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Following surgery, people who wore compression stockings in addition to taking blood thinners did not have fewer DVT than people who only took blood thinners. The quality of the studies was high.
Understanding the problem
For decades, in some hospitals, people undergoing surgery have been told they should wear graduated compression stockings as long as they are in hospital and sometimes even after they are discharged home. Surgery increases inflammation and immobility which increases the risk of DVT and PE. The standard compression stockings used in hospitals apply gentle pressure to the leg veins to increase blood flow with the goal of reducing the risk of DVT and PE.
When compression stockings were first used after surgery decades ago, blood thinners were not typically used, and compression stockings were the only method available to prevent DVT. However, practice has changed and now blood thinners, given by injection or taken by mouth, are commonly used after surgery. Despite the shift in practice, patients are still routinely given compression stockings in addition to blood thinners after surgery at some hospitals.
Unlike blood thinners, compression stockings do not increase the risk of bleeding after surgery. However, they have their own set of complications. Some people who wear compression stockings experience skin breakdown with ulcers, abrasions, and rashes. They can be hot and uncomfortable which makes it difficult for some people to tolerate them. Lastly, compression stockings are associated with a significant cost, especially when you consider the number of surgeries that are performed every day.
The researchers wanted to know if there was any benefit from adding compression stockings to blood thinners in people who have surgery that requires a hospital stay. In other words, are blood thinners plus compression stockings better than blood thinners alone at preventing DVT after surgery?
A summary of 2 studies published up to November 2022.
Who? The studies included 2,653 people who had undergone elective surgery. The types of surgery included orthopedic, gynecologic/pelvic, and major abdominal surgery.
What? The studies compared compression stockings plus blood thinners with blood thinners alone .
Compression Stockings plus blood thinners | vs | Blood thinners alone |
---|---|---|
Compression stockings applied to both legs after surgery PLUS Blood thinner given by injection or taken by mouth Both used until hospital discharge.* *please note that blood thinners are often continued after discharge for some surgeries, but that was not the case for these 2 studies | Blood thinners given by injection or taken by mouth Used until hospital discharge.* *please note that blood thinners are often continued after discharge for some surgeries, but that was not the case for these 2 studies |
Blood thinners plus graduated compression stockings vs blood thinners alone
Outcomes | Rate of events with blood thinners plus compression stockings | Rate of events with blood thinners alone | Results | Number of studies and quality of the evidence |
---|---|---|---|---|
DVT | 24 out of 1,000 people | 28 out of 1,000 people | No difference* | 2 studies; high-quality evidence |
*Although the rates for the 2 groups look different, the differences were not statistically significant—this means that the difference could simply be due to chance rather than due to the different treatments.
This Evidence Summary is based on the following article:
Turner BRH, Machin M, Salih M, et al. An Updated Systematic Review and Meta-analysis of the Impact of Graduated Compression Stockings in Addition to Pharmacological Thromboprophylaxis for Prevention of Venous Thromboembolism in Surgical Inpatients. Ann Surg. 2024 Jan 1;279(1):29-36. doi: 10.1097/SLA.0000000000006096. Epub 2023 Sep 27. PubMed
Lori-Ann Linkins, MD, MSc (Clin Epi), FRCPC
Dr. Linkins is an Associate Professor of Medicine (thrombosis) at McMaster University in Hamilton, Canada. She holds a Masters Degree in Health Research Methodology and is a Deputy Editor with the Health Information Research Unit, McMaster. She is Co-Editor of the ACP Journal Club and Co-lead on the CanVECTOR Knowledge Translation Platform.
Published: Friday, January 19, 2024
Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.
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