DVT prophylaxis: graded compression stockings and heparin were better than heparin alone.

Clinical bottom line (level 1b)

  1. Patients having major abdominal surgery who were considered high risk for venous thromboembolism, had fewer with graded compression stockings and heparin than with heparin alone (NNT = 10 at 7 days) .
Wille-Jorgensen et al: British Journal of Surgery 1985; 72: 579-581
Expires May 2003

The study

Unblinded concealed randomised trial without intention-to-treat
Setting: university hospital, Denmark

176 patients (aged range 36 to 90 years; mean 60, 60% male) having elective major abdominal surgery (colorectal, biliary, gastric, pancreatic) and considered at risk for venous thromboembolism. Risk factors: one or more of
  • older than 39
  • suspected cancer
  • weight >19% normal
  • varicose veins of lower extremities
  • diabetes mellitus
  • hypertension
  • prior venous thromboembolism
  • heart failure


Excluded if
  • liver disease with coagulation factor II, VII, X <40% normal
  • on anticoagulant therapy
  • peripheral arterial insufficiency
  • iodine allergy


    • Control Group: (n = 102, 90 analysed): heparin 5000 units subcutaneously twice daily one hour pre-op, then for seven days or until discharge
    Experimental Group: (n = 94, 86 analysed): heparin as above, plus thigh-length graded elasticated stockings worn day and night
    All patients had I-125 leg scans on day 1, 3, 5, 7 post-op. If abnormal, had venogram bilaterally and a v/q scan (positive if a focal perfusion deficit seen).
    90% followed for 7 days

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    venous thromboembolism 7 days 11
    (12.2%)    		 2
    (2.33%)    		 81%
    (17% to 96%)    		 9.90%
    (2.42% to 17.4%)    		 10
    (6 to 41)

    Comments

    1. I-125 scan is insensitive- some DVTs may have been missed.

    Citation

    1. Wille-Jorgensen P, Thorup J, Fischer A, et al: Heparin with and without graded compression stockings in the prevention of thromboembolic complications of major abdominal surgery: a randomized trial. British Journal of Surgery 1985; 72: 579-581
    Contributor: Chris Ball and Clare Wotton, May 2000
    Reviewer: Alex Gallus

    Clinical Question.
    Patient elective major abdominal surgery
    Intervention or Exposure heparin plus stockings
    Comparison heparin
    Outcome venous thromboembolism