Interventional cardiology

Compression stockings don’t prevent VTE after elective surgery

Experts have called for an ‘urgent revision’ of international VTE prevention guidelines after their trial found compression stockings might be unnecessary for most patients undergoing elective surgery.

A UK multicentre trial randomised almost 2,000 elective surgical inpatients at moderate or high risk of venous thromboembolism (VTE) to low molecular weight heparin alone or with graduated compression stockings.

The researchers found that VTE occurred in 16 out of 937 (1.7%) patients in the LMWH-only group compared with 13 out of 921 (1.4%) patients in the LMWH plus stockings group.

Both deep vein thrombosis and pulmonary embolism occurred in 2 out of 937 (0.2%) patients in the LMWH only group compared with 1 out of 921 (0.1%) in the LMWH plus stockings group. 

The risk difference between the two groups was 0.30% (95% confidence interval −0.65% to 1.26%). Because the 95% confidence interval did not cross the non-inferiority margin of 3.5% (P<0.001 for non-inferiority), LMWH alone was confirmed to be non-inferior.

Little or no differences between groups were found for other measures including quality of life up to 90 days after surgery, adverse drug reactions or deaths.

Writing in the BMJ, the study authors say their findings will probably have clinical implications for patients undergoing elective procedures.

“Initial estimates of the annual cost of purchasing and applying GCS to surgical patients assessed as being at moderate or high risk of VTE exceeded £63m in England (A$120m). A substantial reduction of these costs, scaled globally and on a recurring basis, has the potential to have a major positive financial impact on hospital healthcare systems”, they wrote.

They noted that the events in the current study were much lower than that reported in previous studies. 

“These rates could be partly attributed to shorter lengths of stay, improved operative techniques, and analgesic regimens that allow earlier mobilisation. It is clear that current guidelines are largely based on historical data and should be revisited,” they added. 

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