From the Guidelines
Compression stockings should not be used in the acute phase of deep vein thrombosis (DVT) treatment, but may be considered after the acute phase has resolved, typically after 2-3 weeks of anticoagulation therapy, to reduce post-thrombotic syndrome symptoms. During the acute phase of DVT, the primary focus should be on anticoagulation therapy, such as low molecular weight heparin (enoxaparin, dalteparin), direct oral anticoagulants (apixaban, rivaroxaban, edoxaban, dabigatran), or warfarin with appropriate bridging, as recommended by the American College of Physicians and the American Academy of Family Physicians 1.
The use of compression stockings in the acute phase of DVT could potentially dislodge the clot, increasing the risk of pulmonary embolism. However, studies have shown that compression stockings can be beneficial in reducing post-thrombotic syndrome symptoms when used after the acute phase has resolved 1. The decision to start compression therapy should be made by a healthcare provider who can assess the stability of the clot and the patient's individual risk factors.
Key considerations for the use of compression stockings in DVT treatment include:
- The patient's individual risk factors for post-thrombotic syndrome
- The stability of the clot
- The patient's ability to tolerate compression therapy
- The need for ongoing anticoagulation therapy
- The importance of regular follow-up with a healthcare provider to monitor for signs of worsening or complications. As noted in a study published in the Annals of Internal Medicine, the cumulative incidence of postthrombotic syndrome at the end of 2 years was 25% in the stocking group and 49% in the control group, highlighting the potential benefits of compression stockings in reducing post-thrombotic syndrome symptoms 1.
From the Research
Use of Compression Stockings in Acute DVT Treatment
- Compression stockings, including elastic compression stockings (ECS) and graduated compression stockings (GCS), have been used in the treatment and prevention of deep vein thrombosis (DVT) 2, 3, 4.
- The primary goal of using compression stockings in DVT treatment is to counteract venous hypertension, reduce leg edema, and prevent post-thrombotic syndrome 4.
- Studies have shown that the use of compression stockings, in combination with anticoagulation therapy, can be effective in reducing the risk of DVT and pulmonary embolism (PE) 2, 3.
- A study published in 2001 found that early ambulation with heavy leg compression in patients with symptomatic acute leg deep venous thrombosis can affirm the value of this approach in reducing the risk of recurrent and fatal pulmonary emboli 3.
- Another study published in 2024 recommended the use of elastic compression stockings (ECS) in patients with proximal DVT to reduce leg edema and prevent post-thrombotic syndrome 4.
Effectiveness of Compression Stockings
- A Cochrane Review published in 2018 found high-quality evidence that graduated compression stockings (GCS) are effective in reducing the risk of DVT in hospitalized patients who have undergone general and orthopaedic surgery 2.
- The review also found moderate-quality evidence that GCS probably reduce the risk of proximal DVT, and low-quality evidence that GCS may reduce the risk of PE 2.
- A study published in 2005 found that bed rest or ambulation in the initial treatment of patients with acute DVT or PE did not significantly affect the risk of new PE events, fatal PE, or bleeding complications 5.
Compression Stockings in Combination with Anticoagulation Therapy
- Anticoagulant drugs, including parenteral and oral drugs, are the mainstay of treatment for proximal DVT of the lower limbs 4.
- The use of compression stockings in combination with anticoagulation therapy can be effective in reducing the risk of DVT and PE 2, 3, 4.
- Factors to consider when choosing the anticoagulant strategy include renal and liver function, underlying diseases, and patient preferences 4.