• Kristijonas Milinis, Joseph Shalhoub, Alexander P Coupland, Justin D Salciccioli, Ankur Thapar, and Alun Huw Davies.
• Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom. Electronic address: miliniskristijonas@gmail.com.
• J Vasc Surg Venous Lymphat Disord. 2018 Nov 1; 6 (6): 766-777.e2.

ObjectiveThere is an increasing evidence base to support the use of extended pharmacologic thromboprophylaxis in selected surgical patients to prevent venous thromboembolism (VTE). The benefit of graduated compression stockings (GCS) in addition to extended pharmacologic thromboprophylaxis is unclear. The aim of this study was to systematically review the evidence relating to the effectiveness of using GCS in conjunction with extended pharmacologic thromboprophylaxis to prevent VTE in surgical patients.MethodsA literature search of MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in April 2017. The review protocol was published on PROSPERO (CRD42017062655). Randomized controlled trials (RCTs) were eligible if one of the study arms included patients receiving extended pharmacologic thromboprophylaxis alone (>21 days) or in conjunction with GCS. Data on deep venous thrombosis (DVT), pulmonary embolism (PE), and VTE-related death were compiled. Pooled proportions of the VTE rates were determined using random-effects meta-analysis.ResultsThe systematic search identified 1291 studies, of which 19 studies were eligible for inclusion. No RCT directly compared extended pharmacologic thromboprophylaxis alone with GCS plus extended pharmacologic thromboprophylaxis. A total of 9824 patients from 16 RCTs were treated with extended pharmacologic thromboprophylaxis, of whom 0.81% (95% confidence interval [CI], 0.5-1.20) were diagnosed with symptomatic DVT and 0.2% (95% CI, 0.12-0.36) with PE. Three trials included 337 patients who received extended pharmacologic thromboprophylaxis in conjunction with GCS. In this group, 1.61% (95% CI, 0.03-5.43) had symptomatic DVT with no reported PE. Similar VTE rates were observed when studies in orthopedic and abdominal surgery were analyzed separately.ConclusionsThere is insufficient evidence to recommend GCS in conjunction with extended pharmacologic prophylaxis to prevent VTE in patients undergoing orthopedic and abdominal surgery. A clinical trial directly investigating this important subject is needed.Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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