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Evidence summaries

Physical Methods for Preventing Deep Vein Thrombosis in Stroke

Use of graduated compression stockings (GCS) may not reduce the risk of deep vein thrombosis compared to routine medical care in patients with recent stroke. Thigh-length GCS appear to be better than below-knee stockings. There is insufficient evidence on the use of intermittent pneumatic compression in such patients. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 4 studies with a total of 2 792 subjects. 2 studies (n=2 615) of thigh-length graduated compression stockings (GCS) and 2 studies (n=177) of intermittent pneumatic compression (IPC) in patients with recent stroke. The included studies compared the physical intervention + best medical treatment with best medical treatment alone. Overall, physical methods were not associated with a significant reduction in deep vein thrombosis (DVT) during the treatment period (OR 0.85, 95% CI 0.70 to 1.04; I2 =51%; 4 studies, n=2 792) or deaths (OR 1.12, 95% CI 0.87 to 1.45; 4 studies, n=2 792). Use of GCS was not associated with any significant reduction in risk of DVT (OR 0.88, 95% CI 0.72 to 1.08; statistical heterogeneity I2 =65%; 2 studies, n=2 615) or death (OR 1.13, 95% CI 0.87 to 1.47; 2 studies, n=2 615) at the end of follow up. There was not any statistically significant difference in imaging or autopsy confirmed pulmonary embolism within the first 30 days (13/1256 (1%) allocated to GCS vs. 20/1262 (1.6%) allocated to avoid GCS; OR 0.65, 95% CI 0.33 to 1.30; 1 study, n=2 518). IPC was associated with a non-significant trend towards a lower risk of DVTs (OR 0.45, 95% CI 0.19 to 1.10; 2 studies, n=177) with no evidence of an effect on deaths (OR 1.04, 95% CI 0.37 to 2.89, statistical heterogeneity I2 =57%; 2 studies, n=177).

Another RCT (CLOTS Trial 2) 2 compared thigh-length stockings with below-knee stockings in 3 114 patients with acute stroke and found fewer cases of venous thromboembolism with thigh-length than with below-knee stockings (OR 0.69, 95% CI 0.53 to 0.91). Skin breaks occurred in 3.9% in patients who received thigh-length stockings and 2.9% who received below-knee stockings.

Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies) and by imprecise results (limited study size for each comparison).

    References

    • Naccarato M, Chiodo Grandi F, Dennis M, Sandercock PA. Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev 2010;(8):CD001922. [PubMed]
    • CLOTS (Clots in Legs Or sTockings after Stroke) Trial Collaboration. Thigh-length versus below-knee stockings for deep venous thrombosis prophylaxis after stroke: a randomized trial. Ann Intern Med 2010 Nov 2;153(9):553-62. [PubMed]

Primary/Secondary Keywords