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Elastic Compression Stockings and the risk of post-thrombotic syndrome (PTS) in patients with symptomatic proximal vein thrombosis

Three Part Question

In [patients with confirmed deep vein thrombosis] does [the use of compression stockings] reduce [the risk of post-thrombotic syndrome (PTS)]?

Clinical Scenario

A 35 year old woman attends the Emergency Department with a swollen and painful left leg. A DVT is suspected and confirmed on ultrasound. You are aware of the possible risks of developing post-thrombotic syndrome and wonder whether this young woman would benefit from the use of compression stockings.

Search Strategy

Medline 1966-07/00 using the OVID interface.
{(Exp.thrombosis OR venous thrombosis OR AND { OR exp.TED OR exp. support OR exp. compression OR {exp.graduated compression}. Limit to english language AND human.

Search Outcome

19 papers found of which 18 were irrelevant or of insufficient quality for inclusion. The remaining paper is shown in the table.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Brandjes D et al,
194 consecutive patients with a first episode of proximal DVT(proved on venogram). Custom fitted graduated compression stockings (96), vs no stockings(98). Assessment every 3 months for 2 years, and thereafter every 6 months for at least 5 years.PRCTIncidence of PTSMild to moderate PTS occurred in 19 patients in the stocking group and in 46 patients in the control group(P=<0.001)Due to the non blinded design, potential bias in the assessment of post- thrombotic syndrome Lack of an accepted definition of PTS
PTS was assessed using clinical characteristics and leg measurements11 patients in the stocking group developed severe PTS compared with 23 in the control group(P=<0.001)


The incidence of PTS following confirmed DVT is unknown but it has been reported to be between 20 and 100%. This wide range probably reflects the small size of these retrospective studies with different periods of follow up and selection criteria. Interpretation of the findings from these studies is also hampered by the lack of objective diagnostic criteria for PTS.

Clinical Bottom Line

Elastic Compression Stockings should be used within 2 weeks of onset of acute thrombotic event and worn for up to 2 years.


  1. Brandjes D, Buller HR, Heijboer H, et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal vein thrombosis. Lancet 1997;349:759-62.