Use graduated compression stockings postoperatively to prevent deep vein thrombosis

doi:10.1136/bmj.39513.642789.AD

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Susan M Phillips, director1,
Martin Gallagher, research fellow2,
Heather Buchan, advisor3

¹Research Implementation Program, National Institute of Clinical Studies, National Health and Medical Research Council, Melbourne, VC 3004 Australia
²George Institute for International Health, Sydney, Australia
³National Health and Medical Research Council, Melbourne

Correspondence to: S M Phillips sue.phillips{at}nhmrc.gov.au

Improvements in clinicians’ use of graduated compression stockings are needed, supported by consistent policies in hospitals and general practice

The clinical problem

The overall risk of deep vein thrombosis is higher than 20% after major surgery and higher than 40% in patients having major orthopaedic surgery.1 The level of risk for individual patients depends on their clinical condition and the nature of the operation. Although a deep vein thrombosis may be asymptomatic, it will often give rise to long term morbidity, and there is potential for pulmonary embolism and sudden death. Graduated compression stockings are effective in decreasing the risk of deep vein thrombosis, either alone or in combination with pharmacological prophylaxis in high risk patients. Both forms of prophylaxis are used suboptimally in clinical settings.2 Graduated compression stockings should be used routinely for surgical inpatients.

Key points

Graduated compression stockings are effective in reducing the risk of deep vein thrombosis in surgical patients, either alone or in combination with pharmacological prophylaxis in patients at higher risk
The advantage of stockings in surgical settings is that they do not increase the risk of bleeding, but they should not be used in patients with peripheral arterial disease
All hospitals should have thromboprophylaxis policies that clarify who is responsible for assessing and managing the risk of deep vein thrombosis in admitted patients
All patients admitted to hospital for surgery should have their risk assessed, and “at risk” patients should wear graduated compression stockings from admission until they return to their usual level of mobility