title: The additional benefit of graduated compression stockings to pharmacologic thromboprophylaxis in the prevention of venous thromboembolism in surgical inpatients.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  In 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom. Electronic address: rishimandavia@gmail.com.
authors.forename: Rishi
authors.initials: R
authors.lastname: Mandavia
authors.affiliation: Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shalhoub
authors.affiliation: Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Head
authors.affiliation: Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom.
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D006801:Humans; D007297:Inpatients; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D053828:Stockings, Compression; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants