MedWire News: Patients who are immobilized after a stroke are less likely to suffer deep vein thrombosis (DVT) if they wear thigh-length, rather than below-knee-length, compression stockings, report the CLOTS investigators.
But neither option is likely to yield "clinically important benefits" in patients hospitalized with stroke, they say.
The previous CLOTS (Clots in Legs Or sTockings after Stroke) 1 trial showed that thigh-length stockings were no better than no stockings for preventing proximal DVT, conferring a nonsignificant absolute risk reduction of just 0.5%.
But the current CLOTS 2 study, which appears in the Annals of Internal Medicine, reports an absolute 2.5% DVT risk reduction (31% relative risk reduction) in patients given thigh-length versus below-knee compression stockings.
The trial included 3114 stroke patients randomly assigned to use thigh-length or below-knee stockings during hospitalization. Compression duplex ultrasonography at 7-10 or 25-30 days after enrollment detected proximal DVT (in the popliteal or femoral veins) in 98 (6.3%) patients using thigh-length stockings, compared with 138 (8.8%) of those given below-knee stockings.
Skin breaks were rare, but were more common with use of thigh-length stockings, occurring in 3.9% of 61 patients who wore thigh-length stockings for 30 days or until they were discharged, died, or regained their mobility, compared with 2.9% of 45 patients who wore below-knee stockings for the same period.
"If thigh-length stockings are truly ineffective in patients with stroke, it may be surprising that they seem to be more effective than below-knee stockings," say Martin Dennis (Western General Hospital, Edinburgh, UK) and colleagues.
They suggest that either the CLOTS 1 trial result understated the true effect of thigh-length stockings or that below-knee stockings actually promote DVT.
In an accompanying editorial, Clive Kearon (McMaster University, Ontario, Canada) and Martin O'Donnell (National University of Ireland, Galway) said that the findings "should prompt a re-evaluation of the role of graduated compression stockings in other groups of patients."
They said: "Clinicians need to realize that despite the ubiquity of graduated compression stockings in many settings, the net benefits and risks of this seemingly innocuous intervention remain uncertain."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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