Graduated compression stockings for prevention of deep vein thrombosis.

BACKGROUND One of the settings where deep vein thrombosis (DVT) in the lower limb and pelvic veins occurs is in hospital with prolonged immobilisation of patients for various surgical and medical illnesses. Using graduated compression stockings (GCS) in these patients has been proposed to decrease the risk of DVT. This is an update of a Cochrane review first published in 2000 and updated in 2010. OBJECTIVES To evaluate the effectiveness and safety of graduated compression stockings in preventing DVT in various groups of hospitalised patients. SEARCH METHODS For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched March 2014) and CENTRAL (2014, Issue 2). SELECTION CRITERIA Randomised controlled trials (RCTs) involving GCS alone; or GCS used on a background of any other DVT prophylactic method. Results from both these groups of trials were combined in this update. DATA COLLECTION AND ANALYSIS For this update one review author (AS) extracted the data. These were cross-checked and authenticated by a second author (MJD). Two review authors (AS and MJD) assessed the quality of trials. Disagreements were resolved by discussion. MAIN RESULTS Nineteen RCTs were identified involving 1681 individual patients and 1064 individual legs (2745 analytic units). Of these 19 trials, nine included patients undergoing general surgery, six included patients undergoing orthopaedic surgery, and only one trial included medical patients. Graduated compression stockings were applied on the day before surgery or on the day of surgery and were worn up until discharge or until the patients were fully mobile. In the majority of the included studies DVT was identified by the radioactive I(125) uptake test. Overall, included studies were of good quality.In the treatment group (GCS) of 1391 units 126 developed DVT (9%) in comparison to the control group (without GCS) of 1354 units where 282 (21%) developed DVT. The Peto odds ratio (OR) was 0.33 (95% confidence interval (CI) 0.26 to 0.41) with an overall effect favouring treatment with GCS (P < 0.00001).Based on results from eight included studies, the incidence of proximal DVT was 7 of 517 (1%) units in the treatment group and 28 of 518 (5%) units in the control group. The Peto OR was 0.26 (95% CI 0.13 to 0.53) with an overall effect favouring treatment with GCS (P = 0.0002). Based on results from five included studies, the incidence of PE was 5 of 283 (2%) participants in the treatment group and 14 of 286 (5%) in the control group. The Peto OR was 0.38 (95% CI 0.15 to 0.96) with an overall effect favouring treatment with GCS (P = 0.04). Limited data were available to accurately assess the incidence of adverse effects and complications with the use of GCS. AUTHORS' CONCLUSIONS GCS are effective in diminishing the risk of DVT in hospitalised patients, with strong evidence favouring their use in general and orthopaedic surgery. However, evidence for their effectiveness in medical patients is limited to one trial.

[1]  M. Gao,et al.  [Prophylactic use of low molecular weight heparin in combination with graduated compression stockings in post-operative patients with gynecologic cancer]. , 2014, Zhonghua zhong liu za zhi [Chinese journal of oncology].

[2]  C. Heras-Palou,et al.  GRADED COMPRESSION STOCKINGS FOR PREVENTION OF DEEP-VEIN THROMBOSIS AFTER HIP AND KNEE REPLACEMENT , 1996 .

[3]  P. Davis Prevention and Management of Hip Fractures in Older People (Scottish Intercollegiate Guidelines Network January 2002) , 2002 .

[4]  L. Norgren,et al.  Graduated compression stockings in the prevention of deep vein thrombosis in patients with acute myocardial infarction. , 1993, European heart journal.

[5]  P. Wille-Jørgensen [Low-dosage heparin combined with either dihydroergotamine or graduated supportive stockings. Combined prevention of thrombosis in colonic surgery]. , 1986, Ugeskrift for laeger.

[6]  G. Moser,et al.  [Prophylaxis of Post-operative deep venous thrombosis using small sub-cutaneous heparin doses, associated or not with compressive stockings: comparative study and results (author's transl)]. , 1976, Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis.

[7]  Douglas G. Altman,et al.  Statistical Methods for Examining Heterogeneity and Combining Results from Several Studies in Meta‐Analysis , 2008 .

[8]  K. Lees,et al.  Randomized trial of graded compression stockings for prevention of deep-vein thrombosis after acute stroke. , 2000, QJM : monthly journal of the Association of Physicians.

[9]  Britton Ke,et al.  Letter: E.M.I. and radioisotope brain imaging. , 1976 .

[10]  G. Turner,et al.  The efficacy of graduated compression stockings in the prevention of deep vein thrombosis after major gynaecological surgery , 1984, British journal of obstetrics and gynaecology.

[11]  I. Brenkel,et al.  The use of graduated compression stockings in association with fondaparinux in surgery of the hip A MULTICENTRE, MULTINATIONAL, RANDOMISED, OPEN-LABEL, PARALLEL-GROUP COMPARATIVE STUDY , 2007 .

[12]  W. Hein,et al.  Prevention of deep-vein thrombosis after total hip and knee replacement. Low-molecular-weight heparin in combination with intermittent pneumatic compression. , 2004, The Journal of bone and joint surgery. British volume.

[13]  L P Le Quesne,et al.  The efficacy of graduated compression stockings in the prevention of deep vein thrombosis , 1977, The British journal of surgery.

[14]  P. Sandercock,et al.  The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials , 2011, Journal of thrombosis and haemostasis : JTH.

[15]  J. B. Richards,et al.  Effect of Externally Applied Pressure on Femoral Vein Blood Flow , 1970, British medical journal.

[16]  B. Lindblad,et al.  Thromboprophylaxis in hip arthroplasty. Dextran with graded compression or preoperative dextran compared in 150 patients. , 1989, Acta orthopaedica Scandinavica.

[17]  G. Guyatt,et al.  Grading quality of evidence and strength of recommendations , 2004, BMJ : British Medical Journal.

[18]  H. Potter,et al.  Effect of Mechanical Compression on the Prevalence of Proximal Deep Venous Thrombosis as Assessed by Magnetic Resonance Venography , 2002, The Journal of bone and joint surgery. American volume.

[19]  H. Yanar,et al.  [Venous thromboembolism prophylaxis methods in trauma and emergency surgery intensive care unit patients: low molecular weight heparin versus elastic stockings + intermittent pneumatic compression]. , 2010, Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES.

[20]  I. Olkin,et al.  Improving the quality of reporting of randomized controlled trials. The CONSORT statement. , 1996, JAMA.

[21]  I. Thompson,et al.  A prospective comparison of thromboembolic stockings, external sequential pneumatic compression stockings and heparin sodium/dihydroergotamine mesylate for the prevention of thromboembolic complications in urological surgery. , 1991, The Journal of urology.

[22]  J. Hirsh,et al.  125I-Fibrinogen Leg Scanning: Reassessment of Its Role for the Diagnosis of Venous Thrombosis in Post-Operative Patients , 1993, Thrombosis and Haemostasis.

[23]  M. Sakon,et al.  Darexaban (YM150) prevents venous thromboembolism in Japanese patients undergoing major abdominal surgery: Phase III randomized, mechanical prophylaxis-controlled, open-label study. , 2012, Thrombosis research.

[24]  Nelson Ld,et al.  Deep vein thrombosis in lumbar spinal fusion: a prospective study of antiembolic and pneumatic compression stockings. , 1996 .

[25]  D. Steinemann,et al.  RUNX1 Mutations Are the Most Frequent Leukemia Associated Mutations in Congenital Neutropenia Patients , 2012 .

[26]  M. Borow,et al.  Postoperative venous thrombosis. Evaluation of five methods of treatment. , 1981, American journal of surgery.

[27]  Jie Gao,et al.  Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery: a prospective, randomised study. , 2012, Chinese medical journal.

[28]  M. Tsapogas,et al.  Postoperative venous thrombosis and the effectiveness of prophylactic measures. , 1971, Archives of surgery.

[29]  D. Bergqvist,et al.  Clinical relevance of the fibrinogen uptake test in patients undergoing elective general abdominal surgery--relation to major thromboembolism and mortality. Fragmin Multicentre Study Group. , 1995, Thrombosis research.

[30]  A. Sachdeva,et al.  Elastic compression stockings for prevention of deep vein thrombosis. , 2010, The Cochrane database of systematic reviews.

[31]  R. Collins,et al.  Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. , 2005, Health technology assessment.

[32]  K. Inada,et al.  Postoperative deep venous thrombosis in Japan. Incidence and prophylaxis. , 1983, American journal of surgery.

[33]  M. McNally,et al.  Graduated Compression Stockings: Knee Length or Thigh Length , 2001, Clinical orthopaedics and related research.

[34]  J. Bosson,et al.  Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study , 2005, Journal of thrombosis and haemostasis : JTH.

[35]  E. Oger,et al.  Prevention of venous thrombosis in patients with acute intracerebral hemorrhage , 2005, Neurology.

[36]  W. Edwards,et al.  Elastic compression in the prevention of venous stasis. A critical reevaluation. , 1976, American journal of surgery.

[37]  H. Forta,et al.  Prevention of Deep Venous Thrombosis and Pulmonary Embolism in Patients With Acute Intracerebral Hemorrhage , 2009, The neurologist.

[38]  C. Holford Graded compression for preventing deep venous thrombosis. , 1976, British medical journal.

[39]  M. Sajid,et al.  Knee length versus thigh length graduated compression stockings for prevention of deep vein thrombosis in postoperative surgical patients. , 2012, The Cochrane database of systematic reviews.

[40]  R. Body,et al.  The Anticoagulation of Calf Thrombosis (ACT) project: study protocol for a randomized controlled trial , 2012, Trials.

[41]  O. Simonsen,et al.  Prevention of postoperative deep venous thrombosis. Low-dose heparin versus graded pressure stockings. , 1985, Acta chirurgica Scandinavica.

[42]  W. Zeng,et al.  [The efficacy of intermittent pneumatic compression in the prevention of venous thromboembolism in medical critically ill patients]. , 2011, Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue.

[43]  D. Bergqvist,et al.  Diagnosis of deep vein thrombosis , 1990, World Journal of Surgery.

[44]  D. Lamping,et al.  Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. , 2008, Annals of internal medicine.

[45]  M. Borow,et al.  Prevention of postoperative deep venous thrombosis and pulmonary emboli with combined modalities. , 1983, The American surgeon.

[46]  K. Morley,et al.  Deep venous thrombosis after total hip arthroplasty: A prospective controlled study to determine the prophylactic effect of graded pressure stockings , 1981, The British journal of surgery.

[47]  S. Törngren Low dose heparin and compression stockings in the prevention of postoperative deep venous thrombosis , 1980, The British journal of surgery.

[48]  K. Manella,et al.  Comparing the effectiveness of elastic bandages and shrinker socks for lower extremity amputees. , 1981, Physical therapy.

[49]  J. Marescaux,et al.  [Importance of elastic compression of the lower limbs in the prevention of venous thrombosis in digestive surgery]. , 1981, Phlebologie.

[50]  E. Horváth-Puhó,et al.  30-Year Mortality After Venous Thromboembolism: A Population-Based Cohort Study , 2014, Circulation.

[51]  Y. Wilson,et al.  Influence of compression stockings on lower‐limb venous haemodynamics during laparoscopic cholecystectomy , 1994, The British journal of surgery.

[52]  C. Ibarra-Pérez,et al.  Prevalence and Prevention of Deep Venous Thrombosis of the Lower Extremities in High-Risk Pulmonary Patients , 1988, Angiology.

[53]  J. Caprini,et al.  Thrombosis Prophylaxis Using External Compression , 1983, Thrombosis and Haemostasis.

[54]  Peter Martin,et al.  The failure of compression stockings (tubigrip) to prevent deep venous thrombosis after operation , 1970, The British journal of surgery.

[55]  P. Prandoni,et al.  Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. , 2008, Annals of internal medicine.

[56]  T. Ioka,et al.  Femoral vein stasis during laparoscopic cholecystectomy: effects of graded elastic compression leg bandages in preventing thrombus formation. , 1995, Gastrointestinal endoscopy.

[57]  R. Ramos,et al.  The efficacy of pneumatic compression stockings in the prevention of pulmonary embolism after cardiac surgery. , 1996, Chest.

[58]  H. Büller,et al.  Low Molecular Weight Heparin and Compression Stockings in the Prevention of Venous Thromboembolism in Neurosurgery , 1996, Thrombosis and Haemostasis.

[59]  P. Sandercock,et al.  Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial , 2009, The Lancet.

[60]  P Prandoni,et al.  Prevention and treatment of venous thromboembolism--International Consensus Statement. , 2013, International angiology : a journal of the International Union of Angiology.

[61]  P. Wille-Jørgensen,et al.  Prophylaxis of deep venous thrombosis after acute abdominal operation. , 1991, Surgery, gynecology & obstetrics.

[62]  M. O’Donnell,et al.  Randomized controlled trial of a new portable calf compression device (Venowave) for prevention of venous thrombosis in high‐risk neurosurgical patients , 2012, Journal of thrombosis and haemostasis : JTH.

[63]  N. Lo,et al.  Thromboembolic Prophylaxis for Total Knee Arthroplasty in Asian Patients: A Randomised Controlled Trial , 2009, Journal of orthopaedic surgery.

[64]  S. Young,et al.  Foot pumps without graduated compression stockings for prevention of deep-vein thrombosis in total joint replacement: efficacy, safety and patient compliance , 2008, International Orthopaedics.

[65]  T. Sculco,et al.  Prophylaxis against Deep Venous Thrombosis after Total Knee Arthroplasty. Pneumatic Plantar Compression and Aspirin Compared with Aspirin Alone* , 1996, The Journal of bone and joint surgery. American volume.

[66]  B. Lindblad,et al.  The thromboprophylactic effect of graded elastic compression stockings in combination with dextran 70. , 1984, Archives of surgery.

[67]  F. Regan,et al.  Deep venous thrombosis prophylaxis with low molecular weight heparin and elastic compression in patients having total hip replacement. A randomised controlled trial. , 1996, International angiology : a journal of the International Union of Angiology.

[68]  J. Jespersen,et al.  Venous thrombosis after abdominal surgery. A comparison between subcutaneous heparin and antithrombotic stockings, or both. , 1988, Journal of medicine.

[69]  Joan S. Reisch,et al.  Prevention of Venous Thromboembolism in General Surgical Patients: Results of Meta‐analysis , 1988, Annals of surgery.

[70]  D. Negus,et al.  Thigh length versus knee length stockings in the prevention of deep vein thrombosis , 1989, The British journal of surgery.

[71]  G. Mellbring,et al.  Prophylaxis of deep vein thrombosis after major abdominal surgery. Comparison between dihydroergotamine-heparin and intermittent pneumatic calf compression and evaluation of added graduated static compression. , 1986, Acta chirurgica Scandinavica.

[72]  V. Aboyans,et al.  Intermittent pneumatic compression to prevent venous thromboembolism in patients with high risk of bleeding hospitalized in intensive care units: the CIREA1 randomized trial , 2013, Intensive Care Medicine.

[73]  J. Hirsh,et al.  Prevention of deep vein thrombosis in potential neurosurgical patients. A randomized trial comparing graduated compression stockings alone or graduated compression stockings plus intermittent pneumatic compression with control. , 1989, Archives of internal medicine.

[74]  V. Kakkar,et al.  POSTOPERATIVE DEEP-VEIN THROMBOSIS: EFFECT OF INTENSIVE PROPHYLAXIS , 1969 .

[75]  C. Ohlund,et al.  Calf compression for prevention of thromboembolism following hip surgery. , 1983, Acta orthopaedica Scandinavica.

[76]  M. Sağlam,et al.  A randomised clinical trial comparing the patient comfort and efficacy of three different graduated compression stockings in the prevention of postoperative deep vein thrombosis. , 2015, Journal of clinical nursing.

[77]  A. Cohen,et al.  The use of graduated compression stockings in association with fondaparinux in surgery of the hip. A multicentre, multinational, randomised, open-label, parallel-group comparative study. , 2007, The Journal of bone and joint surgery. British volume.

[78]  Graeme J. Hankey Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial , 2009 .

[79]  A. Nicolaides,et al.  Effect of lightweight compression stockings on venous haemodynamics. , 1997, International angiology : a journal of the International Union of Angiology.

[80]  P. Wille-Jørgensen,et al.  Heparin with and without graded compression stockings in the prevention of thromboembolic complications of major abdominal surgery: A randomized trial , 1985, The British journal of surgery.

[81]  R. Wilkins,et al.  Elastic stockings in the prevention of pulmonary embolism; a preliminary report. , 1952, The New England journal of medicine.

[82]  G. Belcaro,et al.  Prophylaxis of Recurrent Deep Venous Thrombosis. A Randomized, Prospective Study Using Indobufen and Graduated Elastic Compression Stockings , 1993, Angiology.

[83]  J. Hasty,et al.  Regimen for improved effectiveness of intermittent pneumatic compression in deep venous thrombosis prophylaxis. , 1987, Surgery.

[84]  J. Williams,et al.  The use of graduated compression stockings in the prevention of postoperative deep vein thrombosis , 1983, The British journal of surgery.

[85]  Valerie Beral,et al.  Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study , 2009, BMJ : British Medical Journal.