Vasovagal syncope (VVS) is a common and challenging condition with limited effective treatments, affecting a significant portion of the general population during their lifetime.² While elastic compression stockings (ECS) have been proposed as a non-pharmacological therapy to prevent recurrence, their real-world effectiveness has remained uncertain. A new multicentre, randomised, sham-controlled trial has found that thigh-high ECS, when added to standard care, does not significantly reduce the cumulative incidence or frequency of VVS recurrence.¹

The parallel, blinded, randomised sham-controlled trial enrolled 266 adults (mean age 39 years; 58% female) between 18 and 65 years of age who had experienced at least two VVS episodes in the preceding year. Participants were randomised on a 1:1 basis to receive either thigh-length, open-toe active ECS, which applied 25–30 mmHg of pressure, or identical-looking sham ECS that applied minimal pressure (≤10 mmHg).¹

All participants received standard care, including education and lifestyle modification advice, but were not prescribed medications for VVS prevention. Adherence was monitored over the 12-month follow-up period using diary booklets. The coprimary outcomes were the proportion of participants experiencing one or more VVS recurrences and the time to the first recurrence (VVS-free survival).¹

After 12 months, the trial did not meet its primary endpoints. VVS recurred in 29.1% (n=39/134) of participants in the active treatment group compared with 34.8% (n=46/132) in the sham group, a difference that was not statistically significant (absolute risk reduction: 5.7%; p=0.315). Similarly, there was no significant difference in VVS-free survival between the two groups (HR: 0.81; 95% CI: 0.53–1.24; p=0.333).¹

The study noted that adherence to wearing the stockings was suboptimal in both arms, with discontinuation rates of 37.3% in the treatment group and 34.8% in the sham group. Interestingly, a post-hoc analysis revealed that significantly fewer VVS episodes occurred while participants were actively wearing the active ECS compared to the sham stockings (32.7% vs 45.1%; p=0.024).¹

The findings from this trial do not support the routine prescription of thigh-high compression stockings for all patients with VVS. The authors concluded, “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 observation that syncopal events were less frequent when the stockings were actively worn suggests that poor adherence may be a significant barrier to their potential efficacy, rather than a complete lack of a physiological effect.¹

Given the specific focus on thigh-high compression, the investigators suggest that future research is needed to explore more extensive compression methods. They noted, “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.”¹

References

1. Tavolinejad H, Bozorgi A, Emkanjoo Z, et al. Using Compression Stockings to Prevent Recurrence of Vasovagal Syncope: A Randomized Sham-Controlled Trial. JACC. 2025;86(6):412-422. https://doi.org/10.1016/j.jacc.2025.05.049

2. Ganzeboom KS, Mairuhu G, Reitsma JB, et al. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J Cardiovasc Electrophysiol. 2006;17(11):1172-1176. https://doi.org/10.1111/j.1540-8167.2006.00595.x

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