(HealthDay News) — For patients undergoing elective surgery, low molecular weight heparin (LMWH) alone is noninferior to LMWH plus graduated compression stockings (GCS) for prevention of venous thromboembolism, according to a study published online in The BMJ.

Joseph Shalhoub, MBBS, PhD, from Imperial College London, and colleagues conducted a randomized noninferiority trial involving 1905 elective surgical inpatients assessed as being at moderate or high risk for venous thromboembolism. Participants were randomly assigned to either LMWH pharmacothromboprophylaxis alone or LMWH pharmacothromboprophylaxis and GCS.

The intention-to-treat analysis included 1858 patients. The researchers found that a primary outcome event (imaging-confirmed lower limb deep vein thrombosis with or without symptoms or pulmonary embolism with symptoms within 90 days of surgery) occurred in 1.7 and 1.4% of patients in the LMWH alone and LMWH and GCS groups, respectively (risk difference, 0.30%; 95% confidence interval, −0.65 to 1.26%). The 95% confidence interval did not cross the noninferiority margin of 3.5%, and consequently, LMWH alone was confirmed as noninferior.

“If we consider the potential adverse events and cost of GCS, urgent revision of national and international venous thromboembolism prevention guidelines is recommended,” the authors write.

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One author disclosed financial ties to the medical device industry.


Shalhoub J, Lawton R, et al. Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): randomised controlled trial [Published 13 May 2020]. BMJ 2020;369. doi: 10.1136/bmj.m1309