Stockings to prevent post-thrombotic syndrome

Until recently, the effectiveness of elastic compression stockings for the prevention of post-thrombotic syndrome following deep venous thrombosis (DVT) was considered irrefutable. Compression stockings had been embedded in daily practice and in guidelines,1 2 at least in Europe, since two randomised clinical trials showed that compression reduced the incidence of post-thrombotic syndrome by more than 20%.1 2 The results of the SOX trial, published in 2014, challenged this dogma, suggesting that elastic compression did not prevent post-thrombotic syndrome.3 Although the trial was hampered by a lack of adherence to treatment, treating clinicians readily accepted the negative outcome. Since then, guidelines have been updated and compression stockings devalued and even discouraged.4

In a linked paper (doi:10.1136/bmj.i2691), Mol and colleagues report the results of the OCTAVIA trial, a non-inferiority …