• Rishi Mandavia, Joseph Shalhoub, Karen Head, and Alun H Davies.
• Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom. Electronic address: rishimandavia@gmail.com.
• J Vasc Surg Venous Lymphat Disord. 2015 Oct 1; 3 (4): 447-455.e1.

ObjectiveThe evidence base supporting the use of graduated compression stockings (GCS) for venous thromboembolism (VTE) prevention has been challenged, and there appears to be a lack of evidence for the additional benefit of GCS to pharmacologic thromboprophylaxis. This study aimed to summarize and quality assess the existing evidence concerning whether GCS offer a significant benefit in addition to pharmacologic thromboprophylaxis in surgical inpatients.MethodsA systematic review of published literature was performed. Inclusion criteria were (1) randomized controlled trials (RCTs), (2) surgical inpatients, (3) study arms examining prophylactic-dose pharmacologic thromboprophylaxis alone or in conjunction with GCS, and (4) outcome of VTE.ResultsIn the review, 1025 articles were screened, of which 27 RCTs were included. Six RCT study arms included patients with GCS in conjunction with pharmacologic thromboprophylaxis, whereas 22 RCT study arms included patients treated with pharmacologic thromboprophylaxis alone. One RCT had both of its study arms included in the systematic review. The total number of patients that received pharmacologic thromboprophylaxis alone was 12,481. Of these patients, 1292 (10.4%) suffered VTE. The total number of patients that received GCS in conjunction with pharmacologic thromboprophylaxis was 1283. Of these patients, 75 had VTE (5.8%). Heterogeneity analysis demonstrated that the results of included study arms were significantly heterogeneous, precluding a valid summation analysis.ConclusionsThe additional benefit of GCS to pharmacologic thromboprophylaxis in surgical inpatients is not clear on the basis of existing data. Further clinical trials directly evaluating this clinical question are recommended.Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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