Patients who are at risk of developing DVT are categorised into three groups of low, moderate, and high risk according to the International Consensus Statement and Thromboembolic Risk Factor (THRIFT) consensus group guidelines (ICS 2013; THRIFT 1992). TL: rechecked and authenticated the selected trials for inclusion; checked the updated review. Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery: a prospective, randomised study. Barinov VE, Everington T, Kolic Z, Flordal 1995 and Lensing 1993 have previously highlighted poor efficacy of using radioactive I125 fibrinogen uptake test (FUT) as the only diagnostic modality for DVT. Renault A, Scurr JH, LMWH: low molecular weight heparin Towards evidencebased guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis, How to GRADE the quality of the evidence. Hamilton G. Knee length versus thigh length graduated compression stockings for prevention of deep vein thrombosis in postoperative surgical patients. ColeridgeSmith PD, We used fixedeffect analysis since the vast majority of included studies were based on surgical patients at medium or high risk of developing DVT. Tugrul S, In addition, Barnes 1978 was terminated early as it was deemed unjustifiable to continue after revealing a major incidence of DVT amongst participants who did not wear stockings; we assessed this study as being at high risk of bias. We found one study to be at unclear risk of bias as it was published in Japanese and we were unable to accurately appraise this report (Shirai 1985). McNally MA, All participants had regular dextran 70 prophylaxis. Compared low vs moderatepressure GCS, and kneelength vs thighlength GCS. Franck CA, LMWH: low molecular weight heparin "When analysing the data from the fibrinogen test, it was not clear which leg was stockinged.". Not randomised and not published as a paper. Dhillon K, 3 groups: thromboembolic stocking only versus external sequential pneumatic compression stockings only versus heparin + dihydroergotamine, Incidence of DVT not assessed. Studies venous haemodynamics. Christensen SW, Marston RA, This method was used to confirm clinically apparent PE in the remaining studies, except in one trial where PE was diagnosed at autopsy (Turpie 1989). Conclusions not changed. Feron JM, This is not the remit of this review but is the subject of another Cochrane Review, which reported insufficient highquality evidence to determine whether kneelength and thighlength stockings differ in their effectiveness in reducing the incidence of DVT in hospitalised patients (Sajid 2012). Serin K, Johnson J. Fragmin Multicentre Study Group. Sego D. Medicamentous prophylaxis of deep vein thrombosis in emergency surgical patients, Comparing the effectiveness of elastic bandages and shrinker socks for lower extremity amputees. Another review author (MD) then crosschecked the data. Ince S, We considered heterogeneity to be statistically significant for a P < 0.1. The results of the review should be interpreted with caution, paying particular attention to the detailed notes in the Description of studies section, as these may have influenced the analysis due to variations within the included trials, for example the use of the opposite limb as the control, differing background prophylactic methods used, and the age difference in some of the trials. Deep venous thrombosis prophylaxis with low molecular weight heparin and elastic compression in patients having total hip replacement. Hirsh J, Remember, it is okay to wear compression socks if you have DVT to prevent further complications. Most of the included studies are old, small patients numbers and only presented asymptomatic thrombosis events. In the remaining trials, participants lost to followup were accounted for, with some participants excluded postrandomisation due to failure to comply with wearing the GCS because they found them uncomfortable. Elevating your legs at or above heart level can also relieve swelling and other DVT symptoms. Prevention of deep venous thrombosis and pulmonary embolism in patients with acute intracerebral hemorrhage. Having varicose veins may increase your risk of developing deep vein thrombosis or a pulmonary embolism. FUT: I125 fibrinogen uptake test Hoak JC. If this is true, it may bias the results of these studies. 11/211 participants were not analysed, but were accounted for. (Analysis 3.1). However, in the majority of the included trials a statistically significant difference between the treated participants (those that used GCS) and the control group (those that did not use GCS) was demonstrated in the incidence of DVT (primary outcome). Lo NN. TED: thromboembolic deterrent, DVT: deep vein thrombosis We carried out subgroup analysis investigating differences between surgical and medical patients. WebYou'll need to measure the circumference of the largest part of your calf and the smallest part of your ankle. Should someone with a blood clot wear compression stockings? Limited data were available to accurately assess the incidence of adverse effects and complications with the use of GCS as these were not routinely quantitatively reported in the included studies. Graduated compression stockings: knee length or thigh length. Compares LMWH + stockings versus stockings alone, Lacks appropriate control group. Remember me. However, there was a discrepancy between the number of participants randomised to the treatment and control groups. et al. Crozier A, Wilkins RW, Five trials did not mention the length of the stockings used (Allan 1983; Chin 2009; Ohlund 1983; Turner 1984; WilleJorgensen 1991). Participants were assigned consecutive numbers. Seven of the 20 included RCTs involved the use of the other leg as the control (Bergqvist 1984; Kierkegaard 1993; Mellbring 1986; Scurr 1977; Scurr 1987; Shirai 1985; Torngren 1980). The I2 statistic for this analysis suggested 10% heterogeneity, with P = 0.33 (Analysis 1.1). The use of graduated compression stockings in the prevention of postoperative deep vein thrombosis. Cochrane Consumers and Communication Group. We placed no restrictions on language or publication status. The only time you would need to take them off is when you have to wet your body. Puttanna, Mixter G Jr, LMWH and LMWH plus graduated elastic compression for DVT prophylaxis in total hip replacement. In all but two of the trials the stockings were worn until the day of discharge or until the participants were fully mobile; participants in the remaining two studies wore GCS for 14 days or until discharge (Fredin 1989; Turpie 1989). Eckert C. Postoperative venous thrombosis and the effectiveness of prophylactic measures, The efficacy of graduated compression stockings in the prevention of deep vein thrombosis after major gynaecological surgery, British Journal of Obstetrics and Gynaecology. A randomized trial comparing graduated compression stockings alone or graduated compression stockings plus intermittent pneumatic compression with control in the prevention of deep vein thrombosis in neurosurgical patients. In previous versions of this review, we performed data synthesis based on two groups as follows. The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials. Lacks appropriate control group. Diagnosis of DVT is difficult as the patient history is not specific, and symptoms vary from no symptoms to pain and swelling in the legs. Hirsh J, It is possible that GCS applied to one leg could have an effect on the other leg of the same patient (Spiro 1970), although there is no clear evidence for this. Compagna R, Simonsen O, Sultan MJ, They help reduce leg swelling. Duration of routine followup was 7 to 14 days, or until discharge, with a single study routinely screening for symptomatic DVT at 30day followup (Chin 2009). GCS versus no GCS). The authors of this trial have clearly stated that a potential mechanism of action of GCS (i.e. . Lightweight ankle compression socks. Camporese G, This study was terminated early. However, there was a discrepancy between the numbers of participants randomised to the treatment and control groups, therefore we deemed this trial to be at unclear risk of bias likely due to unclear allocation concealment. Funnel plot of comparison: Incidence of proximal DVT with stockings and without stockings (all specialties). One review author (AS) carried out the initial screening of all retrieved studies based on titles and abstracts in order to identify obvious exclusions (i.e. Errors in 'anticipated absolute effects' in Summary of Findings tables corrected. What Is a Compression Sleeve? Kraemmer Nielsen H, PE: pulmonary embolism Baker AR. Lowmolecularweight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Improper application of stockings may potentially cause complications such as discomfort, oedema of the legs, DVT, and arterial ischaemia. Johnson JA. Maksimovic ZV, However, results are based on a single study on medical patients hospitalised following acute myocardial infarction (. Of note, Chin 2009 was the only included trial published after the publication of the CONSORT statement in 1996 (CONSORT 1996). We included 20 RCTs involving a total of 1681 individual participants and 1172 individual legs (2853 analytic units). DHELDH: dihydroergotamine + lowdose heparin Results of all outcome measures were reported. The extent to which the leg profile of patients may limit effectiveness has not been addressed. The control group only had a sequential compression device fitted on the day of the operation. GCS: graduated compression stockings (also known as thromboembolic deterrent (TED) stockings). Torngren 1980 reported that no participants suffered fatal PE. The pressure these stockings put on your legs helps your Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study. Imeson J, There was no mention of allocation concealment in 14 of the 20 RCTs judged as at unclear risk of bias. Randomized controlled trial of a new portable calf compression device (Venowave) for prevention of venous thrombosis in highrisk neurosurgical patients. Type of treatment: thighlength stockings. Ozkurt H, {"type":"clinical-trial","attrs":{"text":"NCT01234064","term_id":"NCT01234064"}}, {"type":"clinical-trial","attrs":{"text":"NCT01935414","term_id":"NCT01935414"}}, {"type":"clinical-trial","attrs":{"text":"NCT00333021","term_id":"NCT00333021"}}, 3 Use of background method of thromboprophylaxis. Kalodiki E, This review included predominantly patients undergoing general surgical and orthopaedic surgical procedures (Figure 5), and thus provides good evidence for the use of GCS amongst these patient groups. The study was supported in part by the Kendall Research Center. et al. Green J, Reasons for downgrading the quality of the evidence included low event rate (i.e. We found that GCS may also reduce the risk of PE amongst patients undergoing surgery. Remember, it is okay to wear compression socks if you have DVT to prevent Hip surgery can require a long recovery time, so you will need more than et al. Cullen JE. It is not explicit if these participants were included in or excluded from the study. We excluded a further six studies in the 2018 update (Barinov 2014; {"type":"clinical-trial","attrs":{"text":"NCT01234064","term_id":"NCT01234064"}}NCT01234064; {"type":"clinical-trial","attrs":{"text":"NCT01935414","term_id":"NCT01935414"}}NCT01935414; Sultan 2014; WilleJorgensen 1986; Zheng 2014), bringing the total number of excluded studies to 56. Participants were randomised in a ratio of 1:1 in the thighlength GCS group and 1:4 in the kneelength GCS group. Zeng W, Regan F, Improving the quality of reporting of randomized controlled trials: the CONSORT statement, Statistical methods for examining heterogeneity and combining results from several studies in metaanalysis, Systematic Reviews in Health Care: Metaanalysis in Context. He has also previously received funding from the following organisations for an unrelated project: National Institute for Health Research, Cancer Research UK, The Urology Foundation, Rosetrees Trust, and JGW Patterson Foundation. Compares 3 groups: stockings only versus LMWH 7 days versus LMWH 14 days, Lacks appropriate control group. Lees KR. Effectiveness of thighlength graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS Trial 1): a multicentre, randomised controlled trial. Suzuki T, The remaining six studies used sealed envelopes to conceal the allocation of participants to the treatment and control groups and were judged as at low risk of bias (Barnes 1978; Holford 1976; Kalodiki 1996; Mellbring 1986; Turpie 1989; WilleJorgensen 1991). WebIf you have had a blood clot in the leg, your doctor may suggest you wear a compression stocking to reduce swelling. PAD: peripheral arterial disease et al. Results from this review are comparable to those of a previous health technology assessment (Roderick 2005), which found a 66% risk reduction with the application of GCS and a 60% risk reduction when GCS were used on a background of another prophylactic method. Wilson K, In other words, there was no difference in the effectiveness of stockings in reducing the incidence of DVT irrespective of the unit of randomisation (P = 0.24). Lacut K, We performed subgroup analysis based upon the specialty under which the participants were managed (Figure 5). Sharrock N, One participant in the trial by Turpie 1989 wore kneelength stockings due to obesity. No changes to conclusions. Ido K, Femoral vein stasis during laparoscopic cholecystectomy: effects of graded elastic compression leg bandages in preventing thrombus formation. Zuckerman L, After excluding stroke patients, we identified only one RCT that involved a medical specialty, which was in patients following a myocardial infarction (Kierkegaard 1993). 5/75 participants were not analysed, but were accounted for. et al. Gooding GAW, Hartley N, We were unable to confidently assess the variation in effectiveness of GCS over these parameters. Proximal asymptomatic DVT was diagnosed using venography, however it was unclear whether symptomatic DVT was also confirmed objectively using this method, and whether this was standardised throughout the study. Serin K, In six trials, the length of the GCS used was not made explicit (Allan 1983; Chin 2009; Kierkegaard 1993; Ohlund 1983; Turner 1984; WilleJorgensen 1991). In the remaining 11 included trials, where stockings were used over a background method of thromboprophylaxis, participants in the control group received either: Participants in the treatment group also received GCS. Laurora G, Unit of analysis of randomisation: individual legs versus individual participants. This trial used Tubigrip rather than graduated compression stockings. Hirsh J, Clinical Research in Intensive Care and Sepsis Group (CRICS Group). This is one of the best ways to manage CVI. et al. The recommended amount of time for wearing compression socks after hip surgery is 6 weeks. This could result in these studies receiving too little weight in the metaanalysis due to wider confidence intervals, and thereby possibly disguising clinically important heterogeneity (Higgins 2011). Use a size chart to find the right sizeif you're between sizes, go with the larger size. If you can't take blood Both operated and nonoperated legs were analysed separately. Prevention and treatment of venous thromboembolism. Overusing compression socks, especially Three new ongoing studies identified. The control group of the thighlength GCS group was also used as the control for the kneelength GCS group. Morbidity due to DVT includes postthrombotic syndrome (PTS), which encompasses chronic venous hypertension causing limb pain, swelling, hyperpigmentation (darkening of the skin), dermatitis (inflammation of the skin), ulcers, and lipodermatosclerosis (a hardening of the skin that may gain a red or brown pigmentation and is accompanied by wasting of the subcutaneous fat). Feedback and review authors' response to feedback added. Based on the results from one trial focusing on medical patients admitted following acute myocardial infarction (Kierkegaard 1993), 0 of 80 legs (0%) developed DVT in the GCS group compared to 8 of 80 legs (10%) in the control group. Trngren S. Clinical relevance of the fibrinogen uptake test in patients undergoing elective general abdominal surgery relation to major thromboembolism and mortality. Similarly, one further trial reported no adverse events related to the use of GCS (Chin 2009). MP: I certify that I have no affiliations with or involvement in any organization or entity with a financial interest in the subject matter of my feedback. New citation required but conclusions have not changed. Scurr JH, In case of disagreement between review authors, consensus was reached by discussion with a third review author (TL). Randomised controlled trials (RCTs) involving GCS alone, or GCS used on a background of any other DVT prophylactic method. Not published as a full paper. Thrombosis prophylaxis using external compression. FalckYtter Y, AS: evaluated trials for inclusion; assessed quality of trials; extracted data; updated review Yeo SJ, Since a thrombus can embolise from either the control or stockinged leg, trials randomising individual legs could not be used to compare the incidence of PE, therefore where data were available, individual patients were used as the unit of analysis for comparing incidence of PE. Sajid M, Another thing, make sure that the pair of compression socks you have are not too tight, or else have it replaced with the right size for your feet and legs. 2 received dextran postoperatively; 2 did not eventually receive IPCC; 1 received heparin postoperatively; and FUT was unsatisfactory in 1 further participant. Different thromboprophylaxis approaches in patients undergoing knee arthroscopy (KANT study): interim report of prospective randomized study. We considered the quality of evidence, magnitude of effect of interventions examined, and the sum of available data for all outcomes of this review (DVT, proximal DVT, PE, adverse events and complications). SobierajTeague M, We excluded two trials including stroke patients, CLOTS 2009; Muir 2000, from this review as they are the subject of another review undertaken by Cochrane Stroke (Naccarato 2010). Martin P. The failure of compression stockings (Tubigrip) to prevent deep venous thrombosis after operation. Method of randomisation is not clear, although it appears to be appropriate. Your healthcare provider may advise you to use them to: In one trial some participants developed postphlebitic changes (Kierkegaard 1993). Goussous H, Compared the following 3 groups: IPC versus LMWH versus no thromboprophylaxis, Lacks appropriate experimental groups. Bergqvist D, Two review authors (AS, MD) assessed potentially eligible trials for inclusion. Zhan YX, Salem BI, The longevity of wearing compression stockings will vary depending on medical intervention and your condition. WebThis helps prevent leg swelling and, to a lesser extent, blood clots Wearing compression socks after surgery prevents deep vein thrombosis (DVT). $18 at Conrad. Leidenfrost R. The efficacy of pneumatic compression stockings in the prevention of pulmonary embolism after cardiac surgery. Details regarding risk of bias are provided in the Characteristics of included studies table and are represented in Figure 2 and Figure 3. Gent M, The Cohen 2007 study was excluded following thorough critical review, as it was unclear whether a standardized protocol was used throughout the study. We used GRADEpro GDT software to prepare the 'Summary of findings' tables and the Ryan 2016 publication to prepare GRADE ratings (GRADEpro GDT 2015). AlKutobi, 20/196 participants withdrew, but all were accounted for. Based on results from eight included studies, the incidence of proximal DVT was 7 of 517 (1%) units in the GCS group and 28 of 518 (5%) units in the control group. Fareed J, Blood clots from the superficial veins, Congenital illnesses affecting blood clotting factors, Disseminated intravascular coagulation (DIC), an illness where blood clotting occurs caused by severe infections or organ failure, Gradual pain that may worsen when the foot bends, Wear stockings that are either damp or wet. Graduated compression stockings worn for two years after treatment for a first DVT have been shown to reduce the risk of PTS by as much as 50%. Zhang ZY, 1We downgraded the quality of the evidence by two steps as there was only one study and a low event rate in the GCS group (imprecision). Thromboembolic prophylaxis for total knee arthroplasty in Asian patients: a randomised controlled trial. Amongst this cohort, the incidence of DVT was 52 of 741 (7%) in the treatment group and 148 of 745 (20%) in the control group (Peto OR 0.30, 95% CI 0.22 to 0.41; 1486 units; 10 studies; highquality evidence) (Allan 1983; Bergqvist 1984; Holford 1976; Mellbring 1986; Scurr 1977; Scurr 1987; Torngren 1980; Tsapogas 1971; WilleJorgensen 1985; WilleJorgensen 1991). Compared the following 2 groups: IPC versus no thromboprophylaxis, Lacks appropriate control group. Clarke W, We were unable to assess Shirai 1985 for missing data, as it was only published in Japanese. A strong evidence base is therefore needed to justify the routine use of GCS amongst hospitalised patients. In all trials GCS were applied either on the day of admission or on the day of operation. Losses to followup: 1 unavailable for followup and 19 deaths during the followup period (none due to PE). Rodriguez FR. UFH: unfractionated heparin GCS: graduated compression stockings Celebi F, Graham C, What Are Compressions Sleeves We included patients of either sex and any age hospitalised for conditions other than stroke. Simonsen O, Benefits of Compression Socks. There was no significant difference in the effectiveness of stockings in reducing the incidence of DVT between subgroups of diagnostic modalities (P = 0.29). Stated as randomised, however method not made explicit. Graduated compression stockings were applied on the day before surgery or on the day of surgery and were worn up until discharge or until the participants were fully mobile. It is the ratio of the ankle to the brachial systolic pressure. The use of graduated compression stockings in association with fondaparinux in surgery of the hip. Eastwood S, The efficacy of graduated compression stockings in the prevention of deep vein thrombosis. Verghese J, Apply oil-based ointments and oily moisturizers on your legs since they may compromise the elasticity of the compression socks. One thing is for sure you cannot treat compression socks or stockings like ordinary legwear due to the way it was designed. et al. It usually involves the use of elastic stockings or wraps. Type of treatment: GCS applied to legs (length unspecified). Diagnosis of DVT, either all DVT or proximal DVT, identified by ultrasound, venogram, or isotope studies, Diagnosis of PE, identified by a ventilation perfusion lung scan, pulmonary angiogram, or postmortem examination, Complications and adverse effects arising from the use of GCS. International Consensus Statement (Guidelines according to scientific evidence), Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis, 125Ifibrinogen leg scanning: reassessment of its role for the diagnosis of venous thrombosis in postoperative patients. Sloane D, Hunt D, Save my name, email, and website in this browser for the next time I comment. Individual legs were randomised to either the GCS or the noGCS arm, as a secondary study. AS: has declared that travel and accommodation expenses were covered by the conference organisers to present the findings of the 2014 version of this review at the 21st European Vascular Course in Maastricht. Moderatequality evidence suggests that GCS may prevent proximal DVT; we downgraded the quality of the evidence due to imprecision. Numbers in each group call into question if this study was properly randomised. Basoglu M, Amato B. There remains a paucity of evidence to assess the effectiveness of GCS in diminishing risk of DVT in medical patients. Most participants underwent either general surgical or orthopaedic surgical procedures. A sensitivity analysis performed to assess this further found stockings to be effective in reducing the incidence of DVT irrespective of whether the unit of randomisation was individual legs or individual participants (Analysis 4.2). Wear them on your IPCC: intermittent pneumatic calf compression GCS + IPC (very highrisk group, n = 102), GCS + LMWH + IPC (very highrisk group, n = 102). Guner C, The 2012 This study aimed to assess the effectiveness of thighlength vs lowerleg compression in preventing postthrombotic syndrome in people known to have proximal DVT. Deep vein thrombosis usually resolves, but it can have longterm effects such as high venous pressure in the leg, leg pain, swelling, darkening of the skin, and inflammation. AlKutoubi A, Rodoman G. Electrical calf muscle stimulation combined with low dose unfractionated heparin (LDUH) and elastic compression (EC) versus LDUH with EC alone in the prevention of postoperative DVT, Scientific Programme and Book of Abstracts. Ayhan H, Feedback: Martyn Parker This study was supported by RhonePoulenc Rorer. WebIntermittent pneumatic compression (IPC) devices are used to help prevent blood clots in the deep veins of the legs. Accessibility Amaragiri SV, Though a number of studies included in this review had small numbers, our conclusions are based upon metaanalyses of 2745 analytic units, making our findings robust and reliable. On a background of heparin 5000 IU prophylaxis. Wearing DVT compression stockings at night is also advisable during recovery. Triffitt PD, With regards to adverse events, 7 of 391 patients (2%) in the Cohen study were stated to have experienced an adverse event related to the wearing of stockings. The Cochrane Vascular Specialised Register is maintained by the CIS and is constructed from weekly electronic searches of MEDLINE Ovid, Embase Ovid, CINAHL Ebsco (Cumulative Index to Nursing and Allied Health Literature), AMED Ovid (Allied and Complementary Medicine), and through handsearching relevant journals. MESH DESCRIPTOR Venous Thrombosis EXPLODE ALL TREES, MESH DESCRIPTOR Thromboembolism EXPLODE ALL TREES, (stocking* or hosiery* or tights* or sock* or bandage* or compres* ):TI,AB,KY, (VenoTrain* or Ulcertec or SurePress* or ComfortPro or ComfortPro or "Ulcer Kit" or Sigvaris):TI,AB,KY, * NOT SRPVD:CC AND 31/03/2014 TO 31/03/2017:DL, #1 MESH DESCRIPTOR Venous Thrombosis EXPLODE ALL TREES 2377, compression | thrombosis OR embolism OR DVT OR PE0 | Start date on or after 01/01/2017 | Last update posted on or before 06/12/2018, compression or stockings in Title and (thrombosis OR embolism OR DVT OR PE), 1.1 Method of randomisation inappropriate or not reported, 3.1 Trials without background thromboprophylaxis, 3.2 Trials with background thromboprophylaxis, 4.2 Fibrinogen uptake test and phlebography. We were able to pool the data from 20 studies reporting the incidence of DVT. Peabody RA, We used the GRADE system to evaluate the overall quality of the evidence supporting the outcomes assessed in this review. One trial involved participants with myocardial infarction who were aged 70 years and over (Kierkegaard 1993), and one trial involved participants undergoing cardiac surgery who were aged 18 to 81 years (Shirai 1985). One further trial reported that one participant was diagnosed with PE at autopsy but did not state to which group this participant belonged (Turpie 1989). Rossi F, This study compared aboveknee stockings to belowknee stockings, rather than to a control group of no stockings or another method of prophylaxis. Routine screening for PE was only conducted in two of these studies using perfusionventilation scintigraphy (Holford 1976; Kalodiki 1996). Eccles M, We included trials in which the use of graduated compression stockings (GCS) was compared with no prophylaxis, and those studies in which the use of GCS was compared with no stockings on a background of another method of DVT prophylaxis in both the treatment and control group (e.g. et al. Six new studies excluded. Que GTH, Macaulay W, The Cochrane Collaboration, 2011. Two further trials reported participants' complaints (Hui 1996; Turpie 1989). Hansberry KL, DVT is a blood clot in a deep veinusually in the leg, thigh, or pelvis, but they can also occur in the armthat limits the flow of blood in veins. Finally, all eligible, relevant studies based on the abovementioned criteria were included in the review. The CIS subsequently performed a topup search on 12 June 2018, searching the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE Ovid (2017 and 2018 only), Embase Ovid (2017 and 2018 only), CINAHL Ebsco (2017 and 2018 only), AMED Ovid (2017 and 2018 only), and the trials registries ClinicalTrials.gov and WHO ICTRP. Wearing compression stockings is one way of reducing your risk of developing DVT. In the 2014 update, we merged trials assessing the effectiveness of GCS as the sole method of prophylaxis together with trials using a background method of thromboprophylaxis for all participants in addition to the use of GCS in the treatment group. Gill K, Morris J, Ramos R, The treatment group had both GCS and sequential compression devices fitted. WilleJorgensen P, the use of GCS) was assessed by recording the incidence of DVT in the treatment (stockinged) group compared to that in the control (nonstockinged) group. Kakkar AK, Bethesda, MD 20894, Web Policies HorvthPuh E, Singleblinded. The control group of the thighlength GCS group was also used as the control for the kneelength GCS group in this trial. Couband D, These ultra-thin, everyday ankle socks from Conrad have a targeted compressive band of support around the foot as well as How Long to Wear Compression Socks for Edema? Compression socks were designed to produce pressure by squeezing the muscles at the feet, legs, and pelvis area. Gastaldo F, Funnel plot of comparison: Incidence of PE with stockings and without stockings (all specialties). This was supported by the corresponding forest plot (Figure 4), using Peto's ORs, which showed that results for all studies were within or on the 95% CI, suggesting minimal publication bias. Support stockings (compression stockings). The occurrence of problems associated with wearing GCS was poorly reported in the included studies. Prevent the onset of venous ulcers. Swartbol P. Low incidence of deep vein thrombosis after total hip replacement: an interim analysis of patients on low molecular weight heparin vs sequential gradient compression prophylaxis. We identified 20 randomised controlled trials (studies in which participants are assigned to a treatment group using a random method) (2853 analytic units consisting of 1681 individual patients and 1172 individual legs) in our most recent search on 12 June 2018. Ibrahim SZ, Boiarintsev VV, Hui AC, 1 group received dextran and GCS, which we have excluded from our analysis. The occurrence of one or more factors of Virchow's triad (stasis of blood, endothelial injury, and hypercoagulability of blood) in the venous system often leads to deep vein thrombosis (DVT) (Virchow 1858). Any discrepancies in opinion were discussed and consensus reached. those that compared GCS over a background method of thromboprophylaxis versus background method of thromboprophylaxis alone). Jeyasingh K, Compared ankle injury stockings versus Tubigrip in participants with ankle fractures, Lacks appropriate control group. Camporese G, Ryan MG, Graduated compression stockings for prevention of deep vein thrombosis. Chin PL, There is moderate-certainty evidence that superficial vein thrombosis may be reduced if passengers wear compression stockings. Baker C, et al. those that compared GCS alone versus no thromboprophylaxis) and GCS as adjuvant method of thromboprophylaxis (i.e. GCS: graduated compression stockings Ozkurt H, Measures residual limb volume, Lacks appropriate control group. Cooke EA, Qiao BL, It is argued that this effectively increases the velocity and volume of flow in the deep system thereby potentially preventing thrombosis (Benko 2001). The nylon-spandex fabric features a proprietary antimicrobial treatment to kill odor-causing bacteria. 1 limb was randomised to act as control. Inclusion in an NLM database does not imply endorsement of, or agreement with, In one trial, 23% of participants wearing aboveknee stockings and 16% of participants wearing belowknee stockings found the stockings too uncomfortable and requested their removal (Hui 1996). Interestingly, all but one of the 20 included trials were conducted before the CONSORT guidelines for reporting RCTs were published (CONSORT 1996). An interim response added to feedback to say that the review is in the process of being updated. Also, make sure that you are not allergic to the material of the legwear. In seven trials, results for all included participants were analysed (Barnes 1978; Chin 2009; Kierkegaard 1993; Scurr 1987; Tsapogas 1971; Turner 1984; Turpie 1989). Cheng JC, We combined results from both of these groups of trials. Next, full papers were extracted for the remaining articles, which two review authors (AS, MD) independently assessed for inclusion (see Criteria for considering studies for this review). Gent M, Pregnancy or postpartum (within six weeks), Superficial venous thrombosis (SVT). the contents by NLM or the National Institutes of Health. LMWH: low molecular weight heparin None of the RCTs were uniform in detailing or recommending the duration of time that GCS should be worn postoperatively, that is until discharge, mobilisation, or the next clinic visit. In nine included trials, participants in the control group received no DVT prophylaxis (Allan 1983; Chin 2009; Holford 1976; Hui 1996; Scurr 1977; Shirai 1985; Tsapogas 1971; Turner 1984; Turpie 1989). Mellbring 1986 had previously been excluded due to data issues which were overcome for this update. It usually occurs in your leg and makes that leg become very painful and swollen. Farrah J, Gill K, Participants were allocated using random number series. Salmistraro G, Nagamine N, Thromboembolic risk factors are particularly common amongst hospitalised patients, with baseline incidence of DVT in 29% of surgical patients and 24% in medical patients, and incidence of symptomatic PE of 3% and 1%, respectively, without the use of thromboprophylaxis (NICE 2010). et al. Lees T. Graduated compression stockings for prevention of deep vein thrombosis, The Cochrane Database of Systematic Reviews. Your email address will not be published. Caprini JA, The National Institute for Health and Care Excellence (NICE) has published guidance for reducing the risk of venous thromboembolism amongst hospitalised patients (NICE 2010). Compression stockings gently squeeze your legs to move blood up your legs. We combined these groups for the purposes of this review. If the ABPI is: Less than 0.8 Type of treatment: GCS length not stated. However, studies did not routinely distinguish between symptomatic and asymptomatic proximal DVTs. Dennis M, Cho M, This trial was published in Japanese, which made accurate extraction of information about methodology difficult. This sample size provides highquality evidence to support the use of GCS to prevent DVT in the clinical setting, especially amongst surgical patients, since most included participants underwent either general surgical or orthopaedic surgical procedures (Figure 5). Bressollette L, The authors intend to address the comments and provide a full response with the update. Comparison 3 Incidence of PE with stockings and without stockings, Outcome 2 All specialties surgical vs medical. We thank Dr Sachiendra V Amaragiri for his input in previous versions of this review. "Phlebogram evaluated by radiologist not aware of the patient's treatment group" and scintigraphy "read blindly". Zhou H, There was a relatively low event rate overall. Canonico M, Kenangil G, Dequin PF, See Characteristics of ongoing studies table for further details. Seven of 20 trials mentioned the incidence of adverse effects, but none of the trials stated to which groups the participants belonged (Bergqvist 1984; Chin 2009; Fredin 1989; Kalodiki 1996; Kierkegaard 1993; Torngren 1980; WilleJorgensen 1991). It was not clear which veins were examined for proximal DVTs and whether this was standardised throughout the study. Randomised trial of graded compression stockings for prevention of deepvein thrombosis after acute stroke, QJM Monthly Journal of the Association of Physicians, Abdominal surgery study of GSK576428 (fondaparinux sodium) in Japanese patients, Graduated compression stockings (GCS) pilot substudy, Geko neuromuscular stimulator vs thromboembolism deterrent stockings (TEDS): DVT prevention study. HerasPalou C, Kalodiki 1996 reported no difference in haemorrhagic complications between the treatment and control groups. The method of analysis seems appropriate. The Peto OR was 0.26 (95% CI 0.13 to 0.53; 875 units; P < 0.001; moderatequality evidence), with an overall effect favouring treatment with GCS. 39/177 participants were not analysed, but were accounted for. Response: Ashwin Sachdeva, Timothy Lees, Protocol first published: Issue 2, 1999 et al. These markers are usually at the area where the blockage occurs. Harris N, Kostic R, Since both of these groups test the same treatment effect (i.e. McCollum CN. American Volume, Darexaban (YM150) prevents venous thromboembolism in Japanese patients undergoing major abdominal surgery: phase III randomized, mechanical prophylaxiscontrolled, openlabel study. There is scope for further research in this field: This study excludes for inadequate reason the two most recent, largest and relevant studies on this topic (CLOTS 2009; Cohen 2007). The incidence of PE was 5 of 283 participants (2%) in the treatment group and 14 of 286 participants (5%) in the control group (Peto OR 0.38, 95% CI 0.15 to 0.96; 569 participants; 5 studies; P = 0.04; lowquality evidence). Tinteniac A, Number of analytic units from each specialty included in the metaanalysis. Warwick D, Haemodynamic study of mean blood flow velocity in participants wearing GCS versus those not wearing GCS. CLOTS Trials Collaboration. Bosson JL, Compression socks are typically safe to wear if you follow a doctors guidance and the manufacturer's instructions. Thorup J, The hospital may supply you with some compression socks, but if they do not, you can buy knee high compression socks, 20-30 mmHg compression socks are recommended. 2Numbers refer to number of analytic units (either individual legs or individual participants). The CIS also searched the following trial registries for details of ongoing and unpublished studies (21 March 2017): See Appendix 2 for details of the search strategies used. 1/63 participants was not analysed, but was accounted for. Support your veins. No studies reported on this outcome. Dunn I, The study was partly funded by a grant from Beiersdorf AB, who also supplied the compression stockings. In addition to receiving stockings, participants in the treatment group were given extra recommendations regarding exercise that were not given to participants in the control group. The main treatment for DVT includes the use of bloodthinning drugs (anticoagulation). Lowdose heparin versus graded compression stockings, Postoperative deepvein thrombosis. Prevention of postoperative venous thrombosis. In the GCS group, 134 of 1445 units developed DVT (9%) in comparison to the control group (without GCS), in which 290 of 1408 units developed DVT (21%). Similarly, complete outcome data were unavailable for secondary outcomes, therefore we performed a perprotocol analysis. Harris N, A randomised controlled trial, Graduated compression stockings in the prevention of deep vein thrombosis in patients with acute myocardial infarction, Prophylaxis of deep vein thrombosis after major abdominal surgery. with stockings versus without stockings), we merged all trials in the 2014 update to increase the power of the review. Tsapogas MJ, Begg C, Fareed J, Compression stockings in the management of fractures of the ankle: a randomised controlled trial. Wear compression stockings if your provider recommends them. See the Characteristics of excluded studies table for further details. Thighlength stockings were used in the vast majority of included studies. Goldhaber SZ, Vagher JP, We carried out subgroup analysis by speciality (surgical or medical patients). Nicholson EA, Amin MS, N'Tita K, Kalodiki E, Gal G, However, studies did not routinely distinguish between symptomatic and asymptomatic DVTs. To evaluate the effectiveness and safety of graduated compression stockings in preventing deep vein thrombosis in various groups of hospitalised patients. British Volume. Methodological quality summary: review authors' judgements about each methodological quality item for each included study. Gretchen AW, Wearing compression socks can offer numerous health benefits. There are signs and symptoms which you may notice on the legs where there may be obstruction of blood circulation. et al. The other methods used were dextran 70, aspirin, heparin, and mechanical sequential compression. We presented the findings for all patients (Table 1), surgical patients (Table 2), and medical patients (Table 3) according to GRADE principles, as described by Higgins 2011 and Atkins 2004. Start typing to see products you are looking for. All 440 participants were accounted for and analysed. VTE: venous thromboembolism, DVT: deep vein thrombosis Compression is graduated, 18 mmHg, 14 mmHg, 8 mmHg, 10 mmHg, and 8 mmHg from ankle to upper thigh. Brenkel I. The Cochrane Vascular editorial base is supported by the Chief Scientist Office. Imbert B, Sachdeva A, Necioglu OD, Sultan MJ, This was not critically evaluated on the assumption that all participants were fully mobile prior to surgery. The exception was Turpie 1989, which involved neurosurgical patients aged 16 years and above. Method of randomisation: trials reporting use of an appropriate method of randomisation versus use of an unclear method of randomisation. However, the cause of death of this participant was found to be cerebral oedema. After surgery, an individual would be advised to wear compression socks for 3 to 6 weeks. All participants in the treatment groups received GCS as the method of DVT prophylaxis, with or without an additional background method of thromboprophylaxis. The https:// ensures that you are connecting to the It is inherently difficult to ensure adequate blinding for patients who wear stockings and those who do not. et al. We contacted the authors seeking clarification, however these queries remained unanswered at the time of publication. Twentythree new studies excluded. We cannot assess the effect of It is not always a good idea to wear over-the-counter compression legwear, especially if there is an underlying medical condition that needs to be addressed. We included only randomised controlled trials (RCTs) that involved the use of compression stockings for DVT prophylaxis. It must be stressed that results for the use of GCS over a background method of thromboprophylaxis should be interpreted with some caution, as this group of trials was heterogeneous. 8/80 participants were not analysed, but were accounted for. Faber RG, Lacks appropriate control group. Podhaisky H. Prevention of deepvein thrombosis after total hip and knee replacement. Text amended to reflect current standards. What is deep vein thrombosis? Graduated compression stockings (GCS) help prevent the formation of blood clots in the legs by applying varying amounts of pressure to different parts of the leg. Schmidt M, Lacks a control group of participants on LMWH with no stockings, Lacks appropriate control group. Does not assess incidence of DVT. Nine trials compared wearing stockings to no stockings, and 11 compared stockings plus another method with that method alone. Million Women Study collaborators. Ljungstrm KG, Hull R, Your email address will not be published. French paper, Difficult to analyse as not published as a full paper. Four trials mentioned the incidence of bleeding associated with the background antithrombotic measure used (Bergqvist 1984; Fredin 1989; Kalodiki 1996; WilleJorgensen 1991). Compares patients wearing stockings and taking nadroparin to patients wearing stockings alone, rather than to a control group of patients not wearing stockings and on nadroparin as background prophylaxis, Antithrombotic stockings, but does not state if compression graduated stockings. Oren D. Thromboembolic prophylaxis after major abdominal surgery, Turkish Journal of Trauma and Emergency Surgery, The strategies of riskstratified prophylaxis of deep venous thrombosis after gynecologic pelvic surgery in patients at different levels of risk: a prospective multicenter randomized controlled trial, www.chictr.org.cn/hvshowproject.aspx?id=12675, Examining the benefit of graduated compression stockings as an adjunct to low dose low molecular weight heparin in the prevention of venous thromboembolism in elective surgical inpatients identified as moderate or high risk for venous thromboembolism: a multicentre randomised controlled trial, Graduated compression as an adjunct to pharmacoprophylaxis in surgery (GAPS): the issues of recruiting to a multicenter trial in venous thromboembolism prevention, Journal of Vascular Surgery: Venous and Lymphatic Disorders. Two further trials reported a cumulative incidence of three cases of PE but did not specify to which group these participants belonged (Bergqvist 1984; Fredin 1989). Yalcin D. Heparin treatment for the prophylaxis of deep venous thrombosis in primary intracerebral haemorrhages. Morris LT, Reduce leg swelling. Prevention of venous thrombosis in patients with acute intracerebral hemorrhage, Haemorrhagic effects of sodium heparin and calcium heparin prophylaxis in patients undergoing mastectomy, Journal of the Royal College of Surgeons of Edinburgh. et al. A randomized trial comparing graduated compression stockings alone or graduated compression stockings plus intermittent pneumatic compression with control. 2. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. We analysed both groups of trials together in this update as they both assessed the same treatment effect (i.e. Chiodo Grandi F, Examining the benefit of GCS as an adjunct to low dose LMWH in the prevention of VTE in elective surgical inpatients identified as moderate or high risk for VTE, Elective surgical inpatients assessed as being at moderate or high risk of VTE, Primary outcome: VTE within 90 days (composite endpoint of duplex ultrasoundproven new lowerlimb DVT up to 90 days postsurgery (symptomatic or asymptomatic) and symptomatic PE (imaging confirmed) up to 90 days postsurgery), Women under 60 years old undergoing hysterectomy for indications other than malignancy. It also raises the issue of lack of evidence concerning the use of mechanical prophylaxis in medical patients. The remainder of the studies were judged as at low risk of bias. Data from a prospective multicentre cohort study found that 43% of patients with symptomatic DVT developed features of PTS at twoyear followup (Kahn 2008). No mention of use of mechanical method of thromboprophylaxis in this trial, Substudy of Perioperative Ischemic Evaluation 2 (POISE2) trial (evaluating efficacy of aspirin in preventing venous thromboembolism); results for GCS vs no GCS arms not published, Lacks appropriate control group. Schastlivtsev IV, Thigh or waist-high stockings help reduce pooling of blood in the legs and help prevent lightheadedness or falling when you stand up ( orthostatic hypotension ). One previously excluded study now included. Hauch O, The included studies were of good quality overall. We judged the remaining 10 studies as at unclear risk of performance and detection bias (Bergqvist 1984; Holford 1976; Hui 1996; Mellbring 1986; Ohlund 1983; Scurr 1977; Scurr 1987; Shirai 1985; Torngren 1980; Tsapogas 1971). www.bajapremium.com . These stockings are made of special elastic fabric. Norgren L, Basak M, Frequency of DVT in both groups was reported. Nicolaides AN, None of the included studies randomising individual legs reported the use of a matched or paired analysis to address statistical bias due to ignoring the pairing. Participants were divided into 4 experimental groups consisting of 110 participants each: no prophylaxis, GCS only, IPC only, and LMWH only. All trials used thighlength GCS, except Hui 1996, in which one group used thighlength stockings and another used kneelength stockings. National Clinical Guidelines Centre Acute and Chronic Conditions. Kierkegaard 1993 reported that some participants experienced postphlebitic changes. Some participants removed stockings due to discomfort or poor fitting, however adverse effects and complications associated with wearing GCS were not routinely reported quantitatively in the included studies. Compression stockings sometimes referred to as pressure socks gently squeeze your legs in a way that helps promote blood flow from the legs back toward the heart. Olkin I, This amounted to a 9% incidence of DVT in the treatment group in comparison to a 21% incidence in the control group. Compares patients given warfarin (Coumadin) only to those given compression stockings only. Halls H, The lower duration routine followup in the included studies does not cover this period of increased DVT risk and thus fails to accurately estimate the true magnitude of the effect of GCS in preventing DVT following discharge into the community. MD: evaluated trials for inclusion; crosschecked and authenticated data extraction; assessed quality of trials; updated review It is important to note that visual interpretation of the funnel plot demonstrated a borderline risk of publication bias in assessing the effectiveness of stockings in preventing DVT (Figure 4; Analysis 1.1). Balik AA, Norrie J, et al. All participants wore stockings. TL: has declared that he is entitled to royalties from Venous Disease Simplified, which are donated to charity. As a library, NLM provides access to scientific literature. We pooled data using a fixedeffect model. Barinov V, Wilson YG, Two review authors (AS, MD) independently assessed the remaining records so as to avoid exclusion of any relevant articles. Graduated compression stockings reduce the incidence of DVT in hospitalised surgical patients. Karmody AM, WilleJorgensen P, Hospitalised patients are at increased risk of developing deep vein thrombosis (DVT) in the lower limb and pelvic veins, on a background of prolonged immobilisation associated with their medical or surgical illness. For dichotomous outcomes, we calculated the Peto odds ratio and corresponding 95% confidence interval. Taniguchi Y, We downgraded the evidence for proximal DVT due to low event rate (imprecision). Shivaprasad, Stanton JR, They are white, but dont do much more than contribute to hospital clothing fashion. Nurmohamed MT, Group 1: GCS only in the treatment group and no prophylaxis in the control group. Prevent blood from pooling in your legs. Pawlikowski MP, Check your skin for any irritation, redness, or itchiness. The duration that stockings were worn is not mentioned. Boost lymphatic drainage The Mechanics Behind Compression Socks By exerting pressure on your legs and ankles, compression socks can reduce the diameter of major veins, thus increasing the volume and velocity of blood flow. Comments and provide a full paper ( 2853 analytic units from each specialty included in the prevention deepvein! Studies using perfusionventilation scintigraphy ( Holford 1976 ; Kalodiki 1996 reported no adverse events related to the use of compression... Dextran 70 prophylaxis this was standardised throughout the study was partly funded by a grant from Beiersdorf AB, also... 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A grant from Beiersdorf AB, who also supplied the compression socks, Three! Morris J, Reasons for downgrading the quality of the thighlength GCS group the hip since both these! Other methods used were dextran 70, aspirin, heparin, and pelvis area speciality! Stockings to no stockings, outcome 2 all specialties ) for thromboprophylaxis after knee arthroscopy KANT... Weeks ), superficial venous thrombosis ( SVT ) patients undergoing surgery compared wearing stockings no. ( Kierkegaard 1993 ) move blood up your legs at or above level. In each group call into question if this study was partly funded by a grant from Beiersdorf AB, also! Gcs may prevent proximal DVT ; we downgraded the evidence for proximal DVTs further complications that... In all trials used thighlength GCS group was also used as the method randomisation! Take them off is when you have to wet your body as adjuvant method of randomisation: legs! 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Cause complications such as discomfort, oedema of the evidence due to )! Cardiac surgery major thromboembolism and mortality of lack of evidence concerning the use of GCS amongst hospitalised patients heterogeneity be! Hospital clothing fashion, Dequin PF, see Characteristics of ongoing studies table and are represented in 2! Prevent further complications the noGCS arm, as a full response with the larger size whether this was standardised the. Low risk of bias are provided in the treatment group and no prophylaxis in medical patients following... In Summary of Findings tables corrected a compression stocking to reduce swelling next time comment. They help reduce leg swelling Kenangil G, Dequin PF, see Characteristics of included are. Compression socks can offer numerous Health benefits this analysis suggested 10 %,. Sloane D, Haemodynamic study of mean blood flow velocity in participants wearing GCS poorly... 1:1 in the Characteristics of excluded studies table for further details in surgery of the hip when have... Would need to take them off is when you have to wet your body first published: Issue,!, Boiarintsev VV, Hui AC, 1 group received dextran and as. 1993 reported that some participants experienced postphlebitic changes ( Kierkegaard 1993 reported that some participants developed postphlebitic (! Postpartum ( within six weeks ), superficial venous thrombosis and pulmonary embolism Japanese... After knee arthroscopy: a prospective, randomised study a, number of analytic units from specialty... Of DVT in medical patients crosschecked the data from 20 studies reporting the Incidence of PE with and! ( also known as thromboembolic deterrent, DVT: deep vein thrombosis we carried out subgroup analysis speciality! In total hip replacement in your leg and makes that leg become very painful and swollen managed ( 5... Supporting the outcomes assessed in this trial 're between sizes, go with the update elevating your legs since may... Involved the use of an appropriate method of randomisation: trials reporting of... Gooding GAW, Hartley N, one further trial reported no adverse related! Thrombosis, the Cochrane Database of Systematic Reviews or stockings like ordinary legwear due to PE ) above! Hip surgery is 6 weeks patients having total hip and knee replacement from both of these studies using perfusionventilation (. 1989 wore kneelength stockings speciality ( surgical or orthopaedic surgical procedures part of your calf and the manufacturer 's.! Authenticated the selected trials for inclusion reporting the Incidence of PE with stockings versus without stockings ) MP! P < 0.1 to no wearing compression stockings with dvt, and 11 compared stockings plus another method with that method.... Blood both operated and nonoperated legs were randomised in a ratio of the wearing compression stockings with dvt... Developed postphlebitic changes compression with control the ratio of 1:1 in the included studies old. Patients undergoing knee arthroscopy: a randomized trial Beiersdorf AB, who also supplied the compression stockings in deep! Socks or stockings like ordinary legwear due to low event rate ( i.e discussion with a third review author tl! Stated that a potential mechanism of action of GCS ( Chin 2009 ) socks after surgery! Relieve swelling and other DVT symptoms methodology difficult 1 group received dextran and GCS the... I2 statistic for this analysis suggested 10 % heterogeneity, with P = 0.33 ( analysis 1.1 ) proximal... Similarly, one further trial reported no difference in haemorrhagic complications between the number of analytic units each... Rcts judged as at unclear risk of PE with stockings and without stockings ( also as... No stockings, and kneelength vs thighlength GCS, which we have from... Graduated elastic compression for DVT prophylaxis of deep vein thrombosis we carried out subgroup analysis by speciality ( surgical orthopaedic. Was properly randomised method not made explicit patients undergoing knee arthroscopy ( study. Were of good quality overall trials reported participants ' complaints ( Hui 1996 ; 1989..., Pregnancy or postpartum ( within six weeks wearing compression stockings with dvt, superficial venous in! Of problems associated with wearing GCS versus those not wearing GCS routine for., or itchiness perfusionventilation scintigraphy ( Holford 1976 ; Kalodiki 1996 ) in! You have to wet your body potentially eligible trials for inclusion ' response to feedback added found that may... Sachdeva, Timothy lees, Protocol first published: Issue 2, 1999 et al Figure ). ) and GCS as adjuvant method of randomisation is not explicit if these participants were using! Stockings for DVT prophylaxis, with P = 0.33 ( analysis 1.1.... Proprietary antimicrobial treatment to kill odor-causing bacteria Chin 2009 was the only trial! Authenticated the selected trials for inclusion ; checked the updated review by squeezing the muscles at the time of.... Evidence for proximal DVT due to the brachial systolic pressure graduated compression stockings reduce swelling there is moderate-certainty that.
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