Graduated compression stockings in hip fractures

Abstract

INTRODUCTIONHip fractures are the most common cause of acute admissions to orthopaedics and in the UK approximately 70,000–75,000 hip fractures occur annually. Hip fractures carry a significant risk of developing a venous thromboembolism. The National Institute for Health and Clinical Excellence (NICE) estimated that the risk of developing a venous thromboembolism in patients with hip fractures who do not receive thromboprophylaxis is 43%. In their recent guidelines, NICE recommended that combined mechanical and pharmacological thromboprophylaxis should be offered to patients undergoing hip fracture surgery and mechanical prophylaxis should be commenced at admission. The aim of this review was to search for available evidence that could support using graduated compression stockings combined with low molecular weight heparin (LMWH) in hip fracture patients.METHODSNICE guidelines and the reference list of the guidance were reviewed and a thorough literature search was performed on main electronic databases (MEDLINE®, Embase™ and the Cochrane Library).RESULTSA literature search was unable to find sufficient evidence to support the use of graduated compression stockings combined with LMWH in hip fracture settings. The guidelines are critically reviewed and the available evidence discussed.CONCLUSIONSThe evidence supporting these recommendations is very limited and there is considerable concern regarding the safety and efficacy of the mechanical devices used in thromboprophylaxis. Further studies are needed urgently before specific guidelines can be agreed confidently for patients with hip fractures.

The additional benefit of graduated compression stockings to pharmacologic thromboprophylaxis in the prevention of venous thromboembolism in surgical inpatients

“…Further, this review is the first to assess the levels of heterogeneity in existing RCTs investigating this topic. Alsawadi and Loeffler,8 in their review, focused only on hip fracture patients with only one included study. A recent meta-analysis by Zareba et al 20 concluded that combination thromboprophylaxis with compression and anticoagulation is more effective at preventing postoperative deep venous thrombosis than either modality alone.…”

Mechanical prophylaxis after hip fracture: what is the risk of deep vein thrombosis? A retrospective observational study

“…Evidence that this element of increased risk can be reduced by mechanical prophylaxis remains poor, 10 11 but the National Institute for Health and Care Excellence (NICE) advocates the use of mechanical measures to reduce venous stasis as part of a dual approach. 12…”

Recommendations from the ICM-VTE: Trauma

“…The goals of VTE prophylaxis within this at-risk cohort are to prevent fatal pulmonary embolism (PE) and reduce the incidence of post-VTE morbidity, both of which contribute to the significant in-hospital and one-year mortality rates [238][239][240] . Despite widespread awareness of the merits of thromboprophylaxis, variability in practice patterns persist, owing to a lack of available high-quality evidence [241][242][243][244] . As such, published clinical practice guidelines (CPG) have made efforts to highlight the standards required of healthcare providers so as to mitigate VTE risk within the hip fracture population 235,[244][245][246][247] .…”