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Q J Med 2000; 93: 359-364
© 2000 Association of Physicians

Randomized trial of graded compression stockings for prevention of deep-vein thrombosis after acute stroke

K.W. MUIR, A. WATT1, G. BAXTER1, D.G. GROSSET and K.R. LEES2

From the Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, and 1 Department of Radiology and 2 Acute Stroke Unit, University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK

Received 11 April 2000 Graded compression stockings are commonly used to prevent deep-vein thrombosis (DVT) after stroke, but their efficacy in this setting has not been evaluated. Extrapolation of effectiveness from trials in patients undergoing elective surgery may be inappropriate. We undertook a randomized, controlled trial, with blinded data review, in a University hospital Acute Stroke Unit. Patients were allocated to graded compression stockings or to standard care alone. DVT incidence was determined at baseline and at day 7±2 by colour-flow Doppler ultrasound. Ninety-eight patients with acute, immobilizing stroke were randomized; 97 had full outcome data. One patient had clinically manifest DVT, and no patient had pulmonary thromboembolism. DVT was detected in 7/65 patients allocated stockings, and 7/32 controls (odds ratio 0.43, 95% CI 0.14–1.36); DVT involving femoral veins was detected in 3/65 and 2/32. In the first week after stroke, radiologically-detected DVT remains common, but is usually clinically silent. Proximal DVT is less common. Graded compression stockings produced a reduction in DVT incidence comparable to that in other patient groups, but the reduction was not statistically significant, and the magnitude of effect size requires confirmation. There is greater doubt over efficacy in early prevention of proximal DVT.

Address correspondence to Dr K.W. Muir, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF. e-mail: k.muir{at}clinmed.gla.ac.uk


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