Incidence of venous thromboembolism in the wake of the Clots in Legs Or sTockings after Stroke (CLOTS) study.
OBJECTIVE
In the United Kingdom, compressive stockings were standard care in all stroke units until the publication of the Clots in Legs Or sTockings after Stroke (CLOTS) trial results in May 2009, which concluded that stockings were ineffective. The aim of this audit was to assess whether this change in practice was associated with any change in venous thromboembolism incidence in routine clinical practice.


METHODS
All stroke register entries at the University Hospital of North Staffordshire from 2 years before the publication of the CLOTS trial results to 2 years after were identified and included in this audit. The hospital radiology reporting system was then cross-checked for evidence of venous thromboembolism on computed tomography pulmonary angiogram, ventilation/perfusion lung scan, and leg Doppler reports.


RESULTS
There were 773 patients in the before cohort and 861 in the after cohort (mean age, 74/74 years; men, 47%/45%; and ischemic stroke, 87%/85%, respectively). Symptomatic venous thromboembolism incidence was the same in both cohorts, 21 (2.7%) in the before cohort and 26 (3.0%) in the after cohort (P=0.8). There was a trend toward more deep vein thrombosis (9 [1.2%] versus 19 [2.2%]; P=0.1) and fewer pulmonary embolisms (12 [1.6%] versus 6 [0.7%]; P=0.2) in the after cohort.


CONCLUSIONS
Discontinuation of compressive stockings did not increase venous thromboembolism incidence. There was a trend toward more deep vein thrombosis and fewer PEs after CLOTS, which might be because of increased clinical vigilance in the diagnosis of deep vein thrombosis, but a chance variation cannot be excluded.
From the School of Medicine (P.J.), Institute for Science and Technology in Medicine (T.N., C.R.), Keele University, Keele, UK; Department of Stroke Medicine, University Hospital of North Staffordshire, Stoke on Trent, UK (E.W.); and Stroke Research, North Staffordshire Combined Healthcare Trust, Stoke on Trent, UK (C.R.).
Palbha
P
Jain
Elizabeth
E
Ward
Tracy
T
Nevatte
Christine
C
Roffe
D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011859:Radiography; D012189:Retrospective Studies; D053828:Stockings, Compression; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D014463:Ultrasonography; D006113:United Kingdom / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
pulmonary embolism; venous thromboembolism; venous thrombosis