Waimei Tai, MD
The CLOTS Trials Collaboration, Dennis M, Sandercock P, Reid J, Graham C, Murray G, et al. The Effect of Graduated Compression Stockings on Long-term Outcomes After Stroke: The CLOTS Trials 1 and 2. Stroke. Published ahead of print on March 12, 2013.
Dennis. et. al. recently published a study demonstrating the relative non-efficacy of graduated compression stockings in patients after ischemic or hemorrhagic stroke. Patients were enrolled within three days of their index event and wore the T.E.D stockings until they were mobile, discharged from the hospital, or they refused to wear them. Overall, there was no added benefit by wearing these stockings. Given the short term utility of the stockings, I can’t imagine how the stockings effects would last longer than the duration of the hospitalization, but they did monitor the patients for thromboembolic events for 6 months after enrollment.
Not surprisingly, this study confirms similar results as other non-stroke specific cohorts of patients. In fact, our hospital has already determined after reviewing best practices, to avoid graduated compression stockings (both knee high and thigh high) for routine DVT prophylaxis.
For general ischemic stroke patients, the AHA guidelines (and JCAHO core measures) recommend chemical prophylaxis within 48 hours of index event. For those patients for which this is contraindicated, sequential compression device is used.
What do you use at your hospital? How should we best incorporate new information to allow best practices be advanced to clinical practice in your hospital?