Department of Surgery and Cancer, Section of Vascular Surgery, Imperial College London, London, UK.
Ann Surg. 2024 Jan 1;279(1):29-36. doi: 10.1097/SLA.0000000000006096. Epub 2023 Sep 27.
To compare the rate of venous thromboembolism (VTE) in surgical inpatients with pharmacological thromboprophylaxis and additional graduated compression stockings (GCSs) versus pharmacological thromboprophylaxis alone.
Surgical inpatients have elevated VTE risk; recent studies cast doubt on whether GCS confers additional protection against VTE, compared with pharmacological thromboprophylaxis alone.
The review followed "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines using a registered protocol (CRD42017062655). The MEDLINE and Embase databases were searched up to November 2022. Randomized trials reporting VTE rate after surgical procedures, utilizing pharmacological thromboprophylaxis, with or without GCS, were included. The rates of deep venous thrombosis (DVT), pulmonary embolism, and VTE-related mortality were pooled through fixed and random effects.
In a head-to-head meta-analysis, the risk of DVT for GCS and pharmacological thromboprophylaxis was 0.85 (95% CI: 0.54-1.36) versus for pharmacological thromboprophylaxis alone (2 studies, 70 events, 2653 participants). The risk of DVT in pooled trial arms for GCS and pharmacological thromboprophylaxis was 0.54 (95% CI: 0.23-1.25) versus pharmacological thromboprophylaxis alone (33 trial arms, 1228 events, 14,108 participants). The risk of pulmonary embolism for GCS and pharmacological prophylaxis versus pharmacological prophylaxis alone was 0.71 (95% CI: 0.0-30.0) (27 trial arms, 32 events, 11,472 participants). There were no between-group differences in VTE-related mortality (27 trial arms, 3 events, 12,982 participants).
Evidence from head-to-head meta-analysis and pooled trial arms demonstrates no additional benefit for GCS in preventing VTE and VTE-related mortality. GCS confer a risk of skin complications and an economic burden; current evidence does not support their use for surgical inpatients.
比较接受药物血栓预防和附加分级加压弹力袜（GCS）与仅接受药物血栓预防的外科住院患者的静脉血栓栓塞（VTE）发生率。
外科住院患者 VTE 风险升高；最近的研究对 GCS 是否比单独药物血栓预防更能预防 VTE 提出了质疑。
本综述遵循“系统评价和荟萃分析的首选报告项目”指南，并使用注册方案（CRD42017062655）。检索了 MEDLINE 和 Embase 数据库，截至 2022 年 11 月。纳入了报告外科手术后使用药物血栓预防，联合或不联合 GCS 的 VTE 发生率的随机试验。通过固定和随机效应汇总了深静脉血栓形成（DVT）、肺栓塞和与 VTE 相关的死亡率。
在头对头荟萃分析中，GCS 和药物血栓预防组的 DVT 风险为 0.85（95%CI：0.54-1.36），而单独药物血栓预防组为 0.27（95%CI：0.0-0.64）（2 项研究，70 例事件，2653 名参与者）。在 GCS 和药物血栓预防联合治疗组的汇总试验臂中，DVT 风险为 0.54（95%CI：0.23-1.25），而在单独药物血栓预防组中，DVT 风险为 0.54（95%CI：0.23-1.25）0.27（95%CI：0.0-0.64）（33 个试验臂，1228 例事件，14108 名参与者）。GCS 和药物预防组与单独药物预防组的肺栓塞风险为 0.71（95%CI：0.0-30.0）（27 个试验臂，32 例事件，11472 名参与者）。两组间与 VTE 相关的死亡率无差异（27 个试验臂，3 例事件，12982 名参与者）。
来自头对头荟萃分析和汇总试验臂的证据表明，GCS 在预防 VTE 和与 VTE 相关的死亡率方面没有额外获益。GCS 会增加皮肤并发症和经济负担的风险；目前的证据并不支持将其用于外科住院患者。
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