Clinical Characteristics, Risk Factors, and Graduated Compression Stockings Use among Patients with Venous Thromboembolism: A Multicenter Prospective Study
This multicenter, prospective observational study included 442 patients with venous thromboembolism (VTE) from 13 hospitals in Anhui Province, China, aiming to systematically analyze their clinical characteristics, risk factors, and use of graduated compression stockings (GCS). The results showed that deep vein thrombosis (DVT) was the predominant clinical presentation (97.1%), of which 87.8% were isolated DVT. Patients with concurrent DVT and pulmonary embolism (PE) had a significantly higher prevalence of pre-existing cardiovascular disease compared to those with isolated DVT or PE (P < 0.05). The five most common risk factors were: history of COVID-19 infection (48.2%), hypertension (28.5%), smoking history (15.6%), obesity (body mass index [BMI] ≥ 28 kg/m², 14.5%), followed by diabetes mellitus and admission for surgical treatment (10.0% each). Among patients with lower-extremity DVT, long-term adherence to graduated compression stockings (GCS) following discharge was suboptimal: only 26.1% maintained consistent use over two months, while 63.7% never used GCS during the entire follow-up period. Multivariate logistic regression revealed that a history of COVID-19 infection (OR = 0.227, 95%CI: 0.139–0.370) and BMI (OR = 1.069, 95%CI: 1.006–1.136) were independent predictors of sustained GCS use. This study provides real-world data on the disease spectrum, risk profile, and secondary prevention practices of VTE patients in a regional Chinese population, offering important evidence for targeted strategies to improve post-discharge GCS adherence and optimize long-term comprehensive management.
[1] Al-Aly, Z., Xie, Y., & Bowe, B. (2021). Highdimensional characterization of post-acute sequelae of COVID-19. Nature, 594(7862), 259-264. https://doi.org/10.1038/s41586-021-03553-9
[2] Ashrani, A. A., & Heit, J. A. (2009). Incidence and cost burden of post-thrombotic syndrome. Journal of Thrombosis and Thrombolysis, 28(4), 465-476. https://doi.org/10.1007/s11239-009-0309-3
[3] Cohen, A. T., Katholing, A., Rietbrock, S., Bamber, L., & Martinez, C. (2017). Epidemiology of first and recurrent venous thromboembolism in patients with active cancer: A population-based cohort study. Thrombosis and Haemostasis, 117(1), 57-65. https://doi.org/10.1160/TH15-08-0686
[4] Cowan, S., Ghayyad, K., Conlon, M. J., Naik, M., Zeini, I., Hawks, M., … & Kachooei, A. R. (2024). Trends in the epidemiology of deep vein thrombosis and pulmonary embolism in patients undergoing surgery. Cureus, 16(12), e74925. https://doi.org/10.7759/cureus.74925
[5] Crous-Bou, M., Harrington, L. B., & Kabrhel, C. (2016). Environmental and genetic risk factors associated with venous thromboembolism. Seminars in Thrombosis and Hemostasis, 42(8), 808-820. https://doi.org/10.1055/s-0036-1592333
[6] Durlach, V., Vergès, B., Al-Salameh, A., Bahougne, T., Benzerouk, F., Berlin, I., … & Le Faou, A. L. (2022). Smoking and diabetes interplay: A comprehensive review and joint statement. Diabetes & Metabolism, 48(6), 101370. https://doi.org/10.1016/j.diabet.2022.101370
[7] Emigh, B., Bose, A., Stephen, A., Arabi, J., & Adams, C. (2025). Perioperative venous thromboembolism prophylaxis in orthopedic trauma: A practical review. Rhode Island Medical Journal, 108(2), 63-68.
[8] Galanaud, J. P., Monreal, M., & Kahn, S. R. (2016). Predictors of the post-thrombotic syndrome and their effect on the therapeutic management of deep vein thrombosis. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 4(4), 531-534. https://doi.org/10.1016/j.jvsv.2015.08.005
[9] Guntupalli, S. R., Spinosa, D., Wethington, S., Eskander, R., & Khorana, A. A. (2023). Prevention of venous thromboembolism in patients with cancer. BMJ, 381, e072715. https://doi.org/10.1136/bmj-2022-072715
[10] Heit, J. A. (2006). The epidemiology of venous thromboembolism in the community: Implications for prevention and management. Journal of Thrombosis and Thrombolysis, 21(1), 23-29. https://doi.org/10.1007/s11239-006-5572-y
[11] Kahn, S. R., Shapiro, S., Wells, P. S., Rodger, M. A., Kovacs, M. J., Anderson, D. R., … SOX Trial Investigators. (2014). Compression stockings to prevent postthrombotic syndrome: A randomised placebo-controlled trial. The Lancet, 383(9920), 880-888. https://doi.org/10.1016/S0140-6736(13)61902-9
[12] Kearon, C., Akl, E. A., Ornelas, J., Blaivas, A., Jimenez, D., Bounameaux, H., … & Moores, L. (2016). Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 149(2), 315-352. https://doi.org/10.1016/j.chest.2015.11.026
[13] Lv, L., Peng, R., Liu, H., Deng, H., & Chen, Q. (2024). Research progress of preventative nursing care for postthrombotic syndrome of deep veins. Journal of Nursing Science, 39(19), 120-123.
[14] Machin, M., Salim, S., Tan, M., Onida, S., Davies, A. H., & Shalhoub, J. (2021). Surgical and non-surgical approaches in the management of lower limb postthrombotic syndrome. Expert Review of Cardiovascular Therapy, 19(3), 191-200. https://doi.org/10.1080/14779072.2021.1876563
[15] Maskova, E., Slivarichova, S., Maly, J., & Mala-Ladova, K. (2025). Electronic monitoring of medication adherence to direct oral anticoagulants: A systematic review. Patient Preference and Adherence, 19, 921-939. https://doi.org/10.2147/PPA.S505485
[16] Meng, J., Liu, W., Wu, Y., Xiao, Y., Tang, H., & Gao, S. (2023). Is it necessary to wear compression stockings and how long should they be worn for preventing post thrombotic syndrome? A meta-analysis of randomized controlled trials. Thrombosis Research, 225, 79-86. https://doi.org/10.1016/j.thromres.2023.03.016
[17] Nazarzadeh, M., Bidel, Z., Mohseni, H., Canoy, D., Pinho-Gomes, A. C., Hassaine, A., … & INVENT Consortium. (2023). Blood pressure and risk of venous thromboembolism: A cohort analysis of 5.5 million UK adults and mendelian randomization studies. Cardiovascular Research, 119(3), 835-842. https://doi.org/10.1093/cvr/cvac135
[18] Olaf, M., & Cooney, R. (2017). Deep venous thrombosis. Emergency Medicine Clinics of North America, 35(4), 743-770. https://doi.org/10.1016/j.emc.2017.06.003
[19] Prandoni, P., Haas, S., Fluharty, M. E., Schellong, S., Gibbs, H., Tse, E., … & Kakkar, L. A. (2024). Incidence and predictors of post-thrombotic syndrome in patients with proximal DVT in a real-world setting: Findings from the GARFIELD-VTE registry. Journal of Thrombosis and Thrombolysis, 57(2), 312-321. https://doi.org/10.1007/s11239-023-02895-7
[20] Raskob, G. E., Angchaisuksiri, P., Blanco, A. N., Buller, H., Gallus, A., Hunt, B. J., … & ISTH Steering Committee for World Thrombosis Day. (2014). Thrombosis: A major contributor to global disease burden. Arteriosclerosis, Thrombosis, and Vascular Biology, 34(11), 2363-2371. https://doi.org/10.1161/ATVBAHA.114.304488
[21] Secades, D., Dufner Krieger, S., Hidalgo Ramos, R. A., Hong, I., Ortiz, M., & Mac Courtney, C. (2025). Incidence of deep vein thrombosis in patients with COVID-19: A systematic review. Cureus, 17(7), e88697. https://doi.org/10.7759/cureus.88697
[22] Shi, X., Yan, S., Huang, Q., Li, X., Wang, Y., Ma, W., … & Jin, Y. (2023). Real world research: Bridging the gap between clinical practice guidelines and clinical decision making. Medical Journal of Peking Union Medical College Hospital, 14(4), 859-867.
[23] Siebenhofer, A., Ulrich, L. R., Mergenthal, K., Berghold, A., Pregartner, G., Kemperdick, B., ... & Petersen, J. J. (2019). Primary care management for patients receiving long-term antithrombotic treatment: A clusterrandomized controlled trial. Plos One, 14(1), e0209366. https://doi.org/10.1371/journal.pone.0209366
[24] Skervin, A. L., Thapar, A., Franchini, A. J., Prandoni, P., Shalhoub, J., & Davies, A. H. (2016). Systematic review and meta-analysis of utility of graduated compression stockings in prevention of post-thrombotic syndrome. European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery, 51(6), 838-845. https://doi.org/10.1016/j.ejvs.2016.02.022
[25] Spencer, F. A., Emery, C., Joffe, S. W., Pacifico, L., Lessard, D., Reed, G., … & Goldberg, R. J. (2009). Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism: The Worcester VTE study. Journal of Thrombosis and Thrombolysis, 28(4), 401-409. https://doi.org/10.1007/s11239-009-0378-3
[26] Van Hecke, A., Grypdonck, M., & Defloor, T. (2009). A review of why patients with leg ulcers do not adhere to treatment. Journal of Clinical Nursing, 18(3), 337-349. https://doi.org/10.1111/j.1365-2702.2008.02575.x
[27] Yao, J. (2020). Development of a clinical prediction model for post thrombotic syndrome in patients with deep venous thrombosis of lower extremities [Master's thesis]. Shanxi Medical University.
[28] Zhang, J., Ma, F., Yao, J., Hao, B., Xu, H., Guo, X., … & Yang, T. (2022). Development and validation of a clinical prediction model for post thrombotic syndrome following anticoagulant therapy for acute deep venous thrombosis. Thrombosis Research, 214, 68-75. https://doi.org/10.1016/j.thromres.2022.04.003
[29] Zhang, Y., Jin, J., Song, B., Wang, Y., & Liang, M. (2021). Vascular boot warming improves clinical outcomes of patients with deep vein thrombosis in lower extremities. American Journal of Translational Research, 13(4), 3800-3805.
[30] Zhang, Z. (2021). Prevalence and susceptibility genes of venous thromboembolism in Chinese population [Master's Thesis]. Peking Union Medical College.