How to obtain compression stockings for a patient?

How to Obtain Compression Stockings for a Patient

Compression stockings can be obtained through prescription from a physician or purchased over-the-counter at pharmacies and medical supply stores, but their use should be carefully considered as current evidence does not support routine use for most venous conditions. 1

Clinical Context and Evidence-Based Indications

Before obtaining compression stockings, understand that recent high-quality evidence has significantly changed recommendations:

• The American Society of Hematology (2020) suggests against routine use of compression stockings for patients with DVT, with or without increased risk for post-thrombotic syndrome, based on very low certainty evidence 1
• The landmark SOX trial (2014) contradicted earlier positive studies and found no benefit for preventing post-thrombotic syndrome 2
• For acute DVT patients, compression stockings should NOT be prescribed with the expectation of preventing post-thrombotic syndrome 2

When Compression Stockings May Be Appropriate

Symptomatic Relief After DVT

• Compression stockings can be offered to manage acute leg symptoms (pain and swelling) after DVT diagnosis, but only for symptom control, not prevention of complications 2
• Must ensure adequate anticoagulation is established first before considering compression therapy 2

Established Post-Thrombotic Syndrome

• For patients with already-established post-thrombotic syndrome, graduated elastic compression stockings (30-40 mmHg) may reduce chronic symptoms 2, 3

Long-Distance Travel (Specific Population)

• For high-risk travelers on long flights, below-knee compression stockings with 20-30 mmHg pressure may be considered 1
• Stockings should be put on 2-3 hours before the flight 1

Obtaining Compression Stockings: Practical Steps

Prescription Requirements

• Most insurance coverage requires a physician prescription specifying the indication, compression level, and length 2
• The prescription should specify: compression strength (mmHg), length (knee-high vs thigh-high), and duration of use 1, 2

Proper Fitting is Critical

• Compression stockings must be professionally fitted to avoid complications 1
• A stocking that is too tight around the knee can prevent venous return, causing blood pooling 1
• A stocking that is too tight can cut into skin and potentially cause ulceration and increased DVT risk 1
• Patients should trial stockings at home before extended use to ensure comfortable fit 1

Specifications When Appropriate

• Compression strength: 30-40 mmHg at the ankle for therapeutic use 2, 3
• Length: Knee-high graduated elastic compression stockings are sufficient; thigh-length provides no additional benefit 2
• Below-knee stockings were used in all nine trials showing any benefit 1

Where to Obtain

• Medical supply stores with trained fitters 2
• Pharmacies (though professional fitting may be limited) 1
• Online retailers (least preferred due to fitting concerns) 1

Critical Contraindications and Safety Checks

Absolute Contraindications

• Peripheral arterial disease: Compression may aggravate symptoms in patients with arterial inflow limitations 2
• Active DVT with sequential compression devices (SCDs) in place: SCDs must be discontinued immediately upon DVT diagnosis 4, 2

Before Prescribing, Always Assess

• Arterial status to rule out peripheral arterial disease 2
• Adequate anticoagulation has been established (compression should never substitute for or delay anticoagulation) 2
• Skin integrity and ability to apply stockings 1, 5

Common Clinical Pitfalls to Avoid

• Prescribing stockings with expectation of preventing post-thrombotic syndrome is not supported by recent high-quality evidence 2
• Continuing mechanical compression devices after DVT diagnosis is contraindicated 4, 2
• Using compression without adequate anticoagulation 2
• Ignoring patient arterial status before prescribing 2
• Failing to ensure proper fitting, leading to complications including skin breakdown (5% risk in stroke patients) 1, 5

Patient Compliance Considerations

• Only 21% of CVD patients use stockings daily, with 63% not using them at all 6
• Primary reasons for non-compliance: unable to specify reason (30%), not prescribed (25%), did not help (14%), binding/cutting off circulation (13%), too hot (8%) 6
• Symptoms persist in about one-third of patients despite apparent compliance 6
• Patient preference should guide selection when compression is deemed appropriate, as hemodynamic benefit does not significantly change with class or length 7