The effectiveness of graduated compression stockings for prevention of venous thromboembolism in orthopedic and abdominal surgery patients requiring extended pharmacological thromboprophylaxis
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Objectives: There is an increasing evidence base to support the use of extended pharmacological thromboprophylaxis in selected surgical patients to prevent venous thromboembolism (VTE). The benefit of graduated compression stockings (GCS) in addition to extended pharmacological thromboprophylaxis is unclear. The aim of this study was to systematically review the evidence relating to the effectiveness of using GCS in conjunction with extended pharmacological thromboprophylaxis to prevent VTE in surgical patients.
Methods: A literature search of MEDLINE, Embase, Cochrane Library and clinicaltrials.gov databases was performed in accordance with PRISMA guidelines in April 2017. The review protocol was published on PROSPERO (CRD42017062655). Randomized controlled trials (RCTs) were eligible if one of the study arms included patients receiving extended pharmacological thromboprophylaxis alone (> 21 days) or in conjunction with GCS. Data on deep vein thrombosis (DVT), pulmonary embolism (PE), and VTE-related death were compiled. Pooled proportions of the VTE rates were determined using random-effects meta-analysis.
Results: The systematic search identified 1291 studies, of which 19 studies were eligible for inclusion. No RCT directly compared extended pharmacological thromboprophylaxis alone with GCS plus extended pharmacological thromboprophylaxis. A total of 9824 patients from 16 RCTs were treated with extended pharmacological thromboprophylaxis, of whom 0.81% (95% CI 0.5-1.20) were diagnosed with symptomatic DVT and 0.2% (95% 0.12-0.36%) with PE. Three trials included 337 patients who received extended pharmacological thromboprophylaxis in conjunction with GCS. In this group, 1.61% (95% CI 0.03-5.43) had symptomatic DVT with no reported PEs. Similar VTE rates were observed when studies in orthopedic and abdominal surgery were analyzed separately.
Conclusions: There is insufficient evidence to recommend GCS in conjunction with extended pharmacological prophylaxis to prevent VTE in patients undergoing orthopedic and abdominal surgery. A clinical trial directly investigating this important subject is needed.
Methods: A literature search of MEDLINE, Embase, Cochrane Library and clinicaltrials.gov databases was performed in accordance with PRISMA guidelines in April 2017. The review protocol was published on PROSPERO (CRD42017062655). Randomized controlled trials (RCTs) were eligible if one of the study arms included patients receiving extended pharmacological thromboprophylaxis alone (> 21 days) or in conjunction with GCS. Data on deep vein thrombosis (DVT), pulmonary embolism (PE), and VTE-related death were compiled. Pooled proportions of the VTE rates were determined using random-effects meta-analysis.
Results: The systematic search identified 1291 studies, of which 19 studies were eligible for inclusion. No RCT directly compared extended pharmacological thromboprophylaxis alone with GCS plus extended pharmacological thromboprophylaxis. A total of 9824 patients from 16 RCTs were treated with extended pharmacological thromboprophylaxis, of whom 0.81% (95% CI 0.5-1.20) were diagnosed with symptomatic DVT and 0.2% (95% 0.12-0.36%) with PE. Three trials included 337 patients who received extended pharmacological thromboprophylaxis in conjunction with GCS. In this group, 1.61% (95% CI 0.03-5.43) had symptomatic DVT with no reported PEs. Similar VTE rates were observed when studies in orthopedic and abdominal surgery were analyzed separately.
Conclusions: There is insufficient evidence to recommend GCS in conjunction with extended pharmacological prophylaxis to prevent VTE in patients undergoing orthopedic and abdominal surgery. A clinical trial directly investigating this important subject is needed.
Date Issued
2018-11-01
Date Acceptance
2018-05-16
Citation
Journal of vascular surgery. Venous and lymphatic disorders, 2018, 6 (6), pp.766-777.e2
ISSN
2213-3348
Publisher
Elsevier
Start Page
766
End Page
777.e2
Journal / Book Title
Journal of vascular surgery. Venous and lymphatic disorders
Volume
6
Issue
6
Copyright Statement
© 2018 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/.
Subjects
Extended pharmacologic thromboprophylaxis
Graduated compression stockings
Venous thromboembolism
Publication Status
Published
Date Publish Online
2018-08-17