Compression Stockings with Bilateral DVT and PE on Apixaban
Yes, you can wear compression stockings while being treated with apixaban for bilateral lower extremity DVT and PE, but they should be used primarily for symptom relief rather than routine prevention of post-thrombotic syndrome. 1
Current Guideline Position
The American Society of Hematology (ASH) 2020 guidelines suggest against the routine use of compression stockings for preventing post-thrombotic syndrome in patients with DVT, regardless of whether they have an increased risk for post-thrombotic syndrome. 1 This represents a significant shift from older recommendations that previously advocated for routine compression stocking use. 2
However, the guidelines explicitly acknowledge that compression stockings may help reduce edema and pain associated with acute DVT in selected patients, even though they are not recommended routinely for post-thrombotic syndrome prevention. 1
When to Use Compression Stockings in Your Situation
Appropriate Indications:
- Symptomatic relief of acute leg pain, swelling, or edema from your bilateral DVT 2, 3
- Active symptoms of discomfort that interfere with daily activities 1
- Significant lower extremity edema requiring management 3
Specifications if Used:
- Pressure gradient: 30-40 mmHg at the ankle 3
- Type: Knee-high graduated elastic compression stockings 3
- Fitting: Must be properly sized-to-fit for each individual patient 3
- Duration: Can be used daily while symptomatic 2, 3
Critical Safety Considerations
Contraindications to Check:
- Ankle-brachial index <0.6 is an absolute contraindication due to arterial insufficiency risk 3, 4
- Severe peripheral arterial disease 3
Important Caveats:
- Compression stockings are not a substitute for anticoagulation therapy with apixaban 3, 4
- Your apixaban (Eliquis) remains the cornerstone of treatment for both the DVT and PE 4, 5
- Potential adverse effects include discomfort, skin breakdown, and allergic reactions 1, 3
Mobility Recommendations
Early ambulation with compression is preferred over bed rest for patients with acute DVT. 2, 6 Research demonstrates that early mobilization in patients with acute lower limb DVT does not increase the risk of symptomatic pulmonary embolism. 6
Why the Guidelines Changed
The evidence base shifted dramatically after the SOX trial, which showed inconsistent evidence that compression stockings decrease the risk of developing post-thrombotic syndrome. 1 The certainty of evidence is very low due to risk of bias and small patient numbers studied. 1 Despite this, up to 30-50% of patients may still develop post-thrombotic syndrome after proximal DVT, with 5-10% experiencing severe cases. 1
Bottom Line for Your Situation
With bilateral lower extremity DVT and PE on apixaban, you may use compression stockings if you have bothersome leg symptoms (pain, swelling, edema), but they are not required or routinely recommended for preventing long-term complications. 1, 2 Your anticoagulation with apixaban is the essential treatment. 4, 5