Background: Venous thromboembolism (VTE) is a well-recognized and preventable complication of
acute stroke. Although graduated compression stockings reduce the risk of VTE for
patients undergoing operation, their benefit in acute stroke remains uncertain. Methods: The relationship between symptomatic VTE (sVTE) and use of stockings using observational
data from the Tinzaparin in Acute Ischemic Stroke Trial, which compared 10 days of
treatment with tinzaparin (175 IU/kg−1 or 100 IU/kg−1) with aspirin (300 mg), was assessed using logistic regression adjusted for known
VTE risk factors and treatment. Results: sVTE Occurred in 28 patients (1.9%; 18 with deep vein thrombosis and 13 with pulmonary
embolism) within 15 days of enrollment in 1479 patients. Patients wearing one or two
stockings for any period of time during the first 10 days (n = 803) had a nonsignificant
increase (odds ratio 2.45, 95% confidence interval 0.95-6.32) in the risk of sVTE.
In contrast, those wearing bilateral stockings for 10 days (n = 374) had a nonsignificant
reduction in the odds of sVTE as compared with those who wore no stockings or wore
them for less than 10 days (odds ratio 0.65, 95% confidence interval 0.26-1.65). Mild
stroke and treatment with tinzaparin were associated with a reduced risk of VTE. Conclusions: Bilateral graduated compression stockings may reduce the incidence of VTE by one
third for patients with acute ischemic stroke. However, the uncertainty in this finding,
low frequency of sVTE, potential for stockings to cause harm, and cost of stockings
highlight the need for a large randomized controlled trial to examine the safety and
efficacy of stockings in acute stroke.
Key Words
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Article info
Publication history
Accepted:
June 16,
2005
Received:
May 1,
2005
Footnotes
Laura Gray is supported, in part, by The Stroke Association (UK) and BUPA Foundation (UK). Philip Bath is Stroke Association Professor of Stroke Medicine. The Division of Stroke Medicine receives a core grant from The Stroke Association (UK).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2005.06.001
Copyright
© 2005 National Stroke Association. Published by Elsevier Inc. All rights reserved.
