How many hours per day should a patient wear compression stockings?

Duration of Compression Stocking Wear

Patients should wear compression stockings for the entire day during waking hours, typically 8-12 hours daily, as full-day wear is more effective than partial-day use for reducing leg swelling and symptoms.

Evidence-Based Wearing Duration

Daily Wearing Time

• Most patients in clinical practice wear compression stockings for approximately 11 hours per day, which represents the typical duration that achieves therapeutic benefit 1.

• Research demonstrates that wearing compression stockings for the entire working day is superior to wearing them for only half the day in reducing volumetric leg changes and evening edema 2.

• When stockings are removed mid-day (after morning-only wear), significant volume increases occur in the afternoon, though half-day wear still provides more benefit than no compression at all 2.

• The majority of compliant patients (105/110 surveyed) wear their compression therapy for more than 6 hours per day, establishing this as a minimum threshold for therapeutic effect 3.

Context-Specific Applications

For air travel (VTE prophylaxis):

• Stockings should be put on 2-3 hours before the flight and worn throughout the flight duration 4.
• Compression strength of 20-30 mmHg at the ankle is recommended for flights 4.

For post-thrombotic syndrome prevention:

• After DVT diagnosis, stockings should be worn daily for up to 2 years, though evidence suggests 1 year may be comparable in efficacy 4, 5.
• The American Heart Association notes that 56% of patients reported frequent use (≥3 days per week) at 2 years, though the SOX trial questioned overall PTS prevention benefit 4.

For chronic venous disease:

• Daily wear is recommended, with patients typically using stockings throughout waking hours to control symptoms 6, 3.

Practical Considerations for Adherence

Compliance Challenges

• Only 21% of CVD patients use stockings daily as prescribed, with 63% not using them at all or abandoning them after trial 6.

• The primary barriers to full-day wear include:

  • Inability to specify reason (30%)
  • Not prescribed by physician (25%)
  • Perceived lack of benefit (14%)
  • Binding or circulation concerns (13%)
  • Heat discomfort (8%) 6

• Starting with lower compression pressures (15-20 mmHg) significantly improves adherence compared to higher pressures, which approximately 50% of patients find unhelpful due to application difficulty 7.

Optimizing Wearing Duration

• Proper fitting is essential - stockings that are too tight around the knee can prevent venous return and potentially increase DVT risk, while those that are too loose provide inadequate compression 4.

• Patients should be counseled that symptoms persist in about one-third of compliant users, setting realistic expectations 6.

• Skin care is critical as 58.5% of patients experience skin dryness, which can limit wearing duration 3.

Clinical Algorithm for Prescribing Duration

1. Initial prescription: Recommend full waking-hour wear (8-12 hours daily)
2. If adherence issues arise: Accept minimum 6-hour daily wear as threshold for benefit 3
3. For poor tolerance: Consider reducing to morning-only wear (better than no compression) 2
4. Monitor at 3 months: Assess actual wearing time and adjust expectations or compression strength 4

Important Caveats

• Do not prescribe compression stockings to patients with peripheral arterial disease, as they may aggravate arterial inflow limitation 4.

• For stroke patients, graduated compression stockings are not recommended as they increase skin damage risk without preventing DVT 4.

• Intermittent pneumatic compression devices require several hours of daily use but show benefit for severe post-thrombotic syndrome with significant edema 4.