Using Compression Stockings to Prevent Recurrence of Vasovagal Syncope: A Randomized Sham-Controlled Trial.

Area of Science:

• Cardiology
• Nephrology
• Vascular Medicine

Background:

• Vasovagal syncope (VVS) is a common condition with limited effective treatment options.
• Elastic compression stockings (ECS) are a proposed therapy for VVS, but their real-world efficacy is not well-established.

Purpose of the Study:

• To compare the effectiveness of thigh-high elastic compression stockings (ECS) versus sham stockings in preventing VVS recurrence.
• To evaluate the impact of ECS on VVS-free survival and the frequency of recurrent episodes.

Main Methods:

• A multicenter, blinded, randomized sham-controlled trial involving 266 adults (18-65 years) with a history of VVS.
• Participants were randomized to receive either active thigh-length ECS (25-30 mm Hg) or sham ECS (≤10 mm Hg) alongside standard care.
• Primary outcomes included the proportion of participants with VVS recurrence and time to first VVS recurrence over 12 months.

Main Results:

• No significant difference in VVS recurrence rates (29.1% vs 34.8%) or VVS-free survival between the ECS and sham groups.
• Adherence to ECS was suboptimal and similar between groups, with significant discontinuation rates.
• A statistically significant reduction in VVS episodes occurred when participants were actively wearing the ECS (32.7% vs 45.1%).

Conclusions:

• Thigh-high ECS did not reduce the cumulative incidence or VVS-free survival in patients with VVS.
• The study does not support the routine use of thigh-length ECS for VVS prevention.
• Future research should explore more extensive compression strategies targeting pelvic and abdominal venous pooling.