Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): randomised controlled trial.

To investigate whether the use of graduated compression stockings (GCS) offers any adjuvant benefit when pharmaco-thromboprophylaxis is used for venous thromboembolism prophylaxis in patients undergoing elective surgery. Open, multicentre, randomised, controlled, non-inferiority trial. Seven National Health Service tertiary hospitals in the United Kingdom. 1905 elective surgical inpatients (≥18 years) assessed as being at moderate or high risk of venous thromboembolism were eligible and consented to participate. Participants were randomly assigned (1:1) to receive low molecular weight heparin (LMWH) pharmaco-thromboprophylaxis alone or LMWH pharmaco-thromboprophylaxis and GCS. The primary outcome was imaging confirmed lower limb deep vein thrombosis with or without symptoms, or pulmonary embolism with symptoms within 90 days of surgery. Secondary outcome measures were quality of life, compliance with stockings and LMWH, lower limb complications related to GCS, bleeding complications, adverse reactions to LMWH, and all cause mortality. Between May 2016 and January 2019, 1905 participants were randomised. 1858 were included in the intention to treat analysis (17 were identified as ineligible after randomisation and 30 did not undergo surgery). A primary outcome event occurred in 16 of 937 (1.7%) patients in the LMWH alone group compared with 13 of 921 (1.4%) in the LMWH and GCS group. The risk difference between the two groups was 0.30% (95% confidence interval -0.65% to 1.26%). Because the 95% confidence interval did not cross the non-inferiority margin of 3.5% (P<0.001 for non-inferiority), LMWH alone was confirmed to be non-inferior. For patients who have elective surgery and are at moderate or high risk of venous thromboembolism, administration of pharmaco-thromboprophylaxis alone is non-inferior to a combination of pharmaco-thromboprophylaxis and GCS. These findings indicate that GCS might be unnecessary in most patients undergoing elective surgery. ISRCTN13911492.

Shalhoub J ，Lawton R ，Hudson J ，Baker C ，Bradbury A ，Dhillon K ，Everington T ，Gohel MS ，Hamady Z ，Hunt BJ ，Stansby G ，Warwick D ，Norrie J ，Davies AH ，GAPS trial investigators ... -  《BMJ-British Medical Journal》

Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT.

Shalhoub J ，Lawton R ，Hudson J ，Baker C ，Bradbury A ，Dhillon K ，Everington T ，Gohel MS ，Hamady Z ，Hunt BJ ，Stansby G ，Warwick D ，Norrie J ，Davies AH ... -  《-》

Graduated Compression Stockings as an Adjunct to Low Dose Low Molecular Weight Heparin in Venous Thromboembolism Prevention in Surgery: A Multicentre Randomised Controlled Trial.

The evidence base upon which current global venous thromboembolism (VTE) prevention recommendations have been made is not optimal. The cost of purchasing and applying graduated compression stockings (GCS) in surgical patients is considerable and has been estimated at £63.1 million per year in England alone. The aim was to determine whether low dose low molecular weight heparin (LMWH) alone is non-inferior to a combination of GCS and low dose LMWH for the prevention of VTE. The randomised controlled Graduated compression as an Adjunct to Pharmacoprophylaxis in Surgery (GAPS) Trial (ISRCTN 13911492) will randomise adult elective surgical patients identified as being at moderate and high risk of VTE to receive either the current "standard" combined thromboprophylactic LMWH with GCS mechanical thromboprophylaxis, or thromboprophylactic LMWH pharmacoprophylaxis alone. To show non-inferiority (3.5% non-inferiority margin) for the primary endpoint of all VTE within 90 days, 2236 patients are required. Recruitment will be from seven UK centres. Secondary outcomes include quality of life, compliance with stockings and LMWH, overall mortality, and GCS or LMWH related complications (including bleeding). Recruitment commenced in April 2016 with the seven UK centres coming "on-line" in a staggered fashion. Recruitment will be over a total of 18 months. The GAPS trial is funded by the National Institute for Health Research Health Technology Assessment in the UK (14/140/61).

Shalhoub J ，Norrie J ，Baker C ，Bradbury AW ，Dhillon K ，Everington T ，Gohel MS ，Hamady Z ，Heatley F ，Hudson J ，Hunt BJ ，Lawton R ，Stansby G ，Stephens-Boal A ，Toh S ，Warwick D ，Davies AH ，GAPS Trial Investigators ... -  《-》

Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial.

Camporese G ，Bernardi E ，Prandoni P ，Noventa F ，Verlato F ，Simioni P ，Ntita K ，Salmistraro G ，Frangos C ，Rossi F ，Cordova R ，Franz F ，Zucchetta P ，Kontothanassis D ，Andreozzi GM ，KANT (Knee Arthroscopy Nadroparin Thromboprophylaxis) Study Group ... -  《-》

[Prophylactic use of low molecular weight heparin in combination with graduated compression stockings in post-operative patients with gynecologic cancer].

Zheng H ，Gao Y ，Yan X ，Gao M ，Gao W ... -  《-》