Deep vein thrombosis: prophylaxis: graduated compression stockings reduce DVT occurence

Clinical bottom line (level 1a)

  1. Immobilised inpatients who wear graduated compression stockings compared with nothing are less likely to develop a deep vein thrombosis (NN T = 7 at days) .
  2. Immobilised inpatients who wear stockings and receive additional DVT prophylaxis compared with the DVT prophylaxis alone are less likely to develop a deep vein thrombosis (NN T = 9 at days) .
Amarigiri and Lees: Cochrane Library 2000; 3 : -
Expires November 2003

The study

Systematic review of all randomised controlled trials of
  • Patients: hospitalised
  • Intervention: graduated compression stocking alone or with any other DVT prophylactiv method compared with no treatment or DVT prophylaxis alone
  • Outcome: deep vein thrombosis

    Articles found in using Cochrane Peripheral Vascular Disease Group trials register, Medline, Embase, (search terms: Cochrane Review Group search strategy ) and hand-searching Index Medicus. Various manufacturers and trialists were contracted.

    Selection criteria: by 1 independent reviewer and cross-checked by another: see above
    Appraisal criteria: by 1 independent reviewer and cross-checked by another: randomisation and allocation concealment
    Articles excluded if:
    • unconcealed randomisation


    16 RCTs found - 9 involving 624 patients (general surgery, orthopaedics, neurosurgery, medicine, obstetrics and gynaecology) assessed stockings alone; 7 involving 501 patients (general surgery, orthopaedics) assessed stocking plus another treatment
    • Patients wore stockings from the day before or the day of surgery until discharge or full mobility. DVT was usually diagnosed using I-125 uptake test.
    Studies assessing stockings with another prophylactic method were found to heterogenous - possibly reflecting the range of methods used (dextran 70, heparin, sequential compression).

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NN T
    (95% CI)
    stockings alone: deep vein thrombosis days 151/581
    (26.0%)    		 0.34
    (0.25 to 0.46)     		7
    (6 to 8)
    stocking + other prophylaxis: deep vein thrombosis days 74/505
    (14.7%)    		 0.24
    (0.15 to 0.37)     		9
    (8 to 12)

    Comments

    1. No study assessed patients considered at low risk for DVT, so no conclusions can be drawn for this group
    2. 5 studies compared one leg with another.

    Citation

    1. Amarigiri SV, and Lees TA: elastic compression stockings for prevention of deep vein thrombosis (Cochrane Review). Cochrane Library 2000; 3 : -
    Search Terms: thromboembol* in Cochrane Library
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient hospitalised
    Intervention or Exposure graduated compression stockings
    Comparison no treatment or DVT prophylaxis
    Outcome deep vein thrombosis
    		•