The efficacy of graduated compression stockings in the prevention of deep vein thrombosis

Scurr, J. H.; Şehitoğlu, İbrahim; Faber, Richard; Quesne, L. P. Le

doi:10.1002/bjs.1800640521

Cited by 100 publications

(31 citation statements)

References 17 publications

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“…Eight RCTs compared GCSs alone with no stockings; the incidence of DVT was statistically significantly lower in the stocking group than in the no stockings group. [22][23][24][25][26][27][28][29] Ten RCTs compared GCSs plus another prophylactic method versus the prophylactic method alone; the incidence of DVT was statistically significantly lower in the stocking plus other prophylactic method group than in the other prophylactic alone group. [30][31][32][33][34][35][36][37][38][39] The authors concluded that GCSs are effective at diminishing the risk of DVT in hospitalised patients.…”

Section: Cochrane Review: Elastic Compression Stockings For Preventiomentioning

confidence: 99%

Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

Wade

Sideris

Paton

et al. 2015

Health Technol Assess

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BackgroundDeep-vein thrombosis (DVT) can occur in surgical patients. Routine prophylaxis can be pharmacological and/or mechanical [e.g. graduated compression stockings (GCSs)]. GCSs are available in knee length or thigh length.ObjectiveTo establish the expected value of undertaking additional research addressing the relative effectiveness of thigh-length GCSs versus knee-length GCSs, in addition to pharmacoprophylaxis, for prevention of DVT in surgical patients.DesignSystematic review and economic model, including value of information (VOI) analysis.Review methodsRandomised controlled trials (RCTs) assessing thigh- or knee-length GCSs in surgical patients were eligible for inclusion. The primary outcome was incidence of DVT. DVT complications and GCSs adverse events were assessed. Random-effects meta-analysis was performed. To draw on a wider evidence base, a random-effects network meta-analysis (NMA) was undertaken for the outcome DVT. A review of trials and observational studies of patient adherence was also conducted. A decision-analytic model was developed to assess the cost-effectiveness of thigh- and knee-length GCSs and the VOI.ResultsTwenty-three RCTs were included in the review of effectiveness. There was substantial variation between trials in terms of the patient characteristics, interventions and methods of outcome assessment. Five trials comparing knee-length with thigh-length GCSs with or without pharmacoprophylaxis were pooled; the summary estimate of effect indicated a non-significant trend favouring thigh-length GCSs [odds ratio (OR) 1.48, 95% confidence interval (CI) 0.80 to 2.73]. Thirteen trials were included in the NMA. In the base-case analysis, thigh-length GCSs with pharmacoprophylaxis were more effective than knee-length GCSs with pharmacoprophylaxis (knee vs. thigh OR 1.76, 95% credible interval 0.82 to 3.53). Overall, thigh-length stockings with pharmacoprophylaxis was the most effective treatment, with a 0.73 probability of being the most effective treatment in a new trial of all the treatments. Patient adherence was generally higher with knee-length GCSs, and patients preferred knee-length GCSs. Thigh-length GCSs were found to be cost-effective in all but the subgroup with the lowest baseline risk, although the absolute differences in costs and effects were relatively small. The expected value of perfect information ranged from £0.2M to £178.0M depending on the scenario and subgroup. The relative effect parameters had the highest expected value of partial perfect information and ranged from £2.0M to £39.4M. The value of further research was most evident in the high-risk subgroups.LimitationsThere was substantial variation across the included trials in terms of patient and intervention characteristics. Many of the included trials were old and poorly reported, which reduces the reliability of the results of the review.ConclusionsGiven that the results from both the standard meta-analysis and the NMA lacked precision (CIs were wide) owing to the heterogeneous evidence base, a new definitive trial in high-risk patients may be warranted. However, the efficiency of any further research (i.e. whether this represents value for money) is dependent on several factors, including the acquisition price of GCSs, expected compliance with thigh-length GCSs wear, and whether or not uncertainty can be resolved around possible effect modifiers, as well as the feasibility and actual cost of undertaking the proposed research.Study registrationThis study is registered as PROSPERO CRD42014007202.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Cochrane Review: Elastic Compression Stockings For Preventiomentioning

confidence: 99%

Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

Wade

Sideris

Paton

et al. 2015

Health Technol Assess

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“…A postal survey of orthopaedic surgeons in the UK showed that 68% used graded compression stockings as prophylaxis for DVT (Laverick, Croal and Mollan 1991). Their efficacy has been well documented in abdominal surgery (Holford 1976;Scurr et al 1977;Allan et al 1983;Turner, Cole and Brooks 1984;Wille-Jorgensen et al 1985;Jeffery and Nicolaides 1990), but there is little information on their use in orthopaedic surgery (Barnes et al 1978;Ishak and Morley 1981;Ohlund, Fransson and Starck 1983).…”

Section: Graded Compression Stockings For Prevention Of Deep-vein Thrmentioning

confidence: 99%

Graded Compression Stockings for Prevention of Deep-Vein Thrombosis After Hip and Knee Replacement

Hui

Heras-Palou

Dunn

et al. 1996

The Journal of Bone and Joint Surgery. British volume

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We performed a prospective, randomised controlled trial in 177 patients who were having either total hip or knee replacement, to evaluate the use of both above-and below-knee graded compression stockings in the prevention of deep-vein thrombosis (DVT).With above-knee stockings, we found no significant reduction of the overall, proximal or major calf (> 5 cm) DVT rates. With below-knee stockings, the overall thrombosis rate was similar to that of the control group but the stockings appeared to have altered the pattern of thrombosis. Patients who had total hip replacement and wore below-knee stockings had a significantly higher rate of proximal or major calf DVT (p = 0.03). This pattern was reversed in patients with total knee replacement who developed a significantly lower rate of proximal or major calf DVT with below-knee stockings (p < 0.05).Our results showed that, with the exception of below-knee stockings in knee replacement patients, graded compression stockings were ineffective in preventing DVT after hip or knee replacement surgery.

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“…The general application of two non-specific and rather insensitive methods for DVT and AD exclusion by the combination of a negative SimpliRed (Simplify) and low clinical score should be estimated as not safe enough mainly because the prevalence of DVT in the low clinical score group may vary widely (3% to 12%) [48,65]. According to our experiences and analysis of literature findings [48,73] the safest and most effective and sensitive approach for DVT and AD exclusion is to start with objective testing with CCUS, followed by a qualitative or less sensitive D-dimer test without the use or need of clinical score assessment (Figures 4 and 7). A first negative CCUS and a negative ELISA VIDAS test (<500 ug/mL) excludes DVT irrespective of clinical score assessment (left arm, Figure 7).…”

Section: Ccus D-dimer and Clinical Score Strategy To Rule In And Outmentioning

confidence: 99%

“…In acute DVT patients (21,41,73,74 MECS may also be used for symptomaticrelief of swollen acute DVT legs combined with low-molecular weight heparins (LMWH) followed by vitamin K antogonists (VKA) or novel oral anticoagulants (NOACs). Pneumatic compression therapy has been proved to be effective, but is probably only realistic in post-operative circumstances, and it has shown to be effective in for example elective knee or hip replacement [21,41,74].…”

Section: Management Of Dvt In the Primary Care And Hospital Settingmentioning

confidence: 99%

Complete Compression Ultrsonography, Clinical Score, Underlying Risk

Michiels¹,

Strijkers²,

Michiels³

et al. 2015

J Hematol Thrombo Dis

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Primary Superficial Thrombophlebitis (SVT)The incidence of superficial thrombophlebitis (SVT) is approximately 1.6 per 1000 persons per year. Several studies have confirmed the association of SVT and VTE. In a systematic review of patients with SVT, 6% to 44% of cases was associated with deep vein thrombosis (DVT), 20% to 33% with asymptomatic pulmonary embolism (PE) and 2% to 13% with symptomatic PE. Assessment of risk factor in the MEGA study a history of clinical SVT was associated with a 6.3-fold risk of DVT and a 3.9 risk of PE. In a study of 263 SVT patients, 30 (11.4%) developed DVT. Among 125 patients with SVT located in the great saphena vein, 16.8% developed DVT. Out of 138 patients with isolated SVT below the knee only 4.5% developed DVT. In a lower limb ultrasound study in 2646 patients 36 (9.3%) of the patients had combined DVT and PTS. These data indicate that primary SVT should be considered an integral part of DVT. The presence of inherited hypercoagulability or venous thrombophilia in both SVT and DVT strongly supports a similar etiology and pathphysiology. In… patients with primar SVT hereditary protein C and s deficiency was detected in 6.45% in the absence of DVT and in 62.5% in SVT patient who had developed DVT. In our experience hereditary heterozygous antithrombin defiencoiency (AT) is associated with a high risk on DVT and PE not preceded by SVT. Congenital protein C (PC) or protein S (PS) deficiency in 27 DVT patients (15 males, 12 females) in 6 unrelated Dutch families had a history of SVT 19 cases (70%) as the hall mark of congenital PC/PS deficiency. The prevalence of FV Leiden, FII A20210 mutation, and PC or PS deficiency in 63 evaluated SVT patients was 16%, 906% and 10% respectively (total 36%) as compared to 3%, 2.4% and 0.6% in 537 controls. The incidence of inherited thrombophilic risk factors in patients with a first DVT is high (31%) as compared to 5 to 6% in the general population (Table 1). In 1668 patients with a first DVT in the Leiden prospective study the incidence of congenital thrombophilia was 25%. In this study 417 (25%) of 1668 patients with a first DVT were on oral contraceptives below the age of 50 years. In 400 Czech young women with VTE on oral contraceptives (distal DVT 58%, proximal DVT 16%, PE 5%, thrombosis at unusual sites 20%) inherited thrombophilia was diagnosed in 195 (49%): FV Leiden 35% FIIA20210 mutation 5%,AT,PC PS deficiency 3.6% and antiphopholipid syndrome 5.3%. We conclude that thrombophilia screening is manadatory in SVT and DVT patients and in women on contraceptive pills in particular for the education of clinicians abling them to much better counsel their SVT and DVT patients and their relatives. AbstractSuperficial vein thrombosis is an integral part of venous thromboembolism (VTE) together with deep vein thrombosis (DVT) and pulmonary embolism (PE). The incidence of SVT is 1.6 per 1000 persons per year. The incidence of DVT is about 1.0 per 1000 persons per year in the general population, 1.8 per 1000 persons per year at age 65 to 69 years...

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The efficacy of graduated compression stockings in the prevention of deep vein thrombosis

Cited by 100 publications

References 17 publications

Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

Graded Compression Stockings for Prevention of Deep-Vein Thrombosis After Hip and Knee Replacement

Complete Compression Ultrsonography, Clinical Score, Underlying Risk

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