Patients with deep vein thrombosis (DVT) are often recommended to wear elastic compression stockings. Several new studies discuss the advantages and disadvantages of wearing compression stocking and also its effectiveness.

Preventing Venous Thrombosis use Elastic Compression Stocking


Thrombosis can occur in the venous circulation, including deep vein thrombosis (DVT) in the lower limb, pelvis, and pulmonary embolism. A DVT can take weeks or months to totally dissolve without complications. But, the pulmonary embolism as a DVT complication causes 300,000 deaths each year in the United States. The cause of thrombosis is multifactorial and often involves a combination of acquired and congenital factors. The most common causes are temporary immobilization (for example, during long flights or general anesthesia surgery) and also long-term immobilization (for example, in hospitalized, stroke, or paraplegic patients)

Venous thrombosis is estimated to occur as much as 104-183 per 100,000 people per year in European ethnicities, and the incidence rate is lower in Asian ethnicities. Thrombosis also often recurs, where around 30% of patients will experience a thrombosis again within 10 years.


Action Mechanism of Elastic Compression Stocking

Wearing elastic compression stocking is a therapeutic option besides elastic and non-elastic bandages, boots, and hosiery. The mechanism of elastic compression stockings' action is to put high pressure on the ankle and progressively reduce the upper garment pressure. This garment ensures blood flow up toward the heart - not downward or into other superficial veins. This compression reduces the major veins' diameter, thereby increasing the velocity and volume of blood flow.


Effectiveness of Elastic compression stockings

Clinical indications for wearing the compression stocking are: 
  • primary chronic venous disease, 
  • postoperative patients, 
  • or interventional varicose vein management, 
  • prevention of venous thromboembolism, 
  • post-thrombotic syndrome, 
  • lymphatic edema, and chronic leg edema, 
  • superficial thrombophlebitis, 
  • and pregnancy.



Prevention of Venous Thromboembolism

Prevention of venous thromboembolism is often recommended for patients hospitalized (especially those who will undergo surgery) and patients who plan to travel long distances on flights. Some postoperative patients are immobilized due to various causes and need the prevention of thromboembolism. Blood-thinning drugs should be avoided in postoperative patients, so it is considered wearing the elastic compression stocking.

At the end of 2014, Cochrane published a systematic review that analyzed 19 randomized controlled trials (RCTs). This review concluded that wearing the elastic compression stocking singly could be beneficial in reducing the DVT risk. However, the effectiveness is reportedly increased when accompanied by pharmacological prevention.

It should be noted that wearing compression stockings coupled with thromboprophylaxis drugs analyzed in this study was from heterogeneous studies in which the drugs used were different.

In 2009, Another study looked at the effects of wearing compression stockings for immobilized stroke patients. In this RCT, 2518 patients were analyzed, and the result was an insignificant reduction in risk of 0.5%. Other side effects such as ulcers, sores, bullae, and skin necrosis are more in patients who use stockings than those who do not.

In 2009. a meta-analysis analyzed 1560 abstracts and 14 studies. It found that the relative risk for thromboembolism was increased 2.8-fold in people who traveled than those who did not. This meta-analysis also found a correlation between 'dose' and an increased risk of thrombosis. 

A systematic review study by Cochrane in 2016 compared DVT rates in aircraft passengers (over 5 hours) who were asked to wear stockings with those who did not. None of the study participants had symptomatic DVT but asymptomatic DVT.

The asymptomatic DVT incidence decreased from about 10 per 1000 passengers to 2-3 per 1000 passengers in patients wearing stockings. The study also stated that only a few patients complained of discomfort wearing stockings.


Postthrombotic Syndrome (PTS)
Complications of post-thrombotic syndrome increase morbidity and burden the patient even more socioeconomically. Symptoms include skin disorders such as mild erythema and local induration to swelling. Symptoms can also occur months to years after the occurrence of DVT. Post-thrombotic syndrome is a complication often experienced by DVT patients, where one in every 3-4 patients with symptomatic proximal DVT will experience these complications.

The RCT study by Prandoni et al. found that wearing compression stockings for 2 years reduced the percentage of DVT patients who experienced PTS from 49% (not using stockings) to 26% (using stockings).

A recommendation from the American College of Chest Physicians in 2012 stated that patients with acute DVT are advised to wear compression stockings for 2 years and even longer if PTS occurs. The recommendation to wear stockings is also for stroke patients, patients at risk of experiencing thromboembolism during pregnancy, and several other conditions. However, this organization's latest guidelines state that compression stockings should not be worn routinely to prevent PTS.

The Cochrane review in 2017 regarding wearing compression stockings to prevent PTS examined 10 randomized controlled trials. Overall, it stated that stockings reduced the PTS incidence even though the evidence was still weak (low-quality evidence). However, wearing stockings did not reduce the number of severe PTS, and there were no precise results regarding the DVT recurrence rate.


Disadvantages of The Compression Stocking

Wearing compression stocking can cause several side effects that adversely affect patients' quality of life, especially elderly patients and malnutrition. Compression stockings that are too tight or uneven distribution of pressure can cause sores on the skin and be ulcerated.

Other side effects of wearing the elastic compression stocking are dry skin, sweating, and itching. Comfort disorders that patients can feel include tingling, burning, movement disorders, constrictions, or pain. These complaints can reduce patient compliance in stockings, and now optimal manufacturing and research of stockings are still under development.


Conclusion
Compression stockings are a tool that is often used in the prevention of DVT, post-thrombotic syndrome, and several other conditions. There is some clinical evidence that the use of compression stockings effectively reduces the risk of DVT. However, the risk reduction is relatively small.

The use of compression stockings is also reported to reduce the incidence of complications from DVT, namely Post-thrombotic Syndrome, but the clinical evidence is still low-quality evidence. Like other health therapies, compression stockings have side effects, and their use can interfere with patient comfort.