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

Abstract

The additional benefit of GCS to pharmacologic thromboprophylaxis in surgical inpatients is not clear on the basis of existing data. Further clinical trials directly evaluating this clinical question are recommended.

Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): randomised controlled trial

“…This single study found no additional benefit in using GCS 11. The review concluded that quantitative comparison or drawing definitive conclusions was difficult 10…”

“…This sample was intended to have 90% power at a one sided 2.5% level of significance to detect a 3.5% non-inferiority margin (considered to be clinically important) over an assumed 6% event rate in the group randomised to LMWH and GCS; this rate was adjusted for 10% loss to follow up and the group sequential design. We derived the imaging confirmed VTE event rate of 6% from a recent systematic review that identified randomised controlled trials with arms exploring VTE outcomes in patients who had elective surgery 10. This margin was chosen because clinicians would not tolerate more than 3.5% absolute deterioration in VTE event rate over combination therapy.…”

“…A large randomised controlled trial in patients with stroke showed increased adverse events with GCS without an accompanying benefit in VTE reduction 9. In the context of elective surgery, a systematic review10 identified only one study in patients undergoing orthopaedic surgery that evaluated the benefit of GCS in addition to pharmaco-thromboprophylaxis. This single study found no additional benefit in using GCS 11.…”

Graduated Compression Stockings as an Adjunct to Low Dose Low Molecular Weight Heparin in Venous Thromboembolism Prevention in Surgery: A Multicentre Randomised Controlled Trial

“…This systematic approach to prevention of healthcare acquired thrombosis has resulted in an 8% fall in deaths due to VTE in England. 8,9 Evidence relating to graduated compression stockings in venous thromboembolism prevention Existing evidence for the additional benefit of GCS in VTE prevention is weak, and this has been highlighted by the present group 10 and others. 11,12 In addition to the limited evidence and variation in recommendations, there remains (despite guidelines) some variation in practice across England.…”

“…The rate of VTE confirmed by imaging of 6% is derived from a recent systematic review. 10 The study population comprises adult patients presenting for elective surgery at the recruiting centres. The inclusion and exclusion criteria are outlined in Table 1.…”