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Updated: Jul 26, 2026

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
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Graduated Compression Stockings as an Adjunct to Low Dose Low Molecular Weight Heparin in Venous Thromboembolism

J Shalhoub1, J Norrie2, C Baker3

  • 1Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|April 12, 2017
PubMed

Insights

This study investigates if low dose low molecular weight heparin (LMWH) alone is as effective as LMWH with graduated compression stockings (GCS) for preventing venous thromboembolism (VTE) in surgical patients.

Area of Science:

  • Medical research
  • Clinical trials
  • Thromboprophylaxis

Background:

  • Current venous thromboembolism (VTE) prevention guidelines lack optimal evidence.
  • Graduated compression stockings (GCS) represent a significant cost in VTE prevention for surgical patients.

Purpose of the Study:

  • To determine if low dose low molecular weight heparin (LMWH) monotherapy is non-inferior to combination therapy (LMWH + GCS) for VTE prevention.
  • To evaluate the efficacy and safety of LMWH alone versus LMWH with GCS in surgical patients at moderate to high risk of VTE.

Main Methods:

  • The Graduated compression as an Adjunct to Pharmacoprophylaxis in Surgery (GAPS) Trial is a randomized controlled trial.
  • Adult elective surgical patients at moderate/high VTE risk will be randomized to LMWH alone or LMWH + GCS.
  • The study requires 2236 patients across seven UK centers to demonstrate non-inferiority for VTE within 90 days.

Main Results:

  • Primary endpoint is the incidence of all VTE within 90 days, with a non-inferiority margin of 3.5%.
  • Secondary outcomes include quality of life, compliance, mortality, and bleeding complications.

Conclusions:

  • The GAPS trial aims to provide crucial evidence on optimizing VTE prevention strategies.
  • Findings will inform recommendations regarding the necessity of GCS in conjunction with LMWH for surgical patients.
Abstract

Keywords:
Deep vein thrombosisGraduated compression stockingsLow molecular weight heparinRandomised controlled trialThromboprophylaxisVenous thromboembolism

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