Are graduated compression stockings still essential for VTE prophylaxis in general surgical patients?^[*]

Summary

Background: Current guidelines for the prevention of venous thromboembolism in surgical patients continue to recommend the use of graduated compression stockings in addition to low molecular weight heparins (LMWH). Nearly all the studies documenting a prophylactic benefit from these stockings were carried out before the introduction of LMWH. Patients, methods: We studied the rate of symptomatic venous thromboembolism (VTE) occurring in patients of a general surgery department during two consecutive time periods of 24 months with different prophylaxis regimen. During the first 24 months (Group A), preventive measures consisted of LMWH and graduated compression stockings. During the second 24 months (Group B) only LMWH was used. Results: In Group A there were 3181 patient with a total of 3050 operations. In Group B there were 2986 patients with a total of 2911 operations. 82.5% of the patients in Group A and 84.0% in Group B received VTE prophylaxis (stockings and LMWH in A, LMWH only in B). Symptoms suggesting venous thromboembolism occured in 44 patients in Group A and in 47 in Group B. Examinations of these patients revealed a VTE in 7 A and 5 B patients. Conclusions: The incidence of symptomatic venous thromboembolism in patients of a general surgery department was kept low with a simple, but strictly applied preventative protocol of LMWH. Graduated compression stockings did not yield additional benefits in our patients.

Zusammenfassung

Hintergrund: Aktuelle Leitlinien zum Thema Thromboseprophlyaxe empfehlen nach wie vor den Einsatz von Thrombose prophylaxestrümpfen zusätzlich zu niedermolekularen Heparinen (NMH). Fast alle Studien, die einen Nutzen dieser Strümpfe aufgezeigt haben, sind vor der Einführung der NMH durchgeführt worden. Patienten, Methoden: Wir untersuchten die Inzidenz von symptomatischen Lungenarterienembolien und Beinvenenthrombosen bei Patienten einer allgemeinchirurgischen Abteilung über je zwei Jahre mit unterschiedlichen Prophylaxe-Schemata: Während der ersten 24 Monate (Gruppe A) erfolgte die Thromboseprophylaxe mit NMH und Kompressionsstrümpfen; während der zweiten 24 Monate (Gruppe B) wurde nur NMH eingesetzt. Ergebnisse: In Gruppe A wurden 3181 Patienten behandelt mit insgesamt 3050 Operationen; in Gruppe B 2989 Patienten mit insgesamt 2911 Operationen. 82,5% der Patienten in Gruppe A und 84% in Gruppe B erhielten Thromboseprophylaxe (Kompressionstrümpfe und NMH in A, nur NMH in B). 44 Patienten in Gruppe A und 47 in Gruppe B entwickelten Symptome einer Beinvenenthrombose oder einer Lungenarterienembolie. Mit den weiteren Untersuchungen ließ sich in Gruppe A bei sieben Patienten und in Gruppe B bei fünf Patienten die Diagnose sichern. Schlussfolgerung: Mit einem einfachen aber strikt eingehaltenen Thromboseprophylaxeregime unter Verwendung von NMH läßt sich die Inzidenz symptomatischer Beinvenenthrombosen und Lungenarterienembolien in einer chirurgischen Abteilung sehr gering halten. Der Einsatz von Thromboseprophylaxestrümpfen bringt unter diesen Voraussetzungen keinen zusätzlichen Nutzen.

Résumé

Historique: Les directives habituelles pour la prévention de la Maladie thrombo-embolique veineuse (MTE) en chirurgie continuent de recommander l’usage de bas à compression élastique dégressive associés à un traitement par héparines à bas poids moléculaire (HBPM). La quasi-totalité de ces études, qui ont montré un bénéfice par la compression élastique, a été faite avant l’apparition des HBPM sur le marché. Patients et méthode: Nous avons étudié le taux de MTE symptomatique survenu dans un département de chirurgie générale au cours de 2 périodes consécutives de 24 mois avec différentes méthodes prophylactiques. Au cours des 24 premiers mois, (groupe A) on a utilisé des HBPM et des bas à compression dégressive. Au cours des 24 mois suivants, (groupe B) seules des HBPM ont été utilisées. Résultats: Dans le groupe A 3181 patients ont été traités sur un total de 3050 opérations. Dans le groupe B 2986 patients ont été traités sur un total de 2911 interventions. 82,5% des patients du groupe A et 84% du groupe B ont reçu une prophylaxie de la MTE. Malgré tout, 44 patients ont présenté une symptomatologie suggérant une MTE dans le groupe A et 47 dans le groupe B. L’examen a révélé 7 cas de MTE dans le groupe A et 5 dans le groupe B. Conclusion: L’incidence de la MTE observé dans un département de chirurgie a été maintenue basse avec un protocole de prévention simple mais appliqué de manière stricte avec HBPM. Des bas à compression élastique dégressive ne semblent pas avoir amené de bénéfice complémentaire chez nos patients.

Keywords

Venous thromboembolism - VTE-prophylaxis - low molecular weight heparins - graduated compression stockings - pulmonary embolism

Schlüsselwörter

Venöse Thromboembolie - VTE-Prophylaxe - niedermolekulare Heparine - Kompressionsstrümpfe - Lungenembolie

Mots clés

Maladie thrombo-embolique veineuse - prophylaxie - héparines à bas poids moléculaire - bas élastiques à compression dégressive - embolie pulmonaire

^* Diese Arbeit wurde anlässlich der 49. Jahrestagung der Deutschen Gesellschaft für Phlebologie in Mainz mit dem Oral Communication Award 2007 ausgezeichnet.

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