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Abstract Introduction Elastic compression stockings (ECSs) are used to treat symptoms of venous insufficiency. However, lack of patient compliance can limit their effectiveness. In a secondary analysis of the SOX Trial, a randomized trial of active vs. placebo ECSs worn for 2 years to prevent postthrombotic syndrome after deep vein thrombosis, we aimed to describe patient‐reported reasons for nondaily use of ECS and to identify predictors of noncompliance during follow‐up. Methods At each follow‐up visit of the SOX Trial, patients were asked how many days per week they wore study stockings, and if not worn daily, to specify the reason(s). Reasons for nondaily use of ECSs were tabulated. Multiple logistic regression modeling was used to identify predictors of stocking noncompliance during follow‐up (defined as use <3 days per week). Results Among the 776 patients who attended at least 1 follow‐up visit, daily use of stockings at each visit was similar in the active and placebo ECS groups. Reasons for nondaily use of stockings was most frequently related to aversive aspects of stockings (~three‐fourths of patients) and less often related to patient behaviors (~one‐fourth of patients). In multivariate analyses, behavior‐related and aversive aspect–related reasons for nondaily use of ECSs at the 1‐month visit were significant predictors of noncompliance during follow‐up (odds ratio [OR] = 4.41 [95% confidence interval, 2.12‐9.17] and OR = 3.99 [2.62‐6.08], respectively). Conclusions Aversive aspects of ECSs and patient behaviors are important reasons for noncompliance. Improving the appeal and tolerability of ECS and education directed at modifying patient behaviors may improve compliance.