Graduated compression stockings in the prevention of venous thromboembolism.
BACKGROUND
Surveys still show a wide variation in routine use of deep vein thrombosis (DVT) prophylaxis despite its established place in current patient management. This article reviews the mechanism of action, efficacy and complications of stockings in preventing DVT.


METHODS
Relevant publications indexed in Medline (1966-1998) and the Cochrane database were identified. Appropriate articles identified from the reference lists of the above searches were also selected and reviewed.


CONCLUSIONS
Graduated compression stockings reduce the overall cross-sectional area of the limb, increase the linear velocity of venous flow, reduce venous wall distension and improve valvular function. Fifteen randomized controlled trials of graduated compression stockings alone were reviewed. Stockings reduced the relative risk of DVT by 64 per cent in general surgical patients and 57 per cent following total hip replacement. The effect of stockings was enhanced by combination with pharmacological agents such as heparin; the combination is recommended in patients at moderate or high risk of DVT. Knee-length stockings are as effective and should replace above-knee stockings. Complications are rare and avoidable.
Agu
O
O
University Department of Surgery, Royal Free Hospital, London NW3 2QP, UK.
Hamilton
G
G
Baker
D
D
D001458:Bandages / Q000009:adverse effects; D004867:Equipment Design; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects; D013513:Obstetric Surgical Procedures / Q000009:adverse effects; D009985:Orthopedics; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*