Thigh-length compression stocking did not reduce VTE after stroke

The use of thigh-length graduated compression stockings did not reduce the occurrence of symptomatic or asymptomatic deep vein thrombosis when used after stroke, according to the results of the CLOTS 1 trial.

“Indeed, [graduated compression stockings] damage the skin and might promote limb ischemia,” Philip M. W. Bath, MD, and Timothy J. England, MD, of the Stroke Trials Unit Institute of Neuroscience at the University of Nottingham, United Kingdom, wrote in an accompanying editorial. “Graduated compression stockings should not be used after stroke and current guidelines will need to be amended.”

They also added that the use of graduated compression stockings in other settings should be “urgently” assessed to determine their efficacy.

The CLOTS 1 trial was a 64-center, outcome-blinded, randomized, controlled trial. It enrolled 2,518 patients admitted to the hospital within one week of an acute stroke who were immobile. Patients were randomly assigned routine care plus a thigh-length graduated compression stocking or routine care alone.

Ten percent of patients assigned a stocking had a symptomatic or asymptomatic DVT in the popliteal or femoral veins as detected by Doppler ultrasound compared with 10.5% of those without a stocking.

In addition, those patients with a stocking also had significantly more frequent skin breaks, ulcers, blisters and skin necrosis than those patients who avoided a stocking (5% vs. 1%).

CLOTS Trials Collaboration. Lancet. 2009;373:1958-1965.

Most non-hemorrhagic stroke patients are placed on aspirin so that compression stockings may not add further DVT protection. These results should not be extended to other at-risk folk such as postsurgical patients where compression stockings (especially pneumatic devices) have been shown to be of significant benefit.

– Harry S. Jacob, MD

HemOnc Today Chief Medical Editor