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Efficacy of compression stockings on preventing post-thrombotic syndrome: a systematic review and meta-analysis of randomized controlled trials
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 16 April 2026
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The effectiveness of elastic compression stockings (ECS) in preventing post-thrombotic syndrome (PTS) following deep vein thrombosis (DVT) remains controversial. A systematic review and meta-analysis was conducted to evaluate whether ECS prevents PTS in DVT patients. A systematic search was performed using PubMed, Scopus, and the Cochrane Library. Risk of bias was assessed using the Cochrane RoB v2 tool, and statistical analysis was conducted with Review Manager 5.4. Of 389 identified articles, 6 studies were included, comprising a total of 1589 participants. A total of 5 randomized controlled trials involving 1490 patients were analyzed. ECS use was associated with a significant reduction in overall PTS risk [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.23-0.86, p=0.02] and mild to moderate PTS (OR 0.54, 95% CI 0.34-0.87, p=0.01). No significant benefit was observed for severe PTS. ECS may reduce PTS risk, particularly in mild to moderate cases.
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Makedonov I, Kahn SR, Abdulrehman J, et al. Prevention of the postthrombotic syndrome with anticoagulation: a narrative review. Thromb Haemost 2022;122:1255-64.
Chandrashekar A, Garry J, Gasparis A, Labropoulos N. Vein wall remodeling in patients with acute deep vein thrombosis and chronic postthrombotic changes. J Thromb Haemost 2017;15:1989-93.
Valerio L, Christodoulou KC, Abele C, et al. Postthrombotic syndrome: risk after deep vein thrombosis and estimates of its incidence and prevalence in Europe. J Thromb Haemost 2026; S1538-7836(26)00006-1.
Soosainathan A, Moore HM, Gohel MS, Davies AH. Scoring systems for the post-thrombotic syndrome. J Vasc Surg 2013;57:254-61.
Lattimer CR, Kalodiki E, Azzam M, Geroulakos G. Validation of the Villalta scale in assessing post-thrombotic syndrome using clinical, duplex, and hemodynamic comparators. J Vasc Surg Venous Lymphat Disord 2014;2:8-14.
Pop CT, Gu CS, Vedantham S, et al. Exploring the Villalta scale to capture postthrombotic syndrome using alternative approaches: a subanalysis of the ATTRACT trial. Res Pract Thromb Haemost 2023;7:100032.
Vazquez SR, Kahn SR. Advances in the diagnosis and management of postthrombotic syndrome. Best Pract Res Clin Haematol 2012;25:391-402.
Baldwin MJ, Moore HM, Rudarakanchana N, et al. Post-thrombotic syndrome: a clinical review. J Thromb Haemost 2013;11:795-805.
Comerota AJ, Cushman M, Evans NS, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies. Circulation 2014;130:1636-61.
Galanaud JP, Monreal M, Kahn SR. Predictors of the post-thrombotic syndrome and their effect on the therapeutic management of deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2016;4:531-4.
Arabi YM, Mehta S. Venous thromboprophylaxis in the ICU: navigating evidence, risk, and practice gaps. Intensive Care Med 2025;51:1508-10.
Noureldin A, Ivankovic V, Delisle M, et al. Extended-duration thromboprophylaxis following major abdominopelvic surgery – For everyone or selected cases only? Thromb Res 2024;235:175-80.
Rasmussen MS, Jørgensen LN, Wille-Jørgensen P. Prolonged thromboprophylaxis with Low Molecular Weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev 2009;1:CD004318.
Brandjes DP, Büller HR, Heijboer H, et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997;349:759-62.
Prandoni P, Lensing AWA, Prins MH, et al. Below-Knee elastic compression stockings to prevent the post-thrombotic syndrome. Ann Intern Med 2004;141:249-56.
Musani M, Matta F, Yaekoub AY, et al. Venous compression for prevention of postthrombotic syndrome: a meta-analysis. Am J Med 2010;123:735-40.
Guyatt GH, Akl EA, Crowther M, et al. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:7S-47S.
Howard LS, Hughes RJ. NICE guideline: management of venous thromboembolic diseases and role of thrombophilia testing. Thorax 2013;68:391-3.
Skervin AL, Thapar A, Franchini AJ, et al. Systematic review and meta-analysis of utility of graduated compression stockings in prevention of post-thrombotic syndrome. Eur J Vasc Endovasc Surg 2016;51:838-45.
Kahn SR, Shapiro S, Wells PS, et al. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 2014;383:880-8.
Subbiah R, Aggarwal V, Zhao H, et al. Effect of compression stockings on post thrombotic syndrome in patients with deep vein thrombosis: a meta-analysis of randomised controlled trials. Lancet Haematol 2016;3:e293-300.
Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016;149:315-52.
National Institute for Health and Care Excellence. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. 2020. Available from: https://www.nice.org.uk/guidance/ng158/chapter/Recommendations#mechanical-interventions.
Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest 2021;160:e545-608.
Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020;4:4693-738.
Kakkos SK, Gohel M, Baekgaard N, et al. European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg 2021;61:9-82.
Nielsen JD, Hermann TS, Fredskilde PCA. Graduated elastic compression stockings in the prevention of post-thrombotic syndrome: a systematic review and meta-analysis. Phlebology 2024;39:229-37
Meng J, Liu W, Wu Y, et al. Is it necessary to wear compression stockings and how long should they be worn for preventing post thrombotic syndrome? A meta-analysis of randomized controlled trials. Thromb Res 2023;225:79-86.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J 2021;372:71.
Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:I4898.
Jayaraj A, Meissner M. Impact of graduated compression stockings on the prevention of post-thrombotic syndrome - results of a randomized controlled trial. Phlebol J Venous Dis 2014;30:541-8.
Yang X, Zhang X, Yin M, et al. Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal. J Vasc Surg Venous Lymphat Disord 2021;10:293-9.
Thapar A, Lawton R, Bradbury A, et al. Compression hosiery to avoid post-thrombotic syndrome: CHAPS randomized clinical trial. Br J Surg 2025;112:znaf018.
Lim CS, Davies AH. Graduated compression stockings. Can Med Assoc J 2014;186:E391-8.
Motykie GD, Caprini JA, Arcelus JI, et al. Evaluation of Therapeutic compression stockings in the treatment of chronic venous insufficiency. Dermatol Surg 1999;25:116-20.
Ibegbuna V, Delis KT, Nicolaides AN, Aina O. Effect of elastic compression stockings on venous hemodynamics during walking. J Vasc Surg 2003;37:420-5.
Liu R, Lao TT, Kwok YL, et al. Effects of graduated compression stockings with different pressure profiles on lower-limb venous structures and haemodynamics. Adv Ther 2008;25:465-78.
Agu O, Baker D, Seifalian AM. Effect of graduated compression stockings on limb oxygenation and venous function during exercise in patients with venous insufficiency. Vascular 2004;12:69-76.
Beidler SK, Douillet CD, Berndt DF, et al. Inflammatory cytokine levels in chronic venous insufficiency ulcer tissue before and after compression therapy. J Vasc Surg 2009;49:1013-20.
Sugisawa R, Unno N, Saito T, et al. Effects of compression stockings on elevation of leg lymph pumping pressure and improvement of quality of life in healthy female volunteers: a randomized controlled trial. Lymphat Res Biol 2016;14:95-103.
Appelen D, van Loo E, Prins MH, et al. Compression therapy for prevention of post‐thrombotic syndrome. Cochrane Database Syst Rev 2017;9:CD004174.
Jin YW, Ye H, Li FY, et al. Compression stockings for prevention of postthrombotic syndrome. Vasc Endovascular Surg 2016;50:328-34.
How to Cite
Efficacy of compression stockings on preventing post-thrombotic syndrome: a systematic review and meta-analysis of randomized controlled trials. (2026). Italian Journal of Medicine. https://doi.org/10.4081/itjm.2026.2463
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