The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Randomized clinical trial of low molecular weight heparin with thigh‐length or knee‐length antiembolism stockings for patients undergoing surgery. BJS 2004; 91: 842-847.

Published: 16th March 2004

Authors: A. Howard, D. Zaccagnini, M. Ellis, A. Williams, A. H. Davies, R. M. Greenhalgh et al.

Background

This was a randomized clinical trial to determine the efficacy and safety of a ‘blanket’ protocol of low molecular weight heparin (LMWH) and the best length of antiembolism stocking, for every patient requiring surgery under general anaesthesia.

Method

Of 426 patients interviewed, 376 agreed to be randomized to receive one of three types of stocking: thigh‐length Medi thrombexin® climax™ (Medi UK, Hereford, UK), knee‐length thrombexin® climax™ and thigh‐length Kendall T.E.D.™ (Tyco Healthcare UK, Redruth, UK). All patients received LMWH thromboprophylaxis. Duplex ultrasonography was used to assess the incidence of postoperative deep vein thrombosis (DVT).

Results

No postoperative DVT occurred in 85 patients at low or moderate risk. Nineteen DVTs occurred, all in the 291 high‐risk patients: two with the Medi thigh‐length stockings, 11 with the Medi knee‐length stockings (odds ratio 0·18 (95 per cent confidence interval 0·04 to 0·82); P = 0·026) and six with the Kendall T.E.D.™ thigh‐length stockings. No patient developed a pulmonary embolism. Stocking groups were similar for age, sex, thromboembolic risk, type of operation and compliance. One significant bleeding complication occurred.

Conclusion

A single protocol comprising LMWH and thigh‐length stockings abolished DVT in low‐ and moderate‐risk patients, and reduced the rate of DVT to 2 per cent in high‐risk patients. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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