In the Journals

Compression stockings may be unnecessary to prevent VTE after elective surgery

Thromboprophylaxis with low-molecular-weight heparin alone appeared noninferior to thromboprophylaxis combined with graduated compression stockings for individuals at moderate or high risk for venous thromboembolism after elective surgery, according to results of a randomized study published in BMJ.

“These findings indicate that graduated compression stockings might be unnecessary in most patients undergoing elective surgery,” Joseph Shalhoub, MD, researcher in the department of surgery and cancer at Imperial College London and Imperial Vascular Unit of the Imperial College Healthcare NHS Trust, and colleagues wrote.

Guidelines recommend thromboprophylaxis in combination with graduated compression stockings for patients undergoing elective surgeries who are at moderate or high risk for VTE. Meanwhile, improvements in care and therapies have led to significant declines in VTE rates, prompting some clinicians to question the need for compression.

Shalhoub and colleagues sought to examine whether graduated compression hosiery conferred adjuvant benefit when combined with low-molecular-weight heparin (LMWH) for VTE prophylaxis among 1,858 adults undergoing elective surgery who were at moderate (15.9%) or high risk (84.1%) for a VTE event.

Researchers randomly assigned patients 1:1 to LMWH with (n = 921; median age, 58.1 years; 63.2% women) or without (n = 937; median age, 59.3 years; 63.4% women) graduated compression stockings. The most common surgical procedures included upper gastrointestinal, obstetrics and gynecology, and lower gastrointestinal surgeries.

Imaging-confirmed lower limb VTE — including deep vein thrombosis with or without symptoms or pulmonary embolism with symptoms — within 90 days of surgery served as the study’s primary endpoint. Quality of life, compliance with compression stockings and LMWH, lower limb complications associated with graduated compression stockings, bleeding complications, adverse events associated with LMWH and all-cause mortality served as secondary endpoints.

Results showed VTE occurred in 1.7% of participants who received LMWH without compression stockings compared with 1.4% of those who received both (risk difference, 0.3; 95% CI, 0.65 to 1.26).

Moreover, DVT and PE events occurred in 0.2% of participants in the LMWH-alone group vs. 0.1% of those in the LMWH-plus-compression group. Among those who underwent full lower limb duplex imaging, 1.5% in the LMWH-alone group experienced DVT without symptoms compared with 1.4% in the LMWH-plus-compression group.

Researchers cited the possibility for missed scans as the main limitation of the study.

“Noninferiority was shown across individual risk subpopulations,” Shalhoub and colleagues wrote. “If we consider the potential adverse events and cost of [graduated compression hosiery], urgent revision of national and international VTE prevention guidelines is recommended.” – by Jennifer Southall

Disclosures: The Health Technology Assessment Programme of the National Institute for Health Research (NIHR) and Imperial College London supported this study. Shalhoub reports grants from the NIHR during the conduct of this study. Please see the study for all other authors’ relevant financial disclosures.

 

Thromboprophylaxis with low-molecular-weight heparin alone appeared noninferior to thromboprophylaxis combined with graduated compression stockings for individuals at moderate or high risk for venous thromboembolism after elective surgery, according to results of a randomized study published in BMJ.

“These findings indicate that graduated compression stockings might be unnecessary in most patients undergoing elective surgery,” Joseph Shalhoub, MD, researcher in the department of surgery and cancer at Imperial College London and Imperial Vascular Unit of the Imperial College Healthcare NHS Trust, and colleagues wrote.

Guidelines recommend thromboprophylaxis in combination with graduated compression stockings for patients undergoing elective surgeries who are at moderate or high risk for VTE. Meanwhile, improvements in care and therapies have led to significant declines in VTE rates, prompting some clinicians to question the need for compression.

Shalhoub and colleagues sought to examine whether graduated compression hosiery conferred adjuvant benefit when combined with low-molecular-weight heparin (LMWH) for VTE prophylaxis among 1,858 adults undergoing elective surgery who were at moderate (15.9%) or high risk (84.1%) for a VTE event.

Researchers randomly assigned patients 1:1 to LMWH with (n = 921; median age, 58.1 years; 63.2% women) or without (n = 937; median age, 59.3 years; 63.4% women) graduated compression stockings. The most common surgical procedures included upper gastrointestinal, obstetrics and gynecology, and lower gastrointestinal surgeries.

Imaging-confirmed lower limb VTE — including deep vein thrombosis with or without symptoms or pulmonary embolism with symptoms — within 90 days of surgery served as the study’s primary endpoint. Quality of life, compliance with compression stockings and LMWH, lower limb complications associated with graduated compression stockings, bleeding complications, adverse events associated with LMWH and all-cause mortality served as secondary endpoints.

Results showed VTE occurred in 1.7% of participants who received LMWH without compression stockings compared with 1.4% of those who received both (risk difference, 0.3; 95% CI, 0.65 to 1.26).

Moreover, DVT and PE events occurred in 0.2% of participants in the LMWH-alone group vs. 0.1% of those in the LMWH-plus-compression group. Among those who underwent full lower limb duplex imaging, 1.5% in the LMWH-alone group experienced DVT without symptoms compared with 1.4% in the LMWH-plus-compression group.

Researchers cited the possibility for missed scans as the main limitation of the study.

“Noninferiority was shown across individual risk subpopulations,” Shalhoub and colleagues wrote. “If we consider the potential adverse events and cost of [graduated compression hosiery], urgent revision of national and international VTE prevention guidelines is recommended.” – by Jennifer Southall

Disclosures: The Health Technology Assessment Programme of the National Institute for Health Research (NIHR) and Imperial College London supported this study. Shalhoub reports grants from the NIHR during the conduct of this study. Please see the study for all other authors’ relevant financial disclosures.