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).
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