Thigh-length Graduated Compression Stockings Research Articles

The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper.

ImportanceThe post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT), occurring in up to 40–50% of cases. There are limited evidence-based approaches for PTS clinical management.ObjectiveTo provide an expert consensus for PTS diagnosis, prevention, and treatment.Evidence-ReviewMEDLINE, Cochrane Database review, and GOOGLE SCHOLAR were searched with the terms “post-thrombotic syndrome” and “post-phlebitic syndrome” used in titles and abstracts up to September 2020.Filters WereEnglish, Controlled Clinical Trial / Systematic Review / Meta-Analysis / Guideline. The relevant literature regarding PTS diagnosis, prevention and treatment was reviewed and summarized by the evidence synthesis team. On the basis of this review, a panel of 15 practicing angiology/vascular medicine specialists assessed the appropriateness of several items regarding PTS management on a Likert-9 point scale, according to the RAND/UCLA method, with a two-round modified Delphi method.FindingsThe panelists rated the following as appropriate for diagnosis: 1-the Villalta scale; 2- pre-existing venous insufficiency evaluation; 3-assessment 3–6 months after diagnosis of iliofemoral or femoro-popliteal DVT, and afterwards periodically, according to a personalized schedule depending on the presence or absence of clinically relevant PTS. The items rated as appropriate for symptom relief and prevention were: 1- graduated compression stockings (GCS) or elastic bandages for symptomatic relief in acute DVT, either iliofemoral, popliteal or calf; 2-thigh-length GCS (30–40 mmHg at the ankle) after ilio-femoral DVT; 3- knee-length GCS (30–40 mmHg at the ankle) after popliteal DVT; 4-GCS for different length of times according to the severity of periodically assessed PTS; 5-catheter-directed thrombolysis, with or without mechanical thrombectomy, in patients with iliofemoral obstruction, severe symptoms, and low risk of bleeding. The items rated as appropriate for treatment were: 1- thigh-length GCS (30–40 mmHg at the ankle) after iliofemoral DVT; 2-compression therapy for ulcer treatment; 3- exercise training. The role of endovascular treatment (angioplasty and/or stenting) was rated as uncertain, but it could be considered for severe PTS only in case of stenosis or occlusion above the inguinal ligament, followed by oral anticoagulation.Conclusions and RelevanceThis position paper can help practicing clinicians in PTS management.

WeMPiC protocol to prevent Deep Venous Thrombosis in patients with neurosurgical diseases

Background: Deep Venous Thrombosis is a common yet difficult problem to prevent in neurosurgical patients. Recent trials did not find sufficient evidence to support use of graduated compression stockings, however we believe, this inefficiency may be due to the method of application which needs to be modified. We have been following a patient specific mechanical prophylaxis protocol, nicknamed WeMPiC. This study aims to evaluate the effectiveness of WeMPiC protocol.
 Methods: An observational cohort study was performed including consecutive patients admitted to neurosurgical ICU who were bedridden for >7 days between April 2014 and September 2017. We developed WeMPiC protocol of early weaning off, early mobilization, limb physiotherapy and alternate two hours on and off application of thigh length graduated compression stockings. Lower limbs compression ultrasound studies were performed on alternate days.
 Results: One hundred thirty-one patients were included in the study. Mean age of patients was 53.7+ 20.6 years. Of these patients, 52.7% had stroke (91% had hemorrhages), 32.1% had head injury and 7.6% each had spine problem and brain tumor each. five (3.8%) developed deep venous thrombosis on the 4th and 6th day of ICU stay, mainly in popliteal veins (2.3%) and femoral veins (1.5%). Deep venous thrombosis was associated with younger age (47 years, p=0.005), ICU stay (13 days, p=0.014), Wells’ score (4.6, p<0.0001) and Poor Glasgow Coma Score at presentation (9, p=0.004). Power of study calculated for the cohort incidence of 3.8% was 100%. Cost benefit of $336 with WeMPiC protocol was seen as compared to the Low molecular weight heparin prophylaxis over four weeks.
 Conclusions: Compared to incidence of 12.1% in CLOTS 3 trial among the unexposed patients, we report a risk reduction of 8.3% with WeMPiC protocol which is cost effective and highly applicable in resource constraint scenarios.

Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis.

Deep-vein thrombosis (DVT) can occur in surgical patients. Routine prophylaxis can be pharmacological and/or mechanical [e.g. graduated compression stockings (GCSs)]. GCSs are available in knee length or thigh length. To establish the expected value of undertaking additional research addressing the relative effectiveness of thigh-length GCSs versus knee-length GCSs, in addition to pharmacoprophylaxis, for prevention of DVT in surgical patients. Systematic review and economic model, including value of information (VOI) analysis. Randomised controlled trials (RCTs) assessing thigh- or knee-length GCSs in surgical patients were eligible for inclusion. The primary outcome was incidence of DVT. DVT complications and GCSs adverse events were assessed. Random-effects meta-analysis was performed. To draw on a wider evidence base, a random-effects network meta-analysis (NMA) was undertaken for the outcome DVT. A review of trials and observational studies of patient adherence was also conducted. A decision-analytic model was developed to assess the cost-effectiveness of thigh- and knee-length GCSs and the VOI. Twenty-three RCTs were included in the review of effectiveness. There was substantial variation between trials in terms of the patient characteristics, interventions and methods of outcome assessment. Five trials comparing knee-length with thigh-length GCSs with or without pharmacoprophylaxis were pooled; the summary estimate of effect indicated a non-significant trend favouring thigh-length GCSs [odds ratio (OR) 1.48, 95% confidence interval (CI) 0.80 to 2.73]. Thirteen trials were included in the NMA. In the base-case analysis, thigh-length GCSs with pharmacoprophylaxis were more effective than knee-length GCSs with pharmacoprophylaxis (knee vs. thigh OR 1.76, 95% credible interval 0.82 to 3.53). Overall, thigh-length stockings with pharmacoprophylaxis was the most effective treatment, with a 0.73 probability of being the most effective treatment in a new trial of all the treatments. Patient adherence was generally higher with knee-length GCSs, and patients preferred knee-length GCSs. Thigh-length GCSs were found to be cost-effective in all but the subgroup with the lowest baseline risk, although the absolute differences in costs and effects were relatively small. The expected value of perfect information ranged from £0.2M to £178.0M depending on the scenario and subgroup. The relative effect parameters had the highest expected value of partial perfect information and ranged from £2.0M to £39.4M. The value of further research was most evident in the high-risk subgroups. There was substantial variation across the included trials in terms of patient and intervention characteristics. Many of the included trials were old and poorly reported, which reduces the reliability of the results of the review. Given that the results from both the standard meta-analysis and the NMA lacked precision (CIs were wide) owing to the heterogeneous evidence base, a new definitive trial in high-risk patients may be warranted. However, the efficiency of any further research (i.e. whether this represents value for money) is dependent on several factors, including the acquisition price of GCSs, expected compliance with thigh-length GCSs wear, and whether or not uncertainty can be resolved around possible effect modifiers, as well as the feasibility and actual cost of undertaking the proposed research. This study is registered as PROSPERO CRD42014007202. The National Institute for Health Research Health Technology Assessment programme.

A randomised clinical trial comparing the patient comfort and efficacy of three different graduated compression stockings in the prevention of postoperative deep vein thrombosis.

To compare the comfort levels of patients regarding the use of three different graduated compression stockings and to analyse the efficacies of the graduated compression stockings in relation to patient comfort and compliance in prevention of postoperative deep vein thrombosis. Graduated compression stockings are very important with other prophylaxis methods in postoperative deep vein thrombosis prophylaxis. In meta-analyses and systematic review studies, it was reported that knee-length and thigh-length graduated compression stockings had similar efficacies. However, there is no randomised study in literature regarding the patient problems and levels of comfort with the use of graduated compression stockings of different sizes and pressures. A randomised clinical trial design. A total of 219 patients were randomised into three groups (n=73 in each group). Group I was given low-pressure, knee-length graduated compression stockings, group II was given low-pressure, thigh-length graduated compression stockings and group III was given moderate-pressure, knee-length graduated compression stockings. The level of patients comfort regarding the graduated compression stockings and occurrence of deep vein thrombosis were examined. The vast majority of the patients (79·5%) in group III and 52·1% of the patients in group II stated experiencing problems during the use of the graduated compression stockings (p<0·001). The graduated compression stockings were reported by the patients as being very comfortable in the group I (p<0·001). No findings of thrombosis were observed in any of the groups. The low-pressure, knee-length graduated compression stockings are as effective as the other graduated compression stockings of different pressures and sizes in the postoperative deep vein thrombosis prophylaxis, and the patients have fewer problems while using these graduated compression stockings with a high satisfaction. The combined use of pharmacological, mechanical and physical methods and patient education is effective in the prevention of postoperative deep vein thrombosis. The use of low-pressure, knee-length graduated compression stockings in clinical practice may be recommended, as the patients have fewer problems while using these graduated compression stockings with a high satisfaction.

Compression in acute stroke: nursing considerations

British Journal of Neuroscience NursingVol. 11, No. Sup2 CommentCompression in acute stroke: nursing considerationsEmma GeeEmma GeeSearch for more papers by this authorEmma GeePublished Online:27 Apr 2015https://doi.org/10.12968/bjnn.2015.11.Sup2.20AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References CLOTS trial collaboration (2009) Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS Trial 1): a multicentre, randomised controlled trial. Lancet 373(9679): 1958–65 Crossref, Google ScholarCLOTS trials collaboration (2010) Thigh-length versus below-knee stockings for DVT prophylaxis after stroke: a randomised trial. Ann Intern Med 153(9): 553–62 Crossref, Google ScholarCLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration et al. (2013) Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS3): a multicentre randomised controlled trial. Lancet 382(9891): 516–24 Crossref, Google ScholarCLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration (2014) Effect of intermittent pneumatic compression on disability, living circumstances, quality of life, and hospital costs after stroke: secondary analyses from CLOTS 3, a randomised trial. Lancet Neurol 13(12): 1186–92 Crossref, Google ScholarKearon C (2003) Natural History of Venous Thromboembolism. Circulation 107(23): 122–30 Google ScholarKelly J, Rudd A, Lewis RR, Coshall C et al. (2004) Venous Thromboembolism after acute ischaemic stroke; a prospective study using magnetic resonance direct thrombus imaging. Stroke 35: 2320–25 Crossref, Google ScholarKohro S, Yamakage M, Sato K et al. (2005) Intermittent pneumatic foot compression can activate blood fibrinolysis without changes in blood coagulability and platelet activation. Acta Anaesthesiologica Scandinavica 49: 660–4 Crossref, Google ScholarLankeit M, Konstantinides S (2011) Mortality risk assessment and the role of thrombolysis in pulmonary embolism. Critical Care Clinics 27(4): 953–67 Crossref, Google ScholarNational Institute for Health and Care Excellence (2010) NICE clinical guidance 92. Venous thromboembolism: reducing the risk: Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. https://www.nice.org.uk/guidance/cg92 (accessed 26 March 2015) Google ScholarNational Institute for Health and Care Excellence (2015) Addendum to NICE clinical guidance CG92. Reducing the risk of venous thromboembolism in patients admitted to hospital (Chapter 24-stroke patients). Draft for consultation. http://tinyurl.com/pdyk9xz (accessed 26 March 2015) Google ScholarStevens S, Woller S (2013) Intermittent pneumatic compression in patients with stroke. Lancet 382(9891): 484–6 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 April 2015Volume 11Issue Sup2ISSN (print): 1747-0307ISSN (online): 2052-2800 Metrics History Published online 27 April 2015 Published in print 1 April 2015 Information© MA Healthcare LimitedPDF download

The Effect of Graduated Compression Stockings on Long-term Outcomes After Stroke

Background and Purpose— Most randomized controlled trials of venous thromboembolism prophylaxis have focused on reduction of deep vein thrombosis, predominantly asymptomatic deep vein thrombosis, detected on imaging. We aimed to estimate the effects of graduated compression stockings on venous thromboembolism events, survival, and functional status at 6 months after stroke. Methods— The CLOTS Trials adopted an international multicentre, parallel group design, with central randomization and a 1:1 treatment allocation. In CLOTS Trial 1, 2518 immobile stroke patients were allocated thigh-length graduated compression stockings or not, and in CLOTS trial 2, 3014 to thigh-length or below-knee graduated compression stockings. We measured vital status, Oxford Handicap Scale, and quality of life (EQ5D-3 L) at 6 months. Results— We compared survival in patients enrolled in Trials 1 and 2 with a Cox proportional hazards model, including variables included in our minimization algorithm. In both trials, allocation to thigh-length graduated compression stockings was associated with a very slight, but nonsignificant, increased hazard of death in the first 6 months (Trial 1: hazard ratio, 1.087; 95% confidence interval, 0.913–1.295; and Trial 2: hazard ratio, 1.037; 95% confidence interval, 0.892–1.205). There were no statistically significant differences in venous thromboembolism events, Oxford Handicap Scale, or EQ5D-3 L between the treatment groups in CLOTS Trials 1 or 2. Conclusions— Although underpowered to detect clinically important effects on long-term outcomes, our results effectively exclude a &gt;10% relative reduction in the hazard of death within 6 months associated with the use of thigh-length stockings. No other long-term benefits were apparent.

Effect of Graduated Compression Stockings on Venous Blood Velocity in Supine Resting Hospitalized Patients

The effects of graduated compression stockings (GCSs) on venous blood velocity were measured in 26 hospitalized medical patients while supine at rest. Peak blood velocity in the right femoral vein was 21.6 cm/s without GCS and 23.0 cm/s with GCS [not significant (NS)]. Peak blood velocity in the right popliteal vein was 12.5 cm/s without GCS and 15.0 cm/s with GCS (NS). Mean blood velocity in the right femoral vein did not increase significantly with GCS, but mean blood velocity in the right popliteal vein increased marginally from 5.0 cm/s to 5.8 cm/s (P = .05). Among 11 patients with venous insufficiency (refilling time ≤19 s), neither peak nor mean blood velocity in the femoral or popliteal veins increased significantly with GCS. In conclusion, thigh-length GCS in hospitalized patients had little or no effect on popliteal or femoral vein blood velocity while supine at rest, irrespective of whether the patients had venous insufficiency.

Knee length versus thigh length graduated compression stockings for prevention of deep vein thrombosis in postoperative surgical patients

Graduated compression stockings (GCS) are a valuable means of thromboprophylaxis in hospitalised postoperative surgical patients. But it is still unclear whether knee length graduated compression stockings (KL) or thigh length (TL) stockings are more effective. The aim of this review was to systematically analyse the randomised, controlled trials that have evaluated the effectiveness of KL versus TL GCS as a thromboprophylaxis tool in hospitalised patients undergoing various types of surgery. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched February 2012) and CENTRAL (2012, Issue 1). The authors searched MEDLINE and EMBASE (until 27 February 2012) and they also searched the reference lists of relevant articles to identify additional trials. Randomised controlled trials published in any language on KL versus TL GCS used as a thromboprophylaxis tool in hospitalised patients of any age and either gender. Data extraction was undertaken independently by two review authors using data extraction sheets and confirmed by the third review author. Three studies, with a combined total of 496 patients, matched the inclusion criteria for this review. All three included studies evaluated the role of KL and TL in thromboprophylaxis among a group of postoperative patients. These studies showed no significant difference in the ability of the two modalities of leg compression to reduce the incidence of deep vein thrombosis in postoperative patients. In both the fixed-effect model (odds ratio (OR) 1.55, 95% confidence interval (CI) 0.78 to 3.07, P = 0.21) and random-effects model (OR 1.32, 95% CI 0.43 to 4.06, P = 0.63) KL graduated compression stockings were as effective as TL stockings in thromboprophylaxis. However, there was significant heterogeneity (Tau(2) = 0.50; Chi(2) = 4.12, df = 2 (P = 0.13); I(2) = 51%) among trials. Results of this review may be considered weak because there was significant heterogeneity among included trials resulting from inadequate randomisation techniques, allocation concealment, power calculations and the absence of intention-to-treat analysis. This review found that there is insufficient high quality evidence to determine whether or not KL and TL GCS differ in their effectiveness in terms of reducing the incidence of deep vein thrombosis (DVT) in hospitalised patients. A major multicentre RCT is required to address this issue.In the meantime, the decision on which type of stocking to use in clinical practice is likely to be influenced by factors such as patient compliance, ease of use and cost implications.

Can clinical features distinguish between immobile patients with stroke at high and low risk of deep vein thrombosis? Statistical modelling based on the CLOTS trials cohorts

BackgroundDeep vein thrombosis (DVT) is an important complication of stroke. Guidelines recommend that DVT prophylaxis should be guided by an assessment of the individual patient's risk. The authors aimed to...

PS174. A Systematic Review on the Effectiveness of Knee Versus Thigh Length Graduated Compression Stockings in Thromboprophylaxis for Surgical Patients

PS174. A Systematic Review on the Effectiveness of Knee Versus Thigh Length Graduated Compression Stockings in Thromboprophylaxis for Surgical Patients

Effect of compression stockings on venous blood velocity and blood flow

The effects of graduated compression stockings (GCS) on venous blood velocity have not been established. In healthy subjects, most investigations showed no effect on blood velocity, but mixed results have been reported. In this investigation we to test the hypothesis that popliteal blood velocity is increased by properly fitted GCS. Time average peak velocity in the popliteal vein, as well as time average mean velocity, vein diameter and mean volumetric flow were measured by pulsed wave Doppler ultrasound in 25 healthy male volunteers without compression stockings and repeated with fitted thigh-length compression stockings. Measurements were obtained while supine and while sitting at rest and during ankle exercise. Thigh-length GCS did not increase popliteal vein blood velocity, diameter, or volumetric blood flow while supine or sitting, with or without ankle exercise.

Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial

Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial

Graduated compression stockings did not prevent deep venous thrombosis after stroke and increased skin complications

Source Citation CLOTS Trials Collaboration. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet. 2009;373:1958-65. 19477503

Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial

SummaryBackgroundDeep vein thrombosis (DVT) and pulmonary embolism are common after stroke. In small trials of patients undergoing surgery, graduated compression stockings (GCS) reduce the risk of DVT. National stroke guidelines extrapolating from these trials recommend their use in patients with stroke despite insufficient evidence. We assessed the effectiveness of thigh-length GCS to reduce DVT after stroke.MethodsIn this outcome-blinded, randomised controlled trial, 2518 patients who were admitted to hospital within 1 week of an acute stroke and who were immobile were enrolled from 64 centres in the UK, Italy, and Australia. Patients were allocated via a central randomisation system to routine care plus thigh-length GCS (n=1256) or to routine care plus avoidance of GCS (n=1262). A technician who was blinded to treatment allocation undertook compression Doppler ultrasound of both legs at about 7–10 days and, when practical, again at 25–30 days after enrolment. The primary outcome was the occurrence of symptomatic or asymptomatic DVT in the popliteal or femoral veins. Analyses were by intention to treat. This study is registered, number ISRCTN28163533.FindingsAll patients were included in the analyses. The primary outcome occurred in 126 (10·0%) patients allocated to thigh-length GCS and in 133 (10·5%) allocated to avoid GCS, resulting in a non-significant absolute reduction in risk of 0·5% (95% CI −1·9% to 2·9%). Skin breaks, ulcers, blisters, and skin necrosis were significantly more common in patients allocated to GCS than in those allocated to avoid their use (64 [5%] vs 16 [1%]; odds ratio 4·18, 95% CI 2·40–7·27).InterpretationThese data do not lend support to the use of thigh-length GCS in patients admitted to hospital with acute stroke. National guidelines for stroke might need to be revised on the basis of these results.FundingMedical Research Council (UK), Chief Scientist Office of Scottish Government, Chest Heart and Stroke Scotland, Tyco Healthcare (Covidien) USA, and UK Stroke Research Network.

Knee versus Thigh Length Graduated Compression Stockings for Prevention of Deep Venous Thrombosis: A Systematic Review

Objective Graduated compression stockings are a valuable means of thrombo-prophylaxis but it is unclear whether knee-length (KL) or thigh length (TL) stockings are more effective. The aim of this review was to systematically analyse randomised controlled trials that have evaluated stocking length and efficacy of thromboprophylaxis. Method A systematic review of the literature was undertaken. Clinical trials on hospitalised populations and passengers on long haul flights were selected according to specific criteria and analysed to generate summated data. Results 14 randomized control trials were analysed. Thirty six of 1568 (2.3%) participants randomised to KL stockings developed a deep venous thrombosis, compared with 79 of 1696 (5%) in the TL control/thigh length group. Substantial heterogeneity was observed amongst trials. KL stockings had a significant effect to reduce the incidence of DVT in long haul flight passengers, odds ration 0.08 (95%CI 0.03–0.22). In hospitalised patients KL stockings did not appear to be far worse than TL stockings, odds ratio 1.01 (95%CI 0.35–2.90). For combined passengers and patients, there was a benefit in favour of KL stockings, weighted odds ratio 0.45 (95% CI 0.30–0.68). Conclusion KL graduated stockings can be as effective as TL stockings for the prevention of DVT, whilst offering advantages in terms of patient compliance and cost.

Knee-length versus thigh-length graduated compression stockings in the prevention of deep vein thrombosis.

Abstract Graduated compression stockings can reduce the incidence of deep vein thrombosis by 60 per cent1, by providing a decreasing compression gradient from the ankle towards the thigh. There is both theoretical and clinical evidence that compression of the thigh as well as the calf does not give extra benefit2,3. Although regarded as safe, improperly used stockings are not without risk. Problems are usually due to areas of localized high pressure, especially under ‘rucked up’ constricting bands of stocking. This is particularly so in the presence of ischaemia; manufacturers state that ischaemia is a contraindication to stocking use. Cases of arterial thrombosis have been reported4, as well as more frequent skin necrosis, when stockings have been used in the presence of reduced arterial blood supply5.

In vivo pressure profiles of thigh-length graduated compression stockings.

The aim of the study was to assess whether the appropriate pressure profile is generated by thigh-length graduated compression stockings in human subjects. The effect of leg posture on the pressure profile was assessed in three commonly used brands of graduated compression stockings. The study involved 17 human volunteers from the Department of Orthopaedic Surgery. Three different brands of stockings commonly recommended for the prevention of deep vein thrombosis were applied to each individual and the interface pressure profile under the stocking was measured. The effect of posture was assessed by comparing the interface pressure profile with the subject supine and in standing and sitting positions. Appropriate median pressure profiles were achieved only with the subject standing or supine. In the sitting position with the knee flexed, a high median interface pressure in excess of 28 mmHg was generated at the popliteal fossa. Overall, inconsistent performance was found in all three brands of stockings; fewer than 30 per cent of the pressure readings fell within 20 per cent of the 'ideal'. Reversed pressure profile was observed in over 70 per cent of subjects. Thigh-length graduated compression stockings may be most effective in bedridden patients. Knee-length stockings may be more suitable for the prevention of deep vein thrombosis in ambulant patients.

Deep vein thrombosis prophylaxis: The effectiveness and implications of using below-knee or thigh-length graduated compression stockings

Potential complications of reduced mobility in both acute and chronically ill patients continue to challenge nurses on a daily basis. Deep vein thrombosis (DVT) is one of the most serious of these complications. Graduated compression stockings, also known as antiembolism stockings, are among the most commonly available and accepted methods of external compression for the prophylaxis of DVT. Currently, there are 2 lengths of graduated compression stockings in common use, thigh-length and below-knee. Although thigh-length stockings are widely perceived to be more effective in prophylaxis, difficulties associated with therapeutic application and maintenance are often encountered in different clinical settings. Below-knee stockings are easier to apply and maintain and appear to be tolerated better by patients. The aim of this article is to examine existing support for both lengths of stockings in terms of their effectiveness in DVT prophylaxis and to discuss the implications for practice. (J Vasc Nurs 2002;20:53-9)

Deep vein thrombosis prophylaxis: The effectiveness and implications of using below-knee or thigh-length graduated compression stockings

Potential complications of reduced mobility in both acute and chronically ill patients continue to challenge nurses on a daily basis. Deep vein thrombosis (DVT) is one of the most serious of these complications. Graduated compression stockings, also known as antiembolism stockings, are among the most commonly available and accepted methods of external compression for the prophylaxis of DVT. Currently, there are 2 lengths of graduated compression stockings in common use, thigh-length and below-knee. Although thigh-length stockings are widely perceived to be more effective in prophylaxis, difficulties associated with therapeutic application and maintenance are often encountered in different clinical settings. Below-knee stockings are easier to apply and maintain and appear to be tolerated better by patients. The aim of this article is to examine existing support for both lengths of stockings in terms of their effectiveness in DVT prophylaxis and to discuss the implications for practice. (Heart Lung® 2001;30:277-84.)

The Effect of Graduated Compression Stockings on Lower Limb Venous Haemodynamics

Objectives: To compare the effect of four types of thigh-length graduated compression stockings (GCS) on lower limb venous blood flow using strain-gauge Plethysmography (SGP). Design: A randomized controlled study. Setting: Inpatient Orthopaedic Centre. Patients: 200 preoperative patients admitted for elective lower limb orthopaedic surgery. Interventions: Patients were randomized to five groups to wear one of four types of GCS or no stocking (control). Resting venous flow parameters were measured prior to application of GCS and after 20 min bed rest with the stockings in situ. Main outcome measures: Effects on resting venous capacitance (Vc) and venous outflow (Vo). Results: In the control group 20 min bed rest had no effect on the parameters studied. Both Vc and Vo were significantly increased ( p&lt;0.001) in all the groups wearing stockings. There was a significant variation in the changes in outflow produced by the different stocking types ( p&lt;0.05). Conclusions: GCS have a beneficial effect on lower limb venous outflow, preventing venous stasis, an important factor in the development of deep venous thrombosis. This effect varies depending on which type of stocking is used.