low certainty evidence. 2
• However, compression stockings may still be beneficial for symptom management in selected patients with DVT-related edema and pain. 2
• This represents a change from the earlier 2012 ACCP recommendations, reflecting newer trial data showing limited benefit for PTS prevention. 2

Practical Application Guidelines

Compression specifications:

• Use knee-high graduated elastic compression stockings with 30-40 mmHg pressure at the ankle. 2
• Thigh-length stockings do not provide superior protection compared to knee-length stockings. 1
• Proper fitting is essential for each individual patient. 2

Duration of use:

• The traditional recommendation was 2 years of daily use. 1, 2
• Continue beyond 2 years if patients have developed PTS and find the stockings helpful. 1
• One trial suggested that wearing compression stockings for two years may be superior to wearing them for one year. 3

Clinical Decision Algorithm

For acute DVT patients, follow this approach:

1. Initiate anticoagulation immediately (this is the primary treatment). 2, 4

2. Add compression stockings if:

   • Patient has significant leg edema or pain. 2
   • Patient values potential symptom relief over the inconvenience of wearing stockings. 1
   • No contraindications exist (see below). 2

3. Consider withholding compression stockings if:

   • Patient places low value on preventing PTS or high value on avoiding inconvenience and discomfort. 1
   • Patient has arterial insufficiency (ankle-brachial index <0.6). 2

Important Safety Considerations

Contraindications:

• Never apply compression stockings when ankle-brachial index is <0.6, as this indicates arterial anomaly requiring revascularization. 2
• Do not apply sequential compression devices to legs with confirmed DVT. 4

Potential adverse effects:

• Discomfort, skin breakdown, and allergic reactions (itching, erythema) may occur. 2, 3
• No serious adverse events have been reported in clinical trials. 3

Special Situations

For severe DVT with significant edema:

• Consider initial treatment with intermittent sequential pneumatic compression followed by daily elastic compression stockings. 2

For established post-thrombotic syndrome:

• A trial of compression stockings (30-40 mmHg) is suggested for symptom management. 1, 2
• If severe PTS is not adequately relieved by compression stockings, consider a trial of an intermittent compression device. 1, 2

For the unaffected contralateral leg:

• The contralateral leg remains at risk for thrombosis. 4
• Sequential compression devices may be used on the unaffected leg for additional prophylaxis. 4

Common Pitfalls to Avoid

• Do not use compression stockings as a substitute for anticoagulation therapy—anticoagulation is the primary treatment. 2
• Do not assume thigh-length stockings are superior to knee-length stockings for DVT treatment. 1
• Do not apply compression therapy without first checking for arterial insufficiency. 2
• Be aware that patient compliance varies, and proper education on application and use is essential. 2, 3

Evidence Quality Note

The recommendation for compression stockings in acute DVT has evolved significantly. While the 2012 ACCP guidelines suggested routine use 1, the 2020 ASH guidelines based on newer evidence (including the SOX trial showing no benefit for pain relief 5 and Cochrane reviews showing limited PTS prevention 3) now suggest against routine use for PTS prevention. 2 However, compression therapy remains reasonable for symptomatic management of edema and pain in selected patients. 2