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

Shalhoub, Joseph; Norrie, John; Baker, Christopher; Bradbury, Andrew W.; Dhillon, Karen; Everington, Tamara; Gohel, Manjit; Hamady, Zaed; Heatley, Francine; Hudson, Jemma; Hunt, Beverley J.; Lawton, Rebecca; Stansby, Gerard; Stephens-Boal, Annya; Toh, Simon; Warwick, David; Davies, Alun H.

doi:10.1016/j.ejvs.2017.02.013

Cited by 17 publications

(27 citation statements)

References 22 publications

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“…The findings of this study will probably have clinical implications on the administration of GCS in patients undergoing elective surgical procedures. Initial estimates of the annual cost of purchasing and applying GCS to surgical patients assessed as being at moderate or high risk of VTE exceeded £63m in England ($79m; €72m) 12. A substantial reduction of these costs, scaled globally and on a recurring basis, has the potential to have a major positive financial impact on hospital healthcare systems.…”

Section: Discussionmentioning

confidence: 99%

“…Between May 2016 and January 2019, we enrolled participants in this randomised, non-inferiority clinical trial at seven centres across the UK (supplementary appendix). Details of the trial design and implementation are provided in the protocol, which has been published previously 12. All participants provided written informed consent and a trial steering committee and independent data monitoring committee provided the study oversight.…”

Section: Methodsmentioning

confidence: 99%

“…We performed the graduated compression as an adjunct to pharmaco-thromboprophylaxis in surgery (GAPS) study,12 a large, pragmatic, multicentre, clinical effectiveness, two arm, parallel group, randomised controlled non-inferiority trial. In this study we evaluated the addition of GCS to LMWH for VTE prevention in patients undergoing elective surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Shalhoub

Lawton

Hudson

et al. 2020

BMJ

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ObjectivesTo investigate whether the use of graduated compression stockings (GCS) offers any adjuvant benefit when pharmaco-thromboprophylaxis is used for venous thromboembolism prophylaxis in patients undergoing elective surgery.DesignOpen, multicentre, randomised, controlled, non-inferiority trial.SettingSeven National Health Service tertiary hospitals in the United Kingdom.Participants1905 elective surgical inpatients (≥18 years) assessed as being at moderate or high risk of venous thromboembolism were eligible and consented to participate.InterventionParticipants were randomly assigned (1:1) to receive low molecular weight heparin (LMWH) pharmaco-thromboprophylaxis alone or LMWH pharmaco-thromboprophylaxis and GCS.Outcome measuresThe primary outcome was imaging confirmed lower limb deep vein thrombosis with or without symptoms, or pulmonary embolism with symptoms within 90 days of surgery. Secondary outcome measures were quality of life, compliance with stockings and LMWH, lower limb complications related to GCS, bleeding complications, adverse reactions to LMWH, and all cause mortality.ResultsBetween May 2016 and January 2019, 1905 participants were randomised. 1858 were included in the intention to treat analysis (17 were identified as ineligible after randomisation and 30 did not undergo surgery). A primary outcome event occurred in 16 of 937 (1.7%) patients in the LMWH alone group compared with 13 of 921 (1.4%) in the LMWH and GCS group. The risk difference between the two groups was 0.30% (95% confidence interval −0.65% to 1.26%). Because the 95% confidence interval did not cross the non-inferiority margin of 3.5% (P<0.001 for non-inferiority), LMWH alone was confirmed to be non-inferior.ConclusionsFor patients who have elective surgery and are at moderate or high risk of venous thromboembolism, administration of pharmaco-thromboprophylaxis alone is non-inferior to a combination of pharmaco-thromboprophylaxis and GCS. These findings indicate that GCS might be unnecessary in most patients undergoing elective surgery.Trial registrationISRCTN13911492.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Shalhoub

Lawton

Hudson

et al. 2020

BMJ

Self Cite

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“…Mechanical methods for prophylaxis include graduated elastic compression stockings and Intermittent Pneumatic Compression (IPC) devices. 29 They are of proven efficacy in preventing DVT in moderate risk surgical patients but have not been shown in clinical trials to significantly reduce the risk of fatal pulmonary embolus. Above-knee stockings are preferred to below-knee for DVT prophylaxis.…”

Section: Risk and Prophylaxis Of Venous Thromboembolismmentioning

confidence: 99%

Live kidney donor: surgical aspect and outcome

Deb¹,

Okechukwu²,

Emara³

et al. 2019

UNOAJ

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There is evidence that delayed graft function and acute rejection, can adversely influence not only the short-term but also long-term graft survival. Obviously, the risk of delayed graft function is considerably lower in living-donor transplants than in cadaver transplants. Also, the incidence of acute rejection is lower, not only in living-related transplants with a good human leukocyte antigen (HLA) match but even in living-unrelated transplants. The aim of this review was to evaluate the surgical procedures applied in live kidney donor transplantation and their outcomes with regards to global best practices. We searched for studies that reported on living kidney transplantation and kidney donor, surgical aspect and Outcome, from inception till 2018, and we preferred articles that were published in English. The following electronic databases were used: PubMed, Science Direct, Medline, Embase, Google Scholar and Cochrane database. Living kidney donor transplantation is better than kidney transplantation from a deceased donor because the transplanted kidney becomes active and functional immediately after transplantation, whereas in transplants derived from deceased donors, the reverse is usually the case due to shorter ischemic time by minimal ischemic damage of the allograft. The surgical procedures applied in live kidney donor transplantation, are constantly undergoing modification inorder to minimize postoperative complications, improve treatment outcomes and enhance patient's quality of life.

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“…10 Most recently, a large randomised-controlled trial (RCT) assessing the use of GCS in addition to low molecular weight heparin (LMWH) for the prevention of VTE in moderate and high risk elective surgical patients estimated the rate of VTE to be as low as 1.4%. 11 However, little is known about the rate of HAT in low-risk surgical patients such as those undergoing day case procedures or those only requiring a short inpatient stay, with a short general anaesthetic time or loco-regional anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Systematic review on the benefit of graduated compression stockings in the prevention of venous thromboembolism in low-risk surgical patients

et al. 2020

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Objectives The aim of this systematic review is to assess the performance of graduated compression stockings (GCS) in comparison to no venous thromboembolism (VTE) prophylaxis in the prevention of hospital-acquired thrombosis in low-risk surgical patients undergoing short-stay procedures. Methods Aligning with PRISMA guidelines, online databases MEDLINE and EMBASE, Cochrane Library® and trial registries were searched. Eligible articles reported the VTE rate in low-risk surgical patients either receiving GCS or no VTE prophylaxis. Results Narrative synthesis was performed on a single eligible article. The included study arm consisted of participants undergoing knee arthroscopy with the use of GCS alone reporting a total of 29 VTE events (4.4%), 16 of which were asymptomatic DVTs (2.4%). Conclusion There is a complete lack of evidence to support the use of GCS in the prevention of HAT for low-risk surgical patients. An adequately powered trial is required to provide level-IA evidence to support this practice.

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

Cited by 17 publications

References 22 publications

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

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

Live kidney donor: surgical aspect and outcome

Systematic review on the benefit of graduated compression stockings in the prevention of venous thromboembolism in low-risk surgical patients

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