Compression Stockings May Not Be Needed After Surgeries, Study Finds
A new study offers reassurance that many surgery patients can safely be freed from one discomfort of recovery -- wearing compression stockings to prevent blood clots.
The garments, which help keep blood from pooling in the lower legs, have long been used post-surgery. One reason has been to thwart blood clots, which can form in the leg veins when a patient is laid up in recovery.
But rates of such blood clots have fallen dramatically over the years, according to researcher Dr. Alun Davies.
That's due to various improvements in care, he said -- like getting patients out of bed and moving soon after surgery, and discharging them from the hospital earlier.
That raises the question of whether old-fashioned compression stockings still hold any benefit. Davies and his colleagues at Imperial College London, and other British hospitals, set up a trial to find out.
The researchers randomly assigned nearly 1,900 patients undergoing elective surgery to one of two groups: One received standard anti-clotting medication after surgery; the other took the same medication and used compression stockings during their hospital stay.
In the end, the two groups showed no difference in the risk of blood clots -- an indication the stockings were unnecessary.
The findings were published online May 13 in the medical journal BMJ.
The results came as no surprise to Dr. Michael Ast, an orthopedic surgeon at the Hospital for Special Surgery, in New York City.
Doctors have already moved away from using compression stockings specifically to prevent clots, he explained.
"The number-one thing in preventing blood clots is getting patients up and moving around," Ast said.
But, he added, compression stockings still have a use: Patients who are prone to swelling in the legs -- which can be painful and hinder their mobility -- may still need to wear them. In those cases, Ast said, he generally recommends patients wear the garments for about a month after they go home.
The new study involved 1,888 patients who were mainly undergoing gastrointestinal or gynecological surgery. All were at moderate or high risk of blood clots -- based on factors like age, obesity and certain health conditions, such as heart disease.
All of the patients were given heparin, an anti-clotting drug. Half wore compression stockings while they recovered in the hospital, while the other half did not.
Overall, 1.7% of patients on medication alone developed a blood clot within 90 days. That figure was 1.4% among patients who used compression stockings -- a difference that was not statistically significant, the researchers said.
In most cases, those blood clots were in the leg veins and not causing any pain or other symptoms; they were caught by ultrasound scans.
And that's part of the good news, Ast said: With modern care, blood clots after surgery have actually become uncommon; when they do occur, they often cause no problem.
The main concern with clots in the legs is that they can break free and travel to the lungs, causing a potentially life-threatening condition called pulmonary embolism. In this study, three patients, all age 65 or older, had a confirmed pulmonary embolism.
According to Ast, the risk of blood clots after surgery was once a much bigger concern: In the 1970s and 1980s, rates were as high as 25% after hip or knee replacements, for example.
But a lot has changed over the years. The recognition that early movement is critical -- along with better pain management to make that possible -- has been key. In fact, Ast said, when it comes to clot-preventing medication, baby aspirin can be used instead of heparin -- an injection drug that carries a higher risk of bleeding complications.
And once patients are home, that's not the time to become a couch potato.
"There's nothing more important than moving around, even if it's causing some pain," Ast said. "We recommend getting up and moving once an hour."
The American Academy of Orthopaedic Surgeons has more on blood clot prevention.
SOURCES: Alun Davies, M.D., professor, vascular surgery, Imperial College London, U.K.; Michael Ast, M.D., orthopedic surgeon, Hospital for Special Surgery, New York City; May 13, 2020 BMJ, online