01 June 2020

Guidelines on the use of compression stockings following elective surgery should be revised after a clinical study found they may no longer be needed, researchers say.

Research published in the British Medical Journal suggests that anti-clotting drugs alone are just as effective for patients undergoing elective surgery who are at moderate or high risk of venous thromboembolism (VTE).

Existing guidelines recommend using a combination of graduated compression stockings and anti-clotting drugs. However, the rates of VTE after surgery have fallen significantly in the past few years because of improved care and drug therapy.

A UK team of researchers followed 1,858 adult patients at moderate or high risk of VTE who underwent non-emergency surgery at seven NHS hospitals between May 2016 and January 2019.

Patients were randomly split into two groups, with 937 patients being given low molecular weight heparin (LMWH) during their hospital stay and asked not to wear any kind of compression stocking for 90 days after surgery.

The remaining 921 patients were given LMWH and were asked to wear graduated compression stockings for 90 days after surgery.

The researchers found that VTE occurred in 16 out of 937 (1.7%) patients in the drugs-only group, compared with 13 out of 921 (1.4%) patients in the drugs plus stockings group.

Imaging-confirmed pulmonary embolism, and symptomatic deep vein thrombosis, both occurred in two out of 937 (0.2%) patients in the drugs-only group, compared with one out of 921 (0.1%) in the drugs plus stockings group.

There was little or no difference between groups for other measures, such as quality of life up to 90 days after surgery, adverse drug reactions or deaths.

The researchers write: “These findings indicate that graduated compression stockings might be unnecessary in most patients undergoing elective surgery, and current guidelines based on historical data should be revised.”

Source: Shalhoub J, Lawton R, Hudson J, Baker C, Bradbury A, Dhillon K, Everington T, Gohel MS, Hamady Z, Hunt BJ, Stansby G, Warwick D, Norrie J, Davies AH, on behalf of the GAPS trial investigators (2020) “Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): randomised controlled trial”, BMJ, doi: 10.1136/bmj.m1309


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