Systematic Review on the Effectiveness of Anti-Embolism Stockings; A Need to Re-Evaluate the Evidence

Abstract Objectives: To systematically review randomized controlled trials that have evaluated elasticated thrombo-embolic graduated compression stockings as prophylaxis of deep venous thrombosis in various health situations. Design: Searches were carried out in the Cochrane Central Register of Controlled Trials, Medline, EMBASE and CINAHL and the results hand searched for trials registered up to March 2021. Participants: A total of 26 relevant randomized controlled trials involving 8,279 participants were systematically reviewed. Main Outcome Measures: Trials were independently assessed and data extracted for the occurrence of deep vein thrombosis, pulmonary embolism and skin ulceration. Public and Patient Involvement: There was no patient or public involvement for this study. Results: The occurrence of deep vein thrombosis was 306/4159(7.4%) with the stocking compared to 492/4120(11.9%) without the stockings (RR 0.49, 95% CI 0.39-0.62). The occurrence of pulmonary embolism was also reduced from 43/3419(1.3%) to 23/3416(0.7%) (RR 0.56, 95% CI 0.35-0.91). These findings may be biased due to the potential underreporting of negative studies and the subsequent changes to clinical practice. For the three large contemporary studies involving 5,171 participants, these failed to show any statistically significant reduction in thrombosis, with deep vein thrombosis confirmed in 158/2572(6.1%) participants in those allocated to stocking, as opposed to 171/2599(6.6%) in the control group (RR 0.92, 95% CI 0.74-1.16). Conclusion: The current recommendations regarding the use of thrombo-embolic stockings need to be re-evaluated, as their effectiveness at reducing the occurrence of post-operative deep vein thrombosis is minimal based on the current evidence and clinical practices.