Clinical Question

Are compression stockings safe and effective for the prevention of deep venous thrombosis (DVT) in airline passengers?

Evidence-Based Answer

Compression stockings are effective at reducing asymptomatic DVT in airline passengers taking flights longer than five hours in both high-risk (number needed to treat [NNT] = 37; 95% CI, 35 to 46) and low-risk (NNT = 111; 95% CI, 100 to 143) populations.¹ (Strength of Recommendation: C, based on disease-oriented evidence.) It is unclear if compression stockings prevent symptomatic DVT, pulmonary embolism (PE), or death. There are no significant adverse events associated with their use.

Practice Pointers

DVT occurs through the formation of a blood clot in the deep veins, typically within the lower extremities. This can ultimately lead to a PE, a significant cause of morbidity and mortality. Prolonged periods of immobility that occur during air travel are a risk factor for the development of venous thromboembolism (VTE).² However, symptomatic VTE (including DVT or PE) after long-distance travel is rare, with an incidence of 27 per 1 million passengers within 14 days of travel.² Asymptomatic DVT is a finding of uncertain clinical significance and occurs in 2.4% of high-risk travelers and 1.5% of low- or medium-risk travelers.¹ Risk factors for VTE with long-distance travel (greater than four hours) include active malignancy, recent surgery, pregnancy or recent postpartum state, hormone therapy, obesity, and a history of VTE.³