Thrombosis prophylaxis stocking

MTS are circular knitted and seamless and have compressive properties due to the incorporated elastic fibres. According to expert opinion, the pressure should not exceed 21 mmHg at any point. The European pre-standard requires a pressure of 13-18 mmHg in the ankle area, with a tolerance of +/-3 mmHg. The pressure curve must decrease proximally, it should be 80-100% above the ankle, 60-80% below the knee and 30-70% in the middle of the thigh. MTS shall have a minimum longitudinal elongation of 30% and a transverse elongation of 120%. - The values given in the European pre-standard have been determined empirically, as no corresponding knowledge material is available.

• Acceleration of the venous return flow
• Reduction of the venous cross section
• Improvement of the venous valve function

According to previous publications, there is clinically no difference in the effectiveness of a knee-length or thigh length MTS. Therefore, for purely practical reasons, a knee-length stocking can be given the advantage.

MTS are indicated for pre-, intra- and postoperative, peri- and postpartum thrombembolic prophylaxis and also for bedridden patients.

They should be worn (according to the guidelines for MTS) preoperatively and for at least seven days postoperatively. However, there is no evidence for these recommendations.

In the current guidelines on thrombosis prophylaxis, only a few indications for the use of physical measures for thrombosis prophylaxis are still seen. The following recommendations apply:

• Basic measures as well as physical measures should not replace an indicated medicinal VTE prophylaxis. ⇑⇑ Conversely, basic measures should not be dispensed with in the case of drug-based VTE prophylaxis and physical measures should be used in accordance with the indication. ⇑ (expert consensus)
• In case of contraindications against a medicinal VTE prophylaxis, physical measures should be applied. ⇑⇑ (Expert consensus

Remember! According to a meta-analysis of studies with adequate blinding, the risk of VTE is increased when physical measures are applied compared to drug prophylaxis with heparins (RR 1.73; 95%CI 1.04-2.86). It follows that whenever there are no plausible contraindications, drug prophylaxis should be preferred. Additional limitations in the application of physical measures result from contraindications (e.g. simultaneous PAVK), their limited availability on site, cumbersome handling or high costs. On the other hand, patients should be given physical VTE prophylaxis measures if indicated drug prophylaxis is contraindicated. This applies, for example, to patients with an increased risk of bleeding. Although this recommendation is not supported by studies, it is justified by the increased risk of VTE in this patient group.

Most important side effects and risks:

• ischemic complications e.g. skin necrosis
• CAVE: Non-responsive intensive care patients with peripheral arterial occlusive disease and/or peripheral neuropathy
• CAVE: undesirable effects due to incorrect fitting and incorrect tightening!

The same undesirable effects apply as for other medical compression stockings

Absolute contraindications:

• advanced peripheral arterial occlusive disease
• Phlegmasia coerulea dolens

Relative contraindications:

• advanced neuropathy

Until today there are no mandatory criteria regarding size, sizing, pressure, pressure distribution on the leg. However, there is a European pre-standard (ENV 12719) of the Comitée Européen de Normalisation (CEN) from August 2001.

MTS are mostly offered as thigh stockings, some manufacturers also produce knee stockings. MTS are currently still supplied in 3-9 sizes depending on the product. In the new European pre-standard the length measurements for knee and thigh stockings are given from distal to proximal through the measuring points B to G. Knee stockings, for example, will then be available in three different lengths: short from 41-43 cm, normal from 45-49 cm and long from 51-53 cm. The handling of the large number of sizes offered is difficult to carry out in practice.

• Encke A et al (2015) Guideline venous thromboembolism prophylaxis
• Gallenkemper G et al (1996) Guideline for medical thrombosis prophylaxis stockings
• Kröger K (2016) Does compression therapy still play a role today in the prevention of thrombosis?