Lancet: Compression stockings do not work for stroke patients
Thigh-length graduated support stockings (TL-GCS) do not reduce the risk of blood clots in stroke patients, based on findings of the CLOTS trial published in the May 28 issue of the Lancet. Since most national guidelines recommend use of TL-GCS, such guidelines should now be urgently revised.

The results of the CLOTS trial were also announced last week's European Stroke Conference in Stockholm, Sweden.

Martin Dennis, MD, from the University of Edinburgh, in Scotland, and colleagues said that pulmonary emboli can cause severe breathlessness and are an important cause of death among hospitalized patients. To date, only small trials have reported TL-GCS reduce the risk of DVT in patients having surgery, but national stroke guidelines recommend their use in patients despite this inadequate evidence.

The randomized, controlled trial analyzed 2,518 patients from 64 centers in the United Kingdom, Italy and Australia. They were admitted to hospital within one week of an acute stroke and were immobile. Patients received routine care plus TL-GCS (1,256 patients), or routine care only (1,262). Each was then given an ultrasound of both legs at 7 to 10 days and again at 25 to 30 days after enrolment. The primary outcome was occurrence of DVT in the thigh.

The researchers found that DVT occurred in 10 percent of patients in the TL-GCS group, and 10.5 percent of patients in the routine care only group, which was not a statistically significant difference. Furthermore, skin breaks, ulcers, blisters and skin tissue death were significantly more common in patients given TL-GCS than in those given routine care only (5 vs. 1 percent).

Referring to the U.K. example, Dennis said that draft guidelines out for public consultation from the National Institute for Health and Clinical Excellence (NICE) recommend that stroke patients should be treated with compression stockings.

"We can estimate that 80,000 patients with stroke in the U.K.--about two-thirds of all admission to hospital with acute stroke--would be treated with stockings if this guideline is followed," Dennis said. "Thus the results of the CLOTS trial 1 will have a major effect on the management of patients. Given that most national guidelines recommend stockings in at least some patients, the results of our study will affect the treatment of millions of patients each year. Abandoning this ineffective and sometimes uncomfortable treatment will free up significant health resources--both funding and nurse time--which might be better used to help stroke patients."

"Compression stockings are used in the majority of stroke units," Dennis concluded. "In this study, we have shown conclusively that compression stockings do not work for stroke patients. National guidelines need to be revised and we need further research to establish effective treatments in this important group of patients."

In an accompanying commentary, Philip Bath, MD and Timothy England, MD, from the stroke trials unit at the University of Nottingham in England, wrote: "GCS do not reduce DVT or overall venous thromboembolism in patients with recent stroke; indeed, they damage the skin and might promote limb ischemia. GCS should not be used after stroke and current guidelines will need to be amended."
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