Should a patient with a recent history of deep vein thrombosis (DVT) after knee surgery continue to wear Thromboembolic Deterrent (TED) hose while sleeping?

TED Hose During Sleep After Post-Knee Surgery DVT

No, the patient should not wear TED hose while sleeping after developing a DVT—compression stockings are intended for daytime use only and should be removed at night. 1

Understanding the Role of Compression After DVT

The primary treatment for a recent DVT is anticoagulation, not mechanical compression. Once DVT is diagnosed, any sequential compression devices (SCDs) that were being used for prophylaxis should be discontinued immediately. 1 This is a common clinical pitfall—continuing mechanical compression in patients who develop DVT while on prophylactic devices. 1

Appropriate Use of Compression Stockings Post-DVT

Graduated compression stockings (30-40 mm Hg) may be beneficial for symptom management and prevention of post-thrombotic syndrome, but only after initial anticoagulation therapy has been started and only during waking hours. 2, 3

Timing and Duration

• Compression stockings should be initiated within 1 month of DVT diagnosis 2
• They should be continued for at least 1-2 years after diagnosis 2, 3
• The American Heart Association specifically recommends daily use (not 24-hour use) of 30-40 mm Hg knee-high graduated elastic compression stockings 3

Evidence for Benefit

• When started early and worn during the day, compression stockings reduce the incidence of post-thrombotic syndrome from 47% to 20% 2, 3
• Two high-quality randomized trials demonstrated significant reduction in both mild-to-moderate (20% vs 47%) and severe (11% vs 23%) post-thrombotic syndrome when stockings were worn during waking hours 2

Important Caveats

The 2020 American Society of Hematology guidelines suggest against routine use of compression stockings for post-thrombotic syndrome prevention (conditional recommendation, very low certainty evidence). 2 However, they acknowledge that stockings may help reduce edema and pain associated with acute DVT in selected patients. 2, 1

When to Avoid Compression

• Peripheral arterial disease (compression may aggravate arterial insufficiency) 2, 4
• Active skin breakdown or dermatitis 2
• Lower-extremity bypass procedures 2

Practical Recommendations

For this patient with recent post-knee surgery DVT:

1. Ensure therapeutic anticoagulation is established first 3
2. Consider graduated compression stockings (30-40 mm Hg) for daytime use only, starting within the first month 2, 3
3. Remove stockings at night—they are designed for use during ambulation and sitting, not during sleep 1, 3
4. Continue daytime compression for at least 2 years to reduce post-thrombotic syndrome risk 2, 3
5. Monitor for adequate arterial flow before initiating compression 4, 3

The correct pressure for therapeutic compression after DVT is 30-40 mm Hg, which is higher than the 18-23 mm Hg used for primary prophylaxis. 2 TED hose typically provide lower compression levels and are primarily designed for prophylaxis, not treatment of established DVT.