Elastic compression stockings for prevention of deep vein thrombosis

Background

One of the settings in which deep vein thrombosis (DVT) in the lower limb and pelvic veins occurs is prolonged immobilisation in hospital for various surgical and medical illnesses. Use of graduated compression stockings (GCS) in these patients has been proposed to decrease the risk of DVT.

Objectives

The objective of this review was to determine the magnitude of effectiveness of GCS in preventing DVT in various groups of hospitalised patients.

Search strategy

The reviewers searched the Cochrane Peripheral Vascular Disease Group trials register, MEDLINE, and EMBASE and handsearched Indexes Medicus. Various GCS manufacturing companies and the trialists in the ongoing trials were contacted.

Selection criteria

Randomized controlled trials (RCTs) involving:

• Graduated compression stockings alone.
• Graduated compression stockings used on a background of any other DVT prophylactic method.

Data collection and analysis

One reviewer extracted the data, assessed the quality of trials and analysed the results (SVA). This was cross-checked and authenticated by the other reviewer (TAL).

Main results

A total of 16 RCTs were identified. GCS were applied on the day before surgery or on the day of surgery. GCS were worn up until discharge or until the patients were fully mobile. In the majority of the included studies, DVT was identified by radioactive I 125 uptake test.

GCS ALONE
Seven RCTs were identified in this group involving 1027 participants. In the treatment group (GCS) of 536 patients, 81 developed DVT (15%) in comparison to the control group of 491 patients, where 144 (29%) had DVT, Peto's odds ratio 0.36 (95% confidence interval 0.26 to 0.49) with an overall effect of favouring treatment with GCS (P<0.00001).

GCS ON A BACKGROUND OF ANOTHER PROPHYLACTIC METHOD
Nine RCTs were identified in this group involving 1184 participants. In the treatment group (GCS plus another method) of 589 patients, 18 (3%) developed DVT whereas in the control group of 595 patients, 84 (14%) developed DVT [Peto's odds ratio 0.22 (95% confidence interval 0.15 to 0.34)]. Overall this also favours treatment with GCS on a background of another DVT prophylactic method (P<0.00001).

Authors' conclusions

Analysis of these RCTs confirm that GCS are effective in diminishing the risk of DVT in hospitalised patients. Data examination also suggests that GCS on a background of another method of prophylaxis is even more effective than GCS on its own.