Venous thromboembolism: graduated compression stockings reduce DVT in surgical patients.

Clinical bottom line (level 1a)

  1. The use of thigh-length graduated compression stockings reduces deep vein thrombosis in abdominal, gynaecological and neurosurgery (NNT = 8 at unknown) .
  2. The effect on patients having orthopaedic surgery is unclear.
Wells et al: Archives of Internal Medicine 1994; 154: 67-72
Expires December 2003

The study

Systematic review of randomised controlled trials of
  • Patients: undergoing surgery
  • Intervention: graduated compression stockings compared with no treatment
  • Outcome: venous thromboembolism (DVT diagnosed by blinded venography or fibrinogen I-125 leg scanning based on predefined criteria)


Articles found in all using MEDLINE, 1966 to June 1992 (search terms: clothing, bandages, thromboembolism, thrombophlebitis and postoperative complications ) and Current Contents and bibliographies of relevant papers were also searched

Selection criteria: as above
Appraisal criteria: two independent reviewers using set criteria (detailed in text)
Articles excluded if: uncompressed stockings used, unreliable tests for diagnosis of DVT, not independent or blinded interpretation of venography

12 studies were found- 11 of 1752 patients having moderate-risk non orthopaedic surgery (ie. abdominal, gynaecologic and neurosurgery). One orthopaedic study (in patients undergoing total hip replacement)
No heterogeneity was found.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
DVT in non-orthopaedic surgery unknown /
(17.6%)		 0.28
(0.23 to 0.42) 		8
(8 to 11)
DVT in orthopaedic surgery unknown /
(45.7%)		 0.50
(0.19 to 1.29) 		6
(NNT = 3 to infinity;
NNH = 16 to infinity)

Comments

  1. Individual study groups were not stratified according to individual operative risk of developing DVT.
  2. No comment was made on the effect on pulmonary embolism could be made.
  3. Majority of studies used thigh-length stockings- these results should not be applied to knee-length stockings.

Citation

  1. Wells PS, Lensing WA, Hirsh J: Graduated compression stockings in the prevention of postoperative venous thromboembolism. A meta-analysis. Archives of Internal Medicine 1994; 154: 67-72
Contributor: Chris Ball and Clare Wotton, June 2000
Reviewer:

Clinical Question.
Patient undergoing surgery
Intervention or Exposure graduated compression stockings
Comparison no treatment
Outcome VTE