Dennis M, Sandercock P A G, Reid J, Graham C, Murray G, Venables G, Rudd A, Bowler G
Division of Clinical Neurosciences, University of Edinburgh, Bramwell Dott Building, Western General Hospital, Edinburgh EH4 2XU, UK.
Lancet. 2009 Jun 6;373(9679):1958-65. doi: 10.1016/S0140-6736(09)60941-7. Epub 2009 May 26.
Deep 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.
In 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.
All 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).
These 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.
Medical Research Council (UK), Chief Scientist Office of Scottish Government, Chest Heart and Stroke Scotland, Tyco Healthcare (Covidien) USA, and UK Stroke Research Network.
深静脉血栓形成（DVT）和肺栓塞在卒中后很常见。在针对接受手术患者的小型试验中，分级压力袜（GCS）可降低DVT风险。尽管证据不足，但基于这些试验的国家卒中指南仍建议在卒中患者中使用GCS。我们评估了大腿长度的GCS对降低卒中后DVT的有效性。
在这项结果盲法的随机对照试验中，从英国、意大利和澳大利亚的64个中心招募了2518例在急性卒中1周内入院且行动不便的患者。患者通过中央随机系统被分配至常规护理加大腿长度的GCS组（n = 1256）或常规护理加不使用GCS组（n = 1262）。一名对治疗分配不知情的技术人员在入组后约7 - 10天对双腿进行压迫式多普勒超声检查，并在可行的情况下在25 - 30天再次检查。主要结局是腘静脉或股静脉出现有症状或无症状的DVT。分析采用意向性分析。本研究已注册，注册号为ISRCTN28163533。
所有患者均纳入分析。在分配至大腿长度GCS组的患者中，126例（10.0%）出现主要结局，在分配至不使用GCS组的患者中，133例（10.5%）出现主要结局，风险绝对降低0.5%，无统计学意义（95%CI -1.9%至2.9%）。与分配至不使用GCS组的患者相比，分配至GCS组的患者皮肤破损、溃疡、水泡和皮肤坏死明显更常见（64例[5%]对16例[1%]；比值比4.18，95%CI 2.40 - 7.27）。
这些数据不支持在急性卒中住院患者中使用大腿长度的GCS。可能需要根据这些结果修订国家卒中指南。
英国医学研究理事会、苏格兰政府首席科学家办公室、苏格兰胸心与卒中协会、美国泰科医疗（柯惠）公司以及英国卒中研究网络。
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