Suna Kenan, Herrmann Eva, Kröger Knut, Schmandra Thomas, Müller Elisa, Hanisch Ernst, Buia Alexander
Clinic for General, Visceral and Thoracic-Surgery, Asklepios Klinik Langen, Academic Teaching Hospital Goethe-Universität Frankfurt, Röntgenstr 20, Langen, 63225, Germany.
Institute of Biostatistics und Mathematical Modeling, Klinikum und Fachbereich Medizin der Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, Frankfurt Am Main, 60590, Germany.
Ann Med Surg (Lond). 2020 Jun 30;56:203-210. doi: 10.1016/j.amsu.2020.06.034. eCollection 2020 Aug.
Recommendations for venous thromboembolism and deep venous thrombosis (DVT) prophylaxis using graduated compression stockings (GCS) is historically based and has been critically examined in current publications. Existing guidelines are inconclusive as to recommend the general use of GCS.Patients/Methods: 24 273 in-patients (general surgery and orthopedic patients) undergoing surgery between 2006 and 2016 were included in a retrospectively analysis from a single center. From January 2006 to January 2011 perioperative GCS was employed additionally to drug prophylaxis and from February 2011 to March 2016 patients received drug prophylaxis alone. According to german guidelines all patients received venous thromboembolism prophylaxis with weight-adapted LMWH. Risk stratification (low risk, moderate risk, high risk) was based on the guideline of the American College of Chest Physicians. Data analysis was performed before and after propensity matching (PM). The defined primary endpoint was the incidence of symptomatic or fatal pulmonary embolism (PE). A secondary endpoint was the incidence of deep venous thromboembolism (DVT).
After risk stratification (low risk n = 16 483; moderate risk n = 4464; high risk n = 3326) a total of 24 273 patient were analyzed. Before to PM the relative risk for the occurrence of a PE or DVT was not increased by abstaining from GCS. After PM two groups of 11 312 patients each, one with and one without GCS application, were formed. When comparing the two groups, the relative risk (RR) for the occurrence of a pulmonary embolism was: Low Risk 0.99 [CI95% 0.998-1.000]; Moderate Risk 0.999 [CI95% 0.95-1.003]; High Risk 0.996 [CI95% 0.992-1.000] (p > 0.05). The incidence of PE in the total group LMWH alone was 0.1% (n = 16). In the total group using LMWH + GCS, the incidence was 0.3% (n = 29). RR after PM was 0.999 [CI95% 0.998-1.00].
In comparison to prior studies with only small numbers of patients our trial shows in a large group of patients with moderate and high risk developing VTE we can support the view that abstaining from GCS-use does not increase the incidence of symptomatic or fatal PE and symptomatic DVT.
使用梯度压力弹力袜（GCS）预防静脉血栓栓塞和深静脉血栓形成（DVT）的建议是基于历史经验，目前的出版物已对其进行了严格审查。现有指南对于是否推荐普遍使用GCS尚无定论。
患者/方法：对2006年至2016年间在单一中心接受手术的24273例住院患者（普通外科和骨科患者）进行回顾性分析。2006年1月至2011年1月，围手术期除药物预防外还使用了GCS，2011年2月至2016年3月，患者仅接受药物预防。根据德国指南，所有患者均接受根据体重调整的低分子肝素（LMWH）进行静脉血栓栓塞预防。风险分层（低风险、中度风险、高风险）基于美国胸科医师学会的指南。在倾向评分匹配（PM）前后进行数据分析。定义的主要终点是有症状或致命性肺栓塞（PE）的发生率。次要终点是深静脉血栓形成（DVT）的发生率。
在进行风险分层后（低风险n = 16483；中度风险n = 4464；高风险n = 3326），共分析了24273例患者。在PM之前，不使用GCS并不会增加发生PE或DVT的相对风险。PM后，形成了两组各11312例患者组，一组使用GCS，一组不使用GCS。比较两组时，发生肺栓塞的相对风险（RR）为：低风险0.99 [CI95% 0.998 - 1.000]；中度风险0.999 [CI95% 0.95 - 1.003]；高风险0.996 [CI95% 0.992 - 1.000]（p > 0.05）。仅使用LMWH的总体组中PE的发生率为0.1%（n = 16）。在使用LMWH + GCS的总体组中，发生率为0.3%（n = 29）。PM后的RR为0.999 [CI95% 0.998 - 1.00]。
与之前仅纳入少量患者的研究相比，我们的试验表明，在一大组有中度和高风险发生静脉血栓栓塞（VTE）的患者中，我们支持以下观点：不使用GCS不会增加有症状或致命性PE以及有症状DVT的发生率。
