Allen J. Blaivas, DO
In patients with stroke, do thigh-length graduated compression stockings (GCSs) prevent deep venous thrombosis (DVT)?
Randomized controlled trial (Clots in Legs Or sTockings after Stroke [CLOTS] trial 1). ISRCTN28163533.
Blinded (outcome assessors for DVT).*
64 hospitals in the UK, Italy, and Australia.
2518 patients (mean age 76 y, 51% women) who were admitted to hospital within 1 week of an acute stroke and were immobile. Exclusion criteria included peripheral vascular disease, diabetic or sensory neuropathy, suspicion of potential for skin damage from the stockings, and subarachnoid hemorrhage.
Continuous use of GCSs on both legs until the patient was independently mobile, was discharged, or refused to wear them or the staff had concerns about the patient’s skin (n = 1256); or avoidance of GCSs unless an indication for their use developed (n = 1262).
Primary outcome was definite or probable symptomatic or asymptomatic DVT in the popliteal or femoral veins, detected on screening compression Doppler ultrasonography or in response to symptoms. Secondary outcomes included symptomatic proximal DVT, any DVT, pulmonary embolism, and skin complications. The trial had 90% power to detect a 4% absolute reduction in the primary outcome.
89% (intention-to-treat analysis).
GCSs did not reduce risk for proximal DVT or other measures of venous thromboembolism (Table). Skin complications (breaks, ulcers, blisters, or necrosis) were more frequent in the GCS group (Table).
In patients with recent stroke, thigh-length graduated compression stockings did not prevent deep venous thrombosis and increased skin complications.
Thigh-length graduated compression stockings vs avoidance of stockings to prevent deep venous thrombosis (DVT) in patients with recent stroke†
†Abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from data in article.
‡Excluding patients who were lost to follow-up or died before any primary outcome, and adjusted for delay from onset to randomization, stoke severity, and leg strength.
Blaivas AJ. Graduated compression stockings did not prevent deep venous thrombosis after stroke and increased skin complications. Ann Intern Med. ;151:JC4–9. doi: 10.7326/0003-4819-151-8-200910200-02009
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Published: Ann Intern Med. 2009;151(8):JC4-9.
Neurology, Stroke, Venous Thromboembolism.
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