Elastic compression stockings for prevention of deep vein thrombosis (Review) Amaragiri SV, Lees TA The Cochrane Database of Systematic Reviews

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Elastic compression stockings for prevention of
deep vein thrombosis (Review)Amaragiri SV, Lees
TAThe Cochrane Database of Systematic Reviews

• Prince of Wales Journal Club
• March 6th 2006
• Matthew Magarey

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DVT Prophylaxis

• Mechanisms of Elastic Compression Stockings
• ? Venous dilatation
• ? Flow velocity
• Improve valve function
• ? Tissue Factor Pathway Inhibitor

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DVT Prophylaxis

• Four hypotheses tested in this review
• Graduated compression stockings (GCS) are
  effective in preventing DVT in all hospitalised
  patients
• In all moderate risk patients, compression
  stockings alone are adequate for DVT prophylaxis,
  except in patients where stockings are
  specifically contraindicated
• Stockings are unnecessary in low risk patients
• Complications are associated with the use of
  compression stockings

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DVT Prophylaxis

• Characteristics of studies included in this
  review
• RCT use of GCS for DVT prophylaxis
• Any hospitalised patients
• GCS vs. no prophylaxis, or compared to another
  method of prophylaxis

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DVT Prophylaxis

• Data collected was placed into two groups
• Group 1 - GCS only vs. no treatment
• Group 2 - GCS other DVT prophylaxis vs. other
  DVT prophylaxis alone

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DVT Prophylaxis

• 28 RCTs found during searches, 16 which met
  criteria for inclusion
• Group 1 seven RCTs
• Group 2 nine RCTs

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DVT Prophylaxis

• Group 1
• 1027 participants
• 536 in treatment group (GCS) 81 DVT (15)
• 491 in control group (no GCS) 144 DVT (29)
• P lt 0.00001

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DVT Prophylaxis

• Group 2
• 1184 participants
• 589 in treatment group (GCS other DVT
  prophylaxis) 18 DVT (3)
• 595 in control group (other DVT prophylaxis
  alone) 84 DVT (14)
• P lt 0.00001

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DVT Prophylaxis

• Conclusions
• GCS significantly decrease incidence of DVT in
  hospitalised patients
• Even more effective when combined with another
  method of DVT prophylaxis

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DVT Prophylaxis

• Strengths
• Meta-analysis
• Large numbers
• Recent
• Initial review 2000
• Reprinted after further review January 2006

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DVT Prophylaxis

• Limitations
• No low risk patients included in study
• Five studies had one leg as a control
• Group 2 patients did not all receive the same
  additional DVT prophylaxis
• Several studies did not state if GCS were knee
  length or above knee

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DVT Prophylaxis

• Limitations
• No trials reported complications
• No trials examined effectiveness of duration of
  GCS pre- or post-operatively

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DVT Prophylaxis

• How should we apply these findings to our own
  hospital practice?

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DVT Prophylaxis

• SIGN review
• Scottish Intercollegiate Guidelines Network
• National guidelines for Scotland
• Published October 2002
• Graded evidence beside each recommendation
• www.sign.ac.uk

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DVT Prophylaxis
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DVT Prophylaxis