Elastic Compression Stockings for Prevention of Deep Vein Thrombosis
One of the settings where deep vein thrombosis (DVT) in the lower limb and pelvic veins occurs is in hospital with prolonged immobilization 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 2003. The objective of this review is to determine the magnitude of effectiveness of GCS in preventing DVT in various groups of hospitalized patients.
For this update the Cochrane Peripheral Vascular Diseases Group searched their Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 4) for randomized controlled trials of elastic or graduated compression stockings for prevention of DVT.
The main results revealed eighteen RCTs were identified. GCS 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. For GCS alone, eight RCTs were identified involving 1279 analytic units (887 patients). In the treatment group (GCS), of 662 units, 86 developed DVT (13%) in comparison to the control group (without GCS) of 617 units where 161 (26%) developed DVT. The odds ratio (OR) was 0.35 (95% confidence interval (CI) 0.26 to 0.47) with an overall effect favoring treatment with GCS (P < 0.00001). For GCS on a background of another prophylactic method, 10 RCTs were identified involving 1248 analytic units (576 patients). In the treatment group (GCS plus another method), of 621 units, 26 (4%) developed DVT, in the control group (the other method alone), of 627 units, 99 (16%) developed DVT (OR 0.25, 95% CI 0.17 to 0.36). The overall effect also favored treatment with GCS on a background of another DVT prophylactic method (P < 0.00001).
The authors concluded that GCS are effective in diminishing the risk of DVT in hospitalized patients. Data examination also suggests that GCS on a background of another method of prophylaxis is more effective than GCS on its own.
REFERENCE:
Sachdeva A, Dalton M, Amaragiri SV, et al. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev. 2010 Jul 7;7:CD001484.
