Thigh-length compression stockings do not prevent recurrence of vasovagal syncope
Thigh-length elastic compression stockings did not significantly reduce overall recurrence rates of vasovagal syncope, although fewer syncopal episodes occurred while patients were wearing real stockings compared to sham stockings, a trial showed.
Wearing thigh-high elastic compression stockings (ECS) for 12 months did not reduce the cumulative incidence of vasovagal syncope recurrence, a sham-controlled trial found.
Researchers randomized 266 participants (mean age, 39 years; 58% female) who had at least two syncopal episodes in the past year to receive either thigh-length, open-toe active ECS (n=134; 25 to 30 mm Hg of pressure to the leg), or identical-looking sham ECS (n=132; ≤10 mm Hg of pressure). All participants received standard care (education and lifestyle modifications) but no medications for preventing recurrence and used diaries to track their ECS adherence. Participants were advised to wear ECS as often as possible during waking hours, especially during prolonged standing or sitting, and to remove them when lying down. Primary outcomes included the proportion of participants with at least one recurrence and the time to first recurrence. Findings were published by JACC on August 4.
During 12 months of follow-up, syncope recurred in 29.1% (n=39) of the treatment group and 34.8% (n=46) of the control group (absolute risk reduction, 5.7%; P=0.315). Syncope-free survival was not significantly different between the two groups (hazard ratio [HR], 0.81 [95% CI, 0.53 to 1.24]; P=0.333). Adherence to the compression stockings was also suboptimal, with discontinuation rates of 37.3% in the treatment arm and 34.8% in the sham arm. Duration of ECS use, adherence rates, and median number of recurrent episodes (2.5 in the treatment group vs. 2 in the sham group; P=0.839) were similar between groups. Significantly fewer episodes occurred when participants were actively wearing ECS (32.7% vs. 45.1%; P=0.024). Five participants in each treatment arm also had recurrence during study follow-up after they decided to discontinue ECS.
Limitations include that nearly one-third of patients discontinued the intervention during the trial and that the trial did not reach its expected number of events.
“The results do not support routine use of thigh-length ECS, although it may be helpful for selected patients when added to standard care,” the researchers concluded. “Because our study specifically tested thigh-high ECS, future studies should aim to assess the effectiveness of more extensive compression targeting pelvic and abdominal venous pooling.”
An accompanying editorial called for nuanced interpretations of the study's findings, because thigh-high ECS may not be adequate.
“The study leaves open the door for investigation in a defined subset of patients with poor response to first-line measures and more frequent VVS [vasovagal syncope] episodes, as well as the study of garments optimized to target the pelvic and splanchnic vasculature,” the editorialists wrote. More research is also needed on long-term adherence to ECS, they said, adding that “thoughtful stratification of VVS phenotypes and innovation in compression strategies may yet yield meaningful benefit for those most in need.”