J Am Coll Cardiol

Thigh-high compression stockings fall short in preventing vasovagal syncope recurrence

September 8, 2025

Routine use of thigh-high elastic compression stockings (ECS) didn’t reduce vasovagal syncope (VVS) recurrence or prolong VVS-free survival when added to standard care, and adherence remained a challenge. Compression stockings may be selectively considered for patients with clear benefit during active use but aren’t broadly recommended for VVS prevention.

Study details: The multicenter, parallel, blinded, randomized, sham-controlled COMFORTS-II trial (NCT05086679) enrolled 266 adults (mean age, 39 years; 58% female) with ≥2 VVS episodes in the prior year. Participants were randomized to thigh-high, open-toe ECS (25–30 mm Hg) or sham stockings (≤10 mm Hg), alongside standard care (education, lifestyle modification). The coprimary outcomes were VVS recurrence and VVS-free survival over 12 months.

Results: VVS recurred in 29.1% of the ECS group vs. 34.8% of the sham group (absolute risk reduction 5.7%; P=0.315). VVS-free survival didn’t differ significantly (hazard ratio 0.81; 95% CI 0.53–1.24; P=0.333). Median recurrent episode counts were similar (2.5 vs. 2; P=0.839). Adherence was suboptimal and comparable between groups. Notably, fewer VVS episodes occurred while actively wearing ECS (32.7% vs. 45.1%; P=0.024).

Source:

Tavolinejad H, et al. (2025, August 12). J Am Coll Cardiol. Using Compression Stockings to Prevent Recurrence of Vasovagal Syncope: A Randomized Sham-Controlled Trial. https://pubmed.ncbi.nlm.nih.gov/40769669/