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Anti-embolism stockings for surgical patients – which length is best?

Posted on 16 March 2016

Surgical patients are at an increased risk of developing deep vein thrombosis (DVT). Anti-embolism stockings, used alongside pharmacological prophylaxis, reduce morbidity, mortality and health service costs in patients at risk. Anti-embolism stockings are available as thigh length or knee length stockings. A systematic review was undertaken to compare the clinical effectiveness of thigh length versus knee length anti-embolism stockings for the prevention of DVT in surgical patients.

Much of the available research evidence is old and of uncertain quality, reducing the reliability of the results. Direct and indirect meta-analyses suggested that thigh length anti-embolism stockings may be more effective than knee length anti-embolism stockings for the prevention of DVT, although the results were not statistically significant. The combination of thigh length stockings with pharmacological prophylaxis was the most effective treatment in a network meta-analysis of all treatments. However, the marginal benefit of thigh length stockings plus heparin over heparin alone is less than the marginal benefit of heparin over no treatment, as heparin has already reduced the risk of DVT substantially. Patient adherence was generally higher with knee length stockings and patients preferred knee length over thigh length stockings.

Ros Wade, who led the systematic review, said “Despite the uncertain quality of many of the existing studies, it is unlikely to be cost-effective to run a new definitive trial comparing thigh length with knee length anti-embolism stockings. Whilst thigh length anti-embolism stockings appear to have superior efficacy, patients prefer knee length stockings and find them easier to use. A pragmatic approach may be to give thigh length stockings to patients who can use them properly and consistently, while knee length stockings are more appropriate for patients who are less physically adept.”