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Effectiveness of long-term graduated compression stockings after deep vein thrombosis: a GRADE-based meta-analysis of

Yuanjie Duan^1,2,3, Juan Liu^1,2,3, Shiyu Lin^1,2

¹Hunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, School of Public Health, Changsha Medical University, Changsha, China.

Frontiers in Medicine

|June 8, 2026

Abstract

Background:

Post-thrombotic syndrome (PTS) is a common long-term complication following deep vein thrombosis (DVT), leading to substantial morbidity and impaired quality of life. Elastic compression stockings (ECS) are widely used for PTS prevention; however, their effectiveness remains controversial, particularly across different severities of PTS.

Method:

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the effectiveness of ECS in preventing PTS after DVT. Electronic databases were searched from inception to January 20, 2026. The primary outcomes were the overall incidence of PTS at final follow-up, as well as the incidence of mild-to-moderate and severe PTS. Secondary outcomes included recurrent DVT and all-cause mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. The certainty of evidence was assessed using the GRADE approach.

Results:

Eight trials involving 1,775 patients were included. ECS were associated with a modest reduction in total PTS (RR 0.70; 95% CI 0.51-0.96; absolute reduction ~127 per 1,000), corresponding to an absolute reduction of approximately 142 cases per 1,000 patients. When stratified by severity, ECS reduced mild-to-moderate PTS (RR 0.69; 95% CI 0.50-0.93; absolute reduction ~129 per 1,000), whereas effects on severe PTS were uncertain (RR 0.56; 95% CI 0.22-1.43). No clear impact was observed on recurrent DVT (RR 0.90; 95% CI 0.73-1.11) or all-cause mortality (RR 0.98; 95% CI 0.68-1.40). Certainty of evidence was low for total and mild-to-moderate PTS and very low for severe PTS, recurrent DVT, and mortality. Heterogeneity in adherence, control group design, PTS definitions, and initial DVT management may have influenced outcomes.

Conclusion:

Long-term ECS may modestly reduce mild-to-moderate PTS after DVT, but their effect on severe PTS, recurrent DVT, and mortality remains uncertain. ECS may improve symptoms, but their preventive effect is limited, and clinical decisions should consider patient-specific factors, adherence, and the multifactorial determinants of PTS.

Systematic Review Registration:

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261386069.

Keywords:

deep venous thrombosis elastic compression stockings meta-analysis post-thrombotic syndrome prophylaxis

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