Review article: Anti-embolism stockings

Area of Science:

• Orthopaedic Surgery
• Vascular Medicine
• Pharmacology

Background:

• National Institute for Health and Clinical Excellence (NICE) guidelines recommend combined mechanical and pharmacological prophylaxis for venous thromboembolism (VTE) prevention in orthopaedic surgery.
• Growing evidence suggests anti-embolic stockings (AES) may have limited efficacy in reducing VTE risk.

Purpose of the Study:

• To evaluate the effectiveness of adding anti-embolic stockings (AES) to pharmacological prophylaxis in preventing VTE in orthopaedic surgery patients.
• To compare VTE rates between patients receiving pharmacological prophylaxis alone versus combined pharmacological prophylaxis and AES.

Main Methods:

• Systematic review of studies from MEDLINE, EMBASE, and Cochrane Library.
• Inclusion of 4 studies involving 1171 orthopaedic patients (trauma and elective).
• Comparison of VTE incidence in patients receiving pharmacological prophylaxis with or without AES.

Main Results:

• Overall VTE rates did not differ significantly between groups (pharmacological alone: 7.5% DVT, 1.2% PE; combined: 5.3% DVT, 1.5% PE).
• The addition of AES did not confer a statistically significant benefit in reducing deep vein thrombosis or pulmonary embolism.
• No VTE-related deaths were reported in the included studies.

Conclusions:

• The addition of anti-embolic stockings to pharmacological prophylaxis does not significantly reduce the risk of venous thromboembolism in orthopaedic surgery patients.
• Current evidence does not support the routine use of AES in conjunction with pharmacological VTE prophylaxis for this patient population.
• Further research may be warranted to refine VTE prophylaxis strategies in orthopaedic surgery.