Compression stockings as thrombosis prophylaxis after abdominal or pelvic surgery

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202503 Registration no: SBU 2024/869

Question

What is the thromboprophylactic effect of compression stockings after abdominal or pelvic surgery?

PICO

  • Population: Patients in abdomnal or pelvic surgery aftercare
  • Intervention: Compression stockings, as monotherapy or in combination with drug therapy
  • Control: Drug therapy only, or no treatment
  • Outcome: Incidence of deep vein thrombosis, pulmonary embolism, adverse events, patient experiences.

Method

A systematic literature search was performed using the following databases: Medline (by Ovid), Scopus and Cinahl (by EBSCO).

Two authors independently assessed the abstracts of all identified studies.

Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

One relevant systematic review with low to moderate risk of bias were identified [1]. The results and conclusions are presented in Table 1. In four relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [2] [3] [4] [5]. In addition, two relevant primary studies were identified [6] [7]. Primary studies are presented in Table 2, and are not assessed for risk for bias.

Table 1 Systematic reviews with low/moderate risk of bias.
Included studies Population, Intervention, Control Outcome and Results
Wille-Jørgensen 2004 [2]
Heparins and mechanical methods for thromboprophylaxis in colorectal surgery
19 RCT 

Relevant studies:
2 RCT 

Setting:
Denmark: 2 studies		 Population:
Patients undergoing major colorectal surgery for cancer 

Intervention:
TED stockings in combination with unfractionated heparin 

Comparison:
Unfractionated heparin		 Unfractionated heparin vs unfractionated heparin and TED stockings
Incidence of deep vein thrombosis
(2 studies, n=111):
Peto odds ratio: 4.62
(95% CI, 1.33 to 16.01), results indicate higher odds of outcome for LDH only as compared to LDH + TED. 

Incidence of pulmonary embolism
(2 studies, n=111):
No statistical difference between treatments
Peto odds ratio: 3.01
(95% CI, 0.64 to 14.16), results indicate higher odds of outcome for LDH only as compared to LDH + TED. 

Incidence of deep vein thrombosis and/or pulmonary embolism
(2 studies, n=111):
Peto odds ratio: 4.17
(95% CI, 1.37 to 12.7), results indicate higher odds of outcome for LDH only as compared to LDH + TED.
Authors' conclusion:
“The optimal prophylaxis in colorectal surgery seems to be the combination of graded compression stockings and low-dose unfractionated heparin. The unfractionated heparin can likely be replaced with low molecular weight heparin.
RCT = randomized controlled study; TED = Thrombo-Embolus deterrent; CI = confidence interval

 

Table 2 Relevant primary studies.
Included studies Population Intervention/control Outcome
Sang et al, 2018 [6]
Different combination strategies for prophylaxis of venous thromboembolism in patients: A prospective multicenter randomized controlled study		 Women who would undergo pelvic surgery for gynecologic diseases (n=625) 

China		 GCS
GCS + LMWH
GCS + Intermittent pneumatic compression
GCS + LMWH + Intermittent pneumatic compression 		 Incidence of deep vein thrombosis 

Incidence of pulmonary embolism
Shalhoub et al, 2020 [7]
Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT		 Patients admitted to hospital for surgery with moderate to high risk of venous thromboembolism (n=1 905)
Note: this population is not exclusively made up of general surgery/pelvic surgery patients. They do however make up most of the studied population. 

United Kingdom		 GCS + LMWH 
LMWH		 Venous thrombo-embolism up to 90 days after surgery
RCT = randomized controlled study; GCS = graduated compression stockings; LMWH = low molecular weight heparin

References

  1. Wille-Jørgensen P, Rasmussen MS, Andersen BR, Borly L. Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database of Systematic Reviews. 2004;2010(1). Available from: https://doi.org/10.1002/14651858.CD001217
  2. Borly L, Wille-Jørgensen P, Rasmussen MS. Systematic review of thromboprophylaxis in colorectal surgery - An update. Colorectal Disease. 2005;7(2):122-7. Available from: https://doi.org/10.1111/j.1463-1318.2004.00734.x
  3. Insin P, Vitoopinyoparb K, Thadanipon K, Charakorn C, Attia J, McKay GJ, et al. Prevention of venous thromboembolism in gynecological cancer patients undergoing major abdominopelvic surgery: A systematic review and network meta-analysis. Gynecologic Oncology. 2021;161(1):304-13. Available from: https://doi.org/10.1016/j.ygyno.2021.01.027
  4. Lu L, Shen Y, Pan Y. Combination of graduated compression stockings and intermittent pneumatic compression is better in preventing deep venous thrombosis than graduated compression stockings alone for patients following gynecological surgery: a meta-analysis. Thrombosis Journal. 2024;22(1). Available from: https://doi.org/10.1186/s12959-024-00636-1
  5. Roderick P, Ferris G, Wilson K, Halls H, Jackson D, Collins R, et al. Towards evidence-based guidelines for the prevention of venous thromboembolism: Systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. Health Technology Assessment. 2005;9(49):iii-76. Available from: https://doi.org/10.3310/hta9490
  6. Sang C-Q, Zhao N, Zhang J, Wang S-Z, Guo S-L, Li S-H, et al. Different combination strategies for prophylaxis of venous thromboembolism in patients: A prospective multicenter randomized controlled study. Scientific reports. 2018;8(1):8277. Available from: https://doi.org/doi:10.1038/s41598-018-25274-2
  7. Shalhoub J, Lawton R, Hudson J, Baker C, Bradbury A, Dhillon K, et al. Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT. Health technology assessment (Winchester, England). 2020;24(69):1-80. Available from: https://doi.org/doi:10.3310/hta24690

Medline via OvidSP 16 December 2024

Title: Compression socks and abdominal surgery SR
Search terms Items found
Population:
1. exp "Embolism and Thrombosis"/ 259 204
2. (thrombo* or thrombu* or embol*).ti,ab,kf,bt. 603 089
Intervention:
3. "Stockings, Compression"/ or "Compression Bandages"/ 3021
4. (stocking* or hosiery* or tights* or sock* or bandage* or compres* or "mechanical *prophylaxis").ti,ab,kf,bt. 238 037
Study types: systematic reviews and meta-analysis / randomized controlled trialsa
5. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/))  
Combined sets:
6. 1 or 2 669 634
7. 3 or 4 238 818
8. 6 and 7 12 465
Final result
9. 8 and 5 403
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase a. Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity- and precision-maximizing version (2008 revision); Ovid format. The Cochrane Collaboration; 2008. Available from: https://training.cochrane.org/handbook/current/chapter-04-technical-supplement-searching-and-selecting-studies#section-3-6-1. with modifications: the following terms are added: clinical trial, phase iii.pt. ; randomised.ab. ; ("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.

2. International Network of Agencies for Health Technology Assessment (INAHTA).

3. Utvärdering av hälso- och sjukvårdens (och i SBU:s fall socialtjänstens) metoder (engelska: Health Technology Assessment)

Medline via OvidSP 21 January 2025

Title: Compression socks and abdominal surgery RCT
Search terms Items found
Population:
1. exp "Embolism and Thrombosis"/ 259 244
2. (thrombo* or thrombu* or embol*).ti,ab,kf,bt. 603 240
Intervention:  
3. "Stockings, Compression"/ or "Compression Bandages"/  3021
4. (stocking* or hosiery* or tights* or sock* or bandage* or compres* or "mechanical *prophylaxis").ti,ab,kf,bt. 238 099
Study types: systematic reviews and meta-analysis / randomized controlled trials
5. (randomized controlled trial.pt. OR controlled clinical trial.pt. OR clinical trial, phase iii.pt. OR ((randomized or randomised).ab.) OR placebo.ab. OR clinical trials as topic.sh. OR randomly.ab. OR trial.ti. OR (("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.)) NOT (exp animals/ not humans.sh.)  
Combined sets:
6. 1 or 2 669 788
7. 3 or 4 238 880
8. 6 and 7 12 469
Limits:    
9. Limit 8 to dt=”20030601-20250121” 8915
Final result
10. 9 and 5 863
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase

Scopus via scopus.com 16 December 2024

Title: Compression socks and abdominal surgery SR
Search terms Items found
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:
1. TITLE-ABS-KEY ( thrombo* or thrombu* or embol* ) 1 245 216
Intervention:
2. TITLE-ABS-KEY ( stocking* or hosiery* or tights* or sock* or bandage* or compres* ) 1 414 436
Study types: systematic reviews and meta-analysis / randomized controlled trials
3. TITLE-ABS-KEY ( ( systematic  W/2  review )  OR  "meta analy*"  OR  metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”))  
Combined sets:
4. 1 and 2 23,992
Final result
5. 4 and 3 996

CINAHL via EBSCO 16 December 2024

Title: Compression socks and abdominal surgery SR
Search terms Items found
Population:
1. TI(thrombo* or thrombu* or embol*) OR AB(thrombo* or thrombu* or embol*) OR SU(thrombo* or thrombu* or embol*) 130 047
Intervention:
2. TI(stocking* or hosiery* or tights* or sock* or bandage* or compres*) OR AB(stocking* or hosiery* or tights* or sock* or bandage* or compres*) OR SU(stocking* or hosiery* or tights* or sock* or bandage* or compres*) 54 040
Study types: systematic reviews and meta-analysis / randomized controlled trialsa
3. ((TI((systematic N3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic N3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic N3 review) OR "meta analys*" OR metaanalys*)) OR (PT "Systematic Review" OR PT "meta analysis")) NOT (MH "Case Studies" OR PT "Commentary" OR PT "Editorial" OR PT "Letter")  
Combined sets:
4. 1 and 2  3099
Final result
5. 4 and 3 167
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); MH = Exact subject heading, indexed keywords; TX = All text; PT = Publication type; Nn = Near. Proximity operator retrieving terms within n words from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase.

a. Glanville J, Dooley G, Wisniewski S, Foxlee R, Noel-Storr A. Development of a search filter to identify reports of controlled clinical trials within CINAHL Plus. Health Info Libr J. 2019;36(1):73-90. Available from: https://doi.org/10.1111/hir.12251.
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