Do patient stockings have intermittent pneumatic compression options?

Compression Stockings vs. Intermittent Pneumatic Compression: Distinct Devices

Compression stockings and intermittent pneumatic compression (IPC) devices are two separate mechanical prophylaxis options—they are not the same device, and IPC is generally superior for VTE prevention.

Key Differences Between the Devices

Compression Stockings (Static Compression)

• Graduated compression stockings are passive elastic garments that apply continuous, graduated pressure from ankle to calf, with typical pressures ranging from 15-40 mmHg depending on indication 1
• They work by providing constant external pressure to reduce venous pooling and improve venous return 1
• Recent evidence shows graduated compression stockings alone are ineffective for DVT prevention in hospitalized patients and may increase skin complications 2

Intermittent Pneumatic Compression (Dynamic Compression)

• IPC devices are active pneumatic sleeves that intermittently inflate and deflate, applying cyclical external pressure to the calf muscles and vasculature 2
• They mechanically augment venous blood flow by mimicking the muscle pump action, with compression cycles typically lasting 10-15 seconds followed by relaxation periods 3
• IPC devices have demonstrated approximately 50% reduction in DVT rates compared to no prophylaxis 2

Clinical Evidence Supporting IPC Over Stockings

Stroke Patients

• The CLOTS 3 trial (2,876 patients, 376 with ICH) demonstrated that IPC reduced proximal DVT occurrence significantly, with particularly prominent effects in hemorrhagic stroke patients (6.7% vs 17.0%, OR 0.36) 2
• The American Heart Association found IPC reduces DVT risk by 35% (RR 0.69,95% CI 0.55-0.86) and may improve 6-month survival in immobile stroke patients 4
• Graduated compression stockings alone showed no benefit in the CLOTS 1 trial and actually increased skin complications 2

Surgical and Medical Patients

• A systematic review of 10 direct comparisons found crude cumulative DVT rates of 2.8% for IPC versus 5.9% for graduated compression stockings 5
• The American Society of Hematology recommends IPC as preferred mechanical prophylaxis over graduated compression stockings for hospitalized patients when pharmacological prophylaxis is contraindicated 2

Clinical Recommendations by Setting

When Pharmacological Prophylaxis is Contraindicated

• Use IPC devices as the primary mechanical prophylaxis method, with a goal of 18 hours daily throughout the period of immobility 6
• Graduated compression stockings should not be used as monotherapy for VTE prevention 2

When Adding Mechanical to Pharmacological Prophylaxis

• IPC devices may be added to pharmacological prophylaxis in very high-risk patients (e.g., cancer surgery, acute spinal cord injury) 2, 6
• The combination provides additive benefit without significantly increasing bleeding risk 2

Stroke Patients Specifically

• Apply IPC devices to both legs (bilateral application) in all immobile stroke patients, regardless of whether hemiparesis is unilateral 4
• Begin IPC as soon as possible within the first 24 hours of admission 4
• For patients with hemorrhagic stroke where anticoagulation carries unacceptable risk, IPC combined with elastic stockings reduced asymptomatic DVT (4.7% vs 15.9%) 2

Important Contraindications and Cautions

IPC Device Contraindications

• Do not apply to legs with confirmed DVT, dermatitis, leg ulcers, severe leg edema, severe peripheral vascular disease, gangrene, or recent vein ligation/grafting 4
• Patients with significant weight loss or cancer cachexia may be at increased risk of peroneal neuropathy from compression devices 7
• Patients in lithotomy position during prolonged surgery are at risk of compartment syndrome with IPC use 7

Compression Stocking Contraindications

• Avoid when ankle-brachial index is <0.6, indicating arterial disease requiring revascularization 1
• Monitor for skin breakdown, discomfort, and allergic reactions 1

Practical Implementation

IPC Device Application

• Apply to both lower extremities in all immobile patients 4
• Target 18 hours of daily use throughout immobility period 6
• Perform daily skin integrity assessments while devices are in use 4

When Compression Stockings May Still Have a Role

• For symptom management (edema, pain) in patients with established DVT or post-thrombotic syndrome, compression stockings at 20-30 mmHg may provide relief 1
• For chronic venous insufficiency or venous leg ulcers (not acute VTE prevention), stockings at 20-40 mmHg remain appropriate 1
• For long-distance travelers at increased VTE risk, 15-30 mmHg below-knee graduated compression stockings are recommended 1

The bottom line: IPC devices and compression stockings are fundamentally different technologies, with IPC demonstrating superior efficacy for VTE prophylaxis in hospitalized and immobile patients.