An updated systematic review and meta-analysis of the impact of graduated compression stockings in addition to pharmacological thromboprophylaxis for prevention of venous thromboembolism in surgical inpatients
Author(s)
Type
Journal Article
Abstract
Objective:
To compare the rate of venous thromboembolism (VTE) in surgical inpatients with pharmacological thromboprophylaxis and additional graduated compression stockings (GCSs) versus pharmacological thromboprophylaxis alone.
Background:
Surgical inpatients have elevated VTE risk; recent studies cast doubt on whether GCS confers additional protection against VTE, compared with pharmacological thromboprophylaxis alone.
Methods:
The review followed “Preferred Reporting Items for Systematic Reviews and Meta-analyses” guidelines using a registered protocol (CRD42017062655). The MEDLINE and Embase databases were searched up to November 2022. Randomized trials reporting VTE rate after surgical procedures, utilizing pharmacological thromboprophylaxis, with or without GCS, were included. The rates of deep venous thrombosis (DVT), pulmonary embolism, and VTE-related mortality were pooled through fixed and random effects.
Results:
In a head-to-head meta-analysis, the risk of DVT for GCS and pharmacological thromboprophylaxis was 0.85 (95% CI: 0.54–1.36) versus for pharmacological thromboprophylaxis alone (2 studies, 70 events, 2653 participants). The risk of DVT in pooled trial arms for GCS and pharmacological thromboprophylaxis was 0.54 (95% CI: 0.23–1.25) versus pharmacological thromboprophylaxis alone (33 trial arms, 1228 events, 14,108 participants). The risk of pulmonary embolism for GCS and pharmacological prophylaxis versus pharmacological prophylaxis alone was 0.71 (95% CI: 0.0–30.0) (27 trial arms, 32 events, 11,472 participants). There were no between-group differences in VTE-related mortality (27 trial arms, 3 events, 12,982 participants).
Conclusions:
Evidence from head-to-head meta-analysis and pooled trial arms demonstrates no additional benefit for GCS in preventing VTE and VTE-related mortality. GCS confer a risk of skin complications and an economic burden; current evidence does not support their use for surgical inpatients.
To compare the rate of venous thromboembolism (VTE) in surgical inpatients with pharmacological thromboprophylaxis and additional graduated compression stockings (GCSs) versus pharmacological thromboprophylaxis alone.
Background:
Surgical inpatients have elevated VTE risk; recent studies cast doubt on whether GCS confers additional protection against VTE, compared with pharmacological thromboprophylaxis alone.
Methods:
The review followed “Preferred Reporting Items for Systematic Reviews and Meta-analyses” guidelines using a registered protocol (CRD42017062655). The MEDLINE and Embase databases were searched up to November 2022. Randomized trials reporting VTE rate after surgical procedures, utilizing pharmacological thromboprophylaxis, with or without GCS, were included. The rates of deep venous thrombosis (DVT), pulmonary embolism, and VTE-related mortality were pooled through fixed and random effects.
Results:
In a head-to-head meta-analysis, the risk of DVT for GCS and pharmacological thromboprophylaxis was 0.85 (95% CI: 0.54–1.36) versus for pharmacological thromboprophylaxis alone (2 studies, 70 events, 2653 participants). The risk of DVT in pooled trial arms for GCS and pharmacological thromboprophylaxis was 0.54 (95% CI: 0.23–1.25) versus pharmacological thromboprophylaxis alone (33 trial arms, 1228 events, 14,108 participants). The risk of pulmonary embolism for GCS and pharmacological prophylaxis versus pharmacological prophylaxis alone was 0.71 (95% CI: 0.0–30.0) (27 trial arms, 32 events, 11,472 participants). There were no between-group differences in VTE-related mortality (27 trial arms, 3 events, 12,982 participants).
Conclusions:
Evidence from head-to-head meta-analysis and pooled trial arms demonstrates no additional benefit for GCS in preventing VTE and VTE-related mortality. GCS confer a risk of skin complications and an economic burden; current evidence does not support their use for surgical inpatients.
Date Issued
2024-01
Date Acceptance
2023-09-01
Citation
Annals of Surgery, 2024, 279 (1), pp.29-36
ISSN
0003-4932
Publisher
Lippincott, Williams & Wilkins
Start Page
29
End Page
36
Journal / Book Title
Annals of Surgery
Volume
279
Issue
1
Copyright Statement
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
License URL
Identifier
https://journals.lww.com/annalsofsurgery/fulltext/2024/01000/an_updated_systematic_review_and_meta_analysis_of.7.aspx
Subjects
deep vein thrombosis
DEEP-VEIN THROMBOSIS
DOUBLE-BLIND
ENOXAPARIN
FACTOR-XA INHIBITOR
graduated compression stockings
KNEE REPLACEMENT SURGERY
Life Sciences & Biomedicine
MAJOR ABDOMINAL-SURGERY
MOLECULAR-WEIGHT HEPARIN
pharmacological prophylaxis
PROPHYLAXIS
pulmonary embolism
Science & Technology
Surgery
THIGH-LENGTH
thromboprophylaxis
TOTAL HIP-ARTHROPLASTY
venous thromboembolism
Publication Status
Published
Date Publish Online
2023-09-27