BMJ  2008;336:1148 (24 May), doi:10.1136/bmj.39583.772234.3A

Letters

Compression stockings

We need to look critically at evidence for universal use

The first 150 words of the full text of this article appear below.

The article by Phillips et al is yet another so called evidence based report that fails to appreciate the clinical aspect of thromboembolism.¹ The report mentions only the incidence of the surrogate outcome measure of asymptomatic venous thromboembolism. Clinical outcomes of clinical deep vein thrombosis, pulmonary embolism, and mortality are not mentioned.

The authors have not used clinically relevant outcomes. They are incorrect to state without reference that asymptomatic venous thrombosis often gives rise to long term morbidity. This is contrary to published evidence in orthopaedics, according to which such asymptomatic thrombi resolve without any associated morbidity.²

In orthopaedics there is lamentable evidence about the efficacy of graduated compression stockings. The four studies on orthopaedic patients in the Cochrane review entailed a total of only 316 participants.³ A reduction in asymptomatic thrombosis was noted but no clinical benefits recorded. A later, more detailed study of 795 participants found no benefit . . . [Full text of this article]

¹ Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough PE3 9GZ

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Use graduated compression stockings postoperatively to prevent deep vein thrombosis

Susan M Phillips, Martin Gallagher, and Heather Buchan
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