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Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS

Joseph Shalhoub1, Rebecca Lawton1, Jemma Hudson2

  • 1Department of Surgery and Cancer, Imperial College London & Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK.

BMJ (Clinical Research Ed.)
|May 15, 2020
PubMed

Insights

For patients undergoing elective surgery, low molecular weight heparin (LMWH) alone is as effective as LMWH plus graduated compression stockings (GCS) for preventing venous thromboembolism. These findings suggest GCS may be unnecessary for most surgical patients.

Area of Science:

  • Vascular Surgery
  • Thrombosis Prevention
  • Medical Devices

Background:

  • Venous thromboembolism (VTE) is a significant risk following elective surgery.
  • Pharmaco-thromboprophylaxis, typically with low molecular weight heparin (LMWH), is standard care.
  • The adjuvant role of graduated compression stockings (GCS) alongside LMWH is debated.

Purpose of the Study:

  • To determine if graduated compression stockings (GCS) provide additional benefit when used with pharmaco-thromboprophylaxis for VTE prevention in elective surgery patients.
  • To assess the non-inferiority of LMWH alone compared to LMWH plus GCS.

Main Methods:

  • An open, multicentre, randomised, controlled, non-inferiority trial involving 1905 elective surgical inpatients at moderate or high risk for VTE.
  • Participants received either LMWH alone or LMWH plus GCS.
  • The primary outcome was the incidence of confirmed deep vein thrombosis or symptomatic pulmonary embolism within 90 days.

Main Results:

  • A primary outcome event occurred in 1.7% of patients receiving LMWH alone versus 1.4% in the LMWH plus GCS group.
  • LMWH alone was confirmed to be non-inferior to the combination therapy (risk difference 0.30%, 95% CI -0.65% to 1.26%).
  • The non-inferiority margin of 3.5% was not crossed (P<0.001).

Conclusions:

  • For elective surgery patients at moderate to high VTE risk, LMWH pharmaco-thromboprophylaxis alone is non-inferior to combined LMWH and GCS.
  • Graduated compression stockings may be unnecessary for the majority of patients undergoing elective surgery when adequate pharmaco-thromboprophylaxis is administered.
Abstract

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