A Cochrane review [Abstract] 1 included 20 studies with a total of 2 853 analytic units (1 172 individual legs and 1 681 individual patients). Ten studies included patients undergoing general surgery, 6 orthopaedic surgery, 3 individual studies included patients undergoing neurosurgery, cardiac surgery, and gynaecological surgery, respectively, and only 1 study included medical patients. Nine studies compared wearing graduated compression stockings (GCS) to no GCS and 11 compared GCS plus another method (Dextran 70, aspirin, s.c. heparin, LMWH, mechanical sequential compression) with that method alone. GCS were applied on the day before surgery or on the day of surgery and were worn up until discharge or until the patients were fully mobile. Thigh-length stockings were used in the vast majority of included studies. In the majority of the included studies DVT was identified by the radioactive I125 uptake test. Duration of follow-up ranged from 7 to 14 days.
Incidence of deep vein thrombosis (DVT), proximal DVT, and pulmonary embolism (PE) were lower in the GCS group compared to the control group (without GCS), see table T1. Subgroup analysis according to the specialty under which the participants were managed found no significant difference. The majority of participants were general surgical (52%) or orthopaedic surgery (21%) patients. Subgroup analysis comparing all surgery versus medical did not reveal any differences in DVT incidence. Combining results from studies on surgical patients found that 9.8% developed DVT in the GCS group compared to 21.2% in the control group (Peto OR 0.35, 95% CI 0.28 to 0.44; 19 studies, n=2 693).Based on the results from 1 study focusing on medical patients admitted following acute myocardial infarction, 0 of 80 legs (0%) developed DVT in the GCS group compared to 8 of 80 legs (10%) in the control group (Peto OR 0.12, 95% CI 0.03 to 0.51). Limited data were available to accurately assess the incidence of adverse effects and complications with the use of GCS.
| Outcome | Relative effect (95% CI) | Risk with no GCS | Risk with GCS (95% CI) | Units/participants (Studies) |
|---|---|---|---|---|
| Deep vein thrombosis (DVT) | Peto OR 0.35(0.28 to 0.43) | 206 per 1000 | 59 per 1000(63 to 96) | 2 853(20 studies) |
| Proximal DVT | Peto OR 0.26(0.13 to 0.53) | 54 per 1000 | 15 per 1000(7 to 29) | 1 035(8 studies) |
| Pulmonary embolism* | Peto OR 0.38(0.15 to 0.96) | 49 per 1000 | 19 per 1000(8 to 47) | 569(5 studies) |
| * Follow-up: 7 to 30 days | ||||
Another Cochrane review[Abstract] 4 included 3 studies with a total of 496 subjects evaluating the role of knee length (KL) and thigh length (TL) graduated compression stockings in thromboprophylaxis among postoperative patients. In both the fixed-effect model (OR 1.55, 95% CI 0.78 to 3.07) and random-effects model (OR 1.32, 95% CI 0.43 to 4.06) KL graduated compression stockings were as effective as TL stockings in thromboprophylaxis. However, there was significant heterogeneity (I2 = 51%) among trials.
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