Contrary To Guidelines, Compression Stockings Do Not Reduce The Risk Of Blood Clots After Stroke (CLOTS Study)

Main Category: Stroke
Also Included In: Blood / Hematology;  Medical Devices / Diagnostics
Article Date: 28 May 2009 - 0:00 PDT

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Thigh-length graduated support stockings (TL-GCS) do not reduce the risk of blood clots in stroke patients. Since guidelines in the UK and many developed nations recommend use of TL-GCS, such guidelines should now be urgently revised. The findings of the CLOTS trial are published in an Article Online First and in an upcoming edition of The Lancet, written by Professor Martin Dennis, University of Edinburgh, UK, and colleagues. Most of the study's funding came from the UK Medical Research Council. The findings are to be announced during this week's European Stroke Conference, Stockholm, Sweden.

About two thirds of stroke patients are unable to walk on admission to hospital, and between 10 and 20% of these will develop a blood clot in the veins of their legs - a deep vein thrombosis (DVT). In some, this blood clot will break up and be carried in the blood stream to the heart and lungs. These life-threatening clots (called pulmonary emboli) can cause severe breathlessness and are an important cause of death among hospitalised 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.

This randomised controlled trial analysed 2518 patients from 64 centres in the UK, 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 (1256 patients), or routine care only (1262). Each was then given an ultrasound of both legs at 7-10 days and again at 25-30 days after enrolment. The primary outcome was occurrence of DVT in the thigh. The researchers found that DVT occurred in 10.0% of patients in the TL-GCS group, and 10.5% of patients in the routine care only group. The difference was not statistically significant. 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%).

Referring to the UK example, Dr Dennis says 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. He says**: "We can estimate that 80,000 patients with stroke in the UK-about 2/3 of all admission to hospital with acute stroke-would be treated with stockings if this guideline is followed. 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."

He concludes**: "Compression stockings are used in the majority of stroke units. 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 Comment, Dr Philip Bath and Dr Timothy England, Stroke Trials Unit, University of Nottingham, UK, say: "GCS do not reduce DVT or overall venous thromboembolism in patients with recent stroke; indeed, they damage the skin and might promote limb ischaemia. GCS should not be used after stroke and current guidelines will need to be amended."

Link to article

Source
The Lancet