Graduated compression stockings demonstrate no additional benefit in preventing VTE

According to the ENDORSE study, 64.4% of surgical inpatients were at high risk of VTE, according to the American College of Chest Physicians criteria, compared to 41.5% of medical inpatients.

According to a recent study published in the Annals of Surgery, Benedict R.H. Turner and colleagues said that head-to-head meta-analysis and pooled trial arms show no additional benefit of GCS (graduated compression stockings) in preventing VTE and VTE-related mortality. GCS pose a risk of skin complications and economic burden. Their use is not supported for surgical inpatients based on current evidence.

This study compared VTE rates in surgical inpatients with pharmacological thromboprophylaxis and additional GCS vs. thromboprophylaxis alone.

Surgical patients have an elevated VTE risk, and recent studies question whether GCS provides extra protection against VTE compared to pharmacological thromboprophylaxis alone.

The review followed PRISMA guidelines. MEDLINE and Embase databases were searched until November 2022 for randomized trials reporting VTE rates after surgical procedures with pharmacological thromboprophylaxis, with or without GCS. The rates of DVT (deep venous thrombosis), pulmonary embolism, and VTE-related mortality were pooled through fixed and random effects.

Key findings from this investigation are:

• The DVT risk for GCS and pharmacological thromboprophylaxis was 0.85 versus pharmacological thromboprophylaxis alone (2 studies, 70 events, 2653 participants).
• The risk of DVT in pooled trial arms for GCS and pharmacological thromboprophylaxis was 0.54 compared to pharmacological thromboprophylaxis alone (33 trial arms, 1228 events, 14,108 participants).
• The risk of pulmonary embolism for GCS and pharmacological prophylaxis versus pharmacological prophylaxis alone was 0.71 (27 trial arms, 32 events, 11,472 participants).
• No between-group differences were reported in VTE-related mortality (27 trial arms, three events, 12,982 participants).

This study's strength lies in its meta-analysis of 2 well-designed, low-bias head-to-head trials involving 2600 participants. The high-quality evidence supports the presentation of pooled DVT, PE, and VTE-related mortality rates, showing no difference between pharmacological prophylaxis and additional GCS versus pharmacological prophylaxis alone.

Reference:

Turner BRH 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.