Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. For patients who underwent elective surgery and were at moderate to high risk of venous thromboembolism, pharmaco-thromboprophylaxis with low molecular weight heparin alone was noninferior to a combination of pharmaco-thromboprophylaxis and graduated compression stockings.

Evidence Rating: 1 (Excellent)

Venous thromboembolism (VTE) is associated with significant mortality and morbidity worldwide. For patients undergoing elective surgical procedures, graduated compression stockings (GCS) in addition to pharmaco-thromboprophylaxis are currently the standard practice for prevention of VTE. As the effectiveness of GCS have been brought into question in recent years, researchers conducted an open-labelled, multicentre, randomised, controlled, non-inferiority trial with 1905 adult elective surgical inpatients assessed at being moderate to high risk of VTE to investigate the necessity of GCS as a preventative measure for VTE. Patients were randomly assigned to receive pharmaco-thromboprophylaxis alone with low molecular weight heparin (LMWH) or pharmaco-thromboprophylaxis with GCS. Primary outcome out interest was the rate of deep vein thrombosis (DVT) in both groups as confirmed by imaging, or symptomatic pulmonary embolism within 90 days. Secondary outcomes were quality of life, compliance with GCS and LMWH, lower limb complications resulting from GCS application, bleeding complications, adverse reactions to LMWH, and all-cause mortality. Intention to treat analysis revealed a risk difference of 0.3% (95% CI, -0.65% to 1.26%), as the primary event was observed in 1.7% of the no GCS group and 1.4% in the GCS group receiving standard care. These findings were well within the predefined margin of non-inferiority of 3.5% (P<0.001). No significant differences in quality of life or other secondary outcomes were reported. Although further studies must be carried out to expand generalizability of findings, these findings suggest that GCS inclusion is an unnecessary component of current standard practice for VTE patients who undergo elective surgical procedures.

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