Is compression therapy for thromboprophylaxis still worthwhile today?

Summary

Physical thromboprophylaxis to prevent deep vein thrombosis of the legs was first introduced in the 1970s and 80s and is still in use. But the question “Is compression therapy for thromboprophylaxis still worthwhile today?” provokes great controversy in the literature. The current German S3 guideline goes so far as to say “Put explicitly, not using thromboembolic deterrent stockings (TEDs) in the vast majority of cases lies completely within the scope of the recommendations in this guideline.” However, the “vast majority of cases” does not mean that it is always right not to use TEDs. The general consensus in the guidelines is the use of compression as a physical means of thromboprophylaxis in patients at high risk of bleeding or with active bleeding, irrespective of whether it consists of TEDs or intermittent pneumatic compression therapy. The decision to use compression in the individual case ultimately rests with the doctor. Physical venous thromboembolism (VTE) prophylaxis still has a place in surgery during the perioperative period when regular pharmacological anticoagulation to prevent VTE has to be interrupted.

Keywords

Thromboprophylaxis - thromboembolic deterrent stockings - TEDs - compression stockings - thrombosis - guideline

• References

• 1 Cohen AT, Skinner JA, Warwick D, Brenkel I. The use of graduated compression stockings in association with fondaparinux in surgery of the hip. A multicentre, multinational, randomised, openlabel, parallel-group comparative study. J Bone Joint Surg Br 2007; 89: 887-892.
• 2 Dennis M, Sandercock PA, Reid J, Graham C, Murray G, Venables G, Rudd A, Bowler G. for the 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 (9679): 1958-1965.
• 3 Encke A, Haas S, Sauerland S. et al. S3-Leitlinie zur Prophylaxe der venösen Thromboembolie (VTE). 2015 AWMF.de.
• 4 Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM. Prevention of VTE in Nonorthopedic Surgical Patients. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e227S-e277S.
• 5 Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, Cook DJ, Balekian AA, Klein RC, Le H, Schulman S, Murad MH. Prevention of VTE in Nonsurgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e195S-e226S.
• 6 McLellan DG. Compression Profiles of Antiembolic stockings. Australian & NZ J of Phleboloy 2002; 06: 9-14.
• 7 Sachdeva A, Dalton M, Amaragiri SV, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2014; 12: CD001484.
• 8 Wegener U, Kraft M, Kröger K, Kujath P, Storck M, Krüger CM. Biomechanische Charakterisierung von medizinischen Thromboseprophylaxestrümpfen (MTPS). Gefäßchirurgie 2013; 18: 278-286.