The Pharmaceutical Journal Vol 267 No 7160 p181-186
11 August 2001

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Confusion over compression level for prevention of DVT in travellers

Deep vein thrombosis (DVT) related to air travel is in the news once again. However, expert opinion is divided over which level of compression hosiery is best for preventing DVT.

This week Which? magazine asked three experts to recommend one of three recently launched stockings: Activa air socks, Mediven travel stockings and Scholl flight socks. Two of the experts preferred the Mediven stockings, which offer the highest level of compression. However, Mr Stephen Barker, consultant vascular surgeon, Middlesex hospital, London, told The Journal that he recommends a lower level of compression.

Pharmacists should be aware that although marketed as class I compression, the Mediven stockings offer 18–21mmHg compression, equivalent to class II standard in the United Kingdom. Mediven says that its stockings are classified according to European standards in which this level of compression is class I. The Activa stockings offer 14–17mmHg, equivalent to UK class I compression, and the Scholl stockings 10mmHg, slightly less than class I. (The boundaries for compression classification in the UK are class I, 14–17mmHg; class II, 18–24mmHg; class III, 25–35mmHg.)

The Which? experts note that the higher-pressure stockings should not be used without medical advice adding that “your pharmacist should advise you on suitability and fit”. Mr Barker told The Journal on August 8: “I recommend use of one of the tailored class I products.” Compression stockings used in hospitals to prevent DVT are class I and research supports use of class I stockings, he said. Mr Barker also pointed out that class II stockings are not practical as people would have difficulty trying to put them on in an aeroplane. He stressed the importance of advising travellers on how to prevent DVT, ie, drinking plenty of water, avoiding alcohol and moving the legs (see PJ, January 27).

No matter which stockings are chosen, it is important to ensure that the correct size is worn. When stockings are supplied on prescription, pharmacists are paid a fee to measure and fit them. This is not the case when stockings are purchased. The Scholl stockings are sold on shoe size for the majority of the population and ankle size for people who have particularly large or small ankles compared with their shoe size.

This week, the Observer reported that the Government was going to issue guidelines to the airline industry on providing warnings about DVT with tickets for long-haul flights. A spokesman for the Department of Health told The Journal that this was not true. A Government report to be published soon will examine illness related to air travel but will not be making any new recommendations about DVT.

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