Source: Naccarato M, Chiodo Grandi F, Dennis M, Sandercock PAG. Physical methods for preventing deep vein thrombosis in stroke (Review). Cochrane Database Syst Rev. 2010. Issue 8. Art. No.: CD001922. DOI: 10.1002/14651858.CD001922.pub3
The CLOTS Trials Collaboration Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet 2009; 373: 1958–65
Efficacy Endpoints: Deep Vein Thrombosis (DVT), PE, Death
Harm Endpoints: Skin breakdown, blisters, ulcers, skin necrosis
Narrative: It has long been observed that hospitalized patients are at increased risk for developing a DVT. Venous stasis and lack of mobility are known risk factors for developing venous thromboemboli. It has been hypothesized that compression stockings, by compressing superficial veins, cause increased blood flow through the deep veins in the extremities, decreasing venous stasis and DVT.
The Cochrane review identified two trials comparing GCS (graduated compression stockings) with routine care for DVT prophylaxis including a total of 2615 patients. The larger is the 2009 CLOTS trial, with 2518 (96%) of the subjects included in the review. Approximately 12% of subjects in each group were on anticoagulants in this study and the review showed no difference in DVT, PE, or death between the control and the study group, regardless of anticoagulation status. The stocking group, however did have an increased risk of harm including skin breakdown, blisters, ulcers, or skin necrosis.
Caveats: The purpose of preventing DVT is to prevent the life threatening or physiologically uncomfortable symptoms of either DVT or pulmonary embolism. The great bulk of the included trials did not measure these outcomes, making it impossible to know if preventing DVTs has an important impact on patient-oriented outcomes. Large, high quality, well-powered trials that closely track both the adverse effects of stockings (discomfort, etc.) and clinically important events related to venous thromboembolism are badly needed.
All of the included trials involved patients with acute stroke as the reason for their hospitalization, and none of the studies included low risk patients. Consequently, firm conclusions from these data can only be drawn regarding GCS for stroke patients.
It should be noted that there is relatively robust data to suggest that GCS appear to be of benefit when used for surgical patients in the post-operative inpatient setting. For more information, please refer to related entries on this topic.
Author: Viral Patel, MD
Published/Updated: January 30, 2012
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