The Peto OR was 0.35 (95% CI 0.28 to 0.44 high‐quality evidence), with an overall effect favouring treatment with GCS (P < 0.001). Combining results from 19 trials focusing on surgical patients, 134 of 1365 (9.8%) units developed DVT in the GCS group compared to 282 of 1328 (21.2%) units in the control group. We carried out subgroup analysis by speciality (surgical or medical patients). We downgraded the quality of the evidence for proximal DVT and PE due to low event rate (imprecision) and lack of routine screening for PE (inconsistency). The Peto OR was 0.38 (95% CI 0.15 to 0.96 5 studies 569 participants low‐quality evidence) with an overall effect favouring treatment with GCS (P = 0.04). Combining results from five studies, all based on surgical patients, the incidence of PE was 5 of 283 (2%) participants in the GCS group and 14 of 286 (5%) in the control group. The Peto OR was 0.26 (95% CI 0.13 to 0.53 8 studies 1035 units moderate‐quality evidence) with an overall effect favouring treatment with GCS (P < 0.001). The Peto odds ratio (OR) was 0.35 (95% confidence interval (CI) 0.28 to 0.43 20 studies 2853 units high‐quality evidence), showing an overall effect favouring treatment with GCS (P < 0.001).īased on results from eight included studies, the incidence of proximal DVT was 7 of 517 (1%) units in the GCS group and 28 of 518 (5%) units in the control group. In the GCS group, 134 of 1445 units developed DVT (9%) in comparison to the control group (without GCS), in which 290 of 1408 units developed DVT (21%). We were able to pool the data from 20 studies reporting the incidence of DVT. The included studies were at an overall low risk of bias. Duration of follow‐up ranged from seven to 14 days. In the majority of the included studies DVT was identified by the radioactive I 125 uptake test. Graduated compression stockings were applied on the day before surgery or on the day of surgery and were worn up until discharge or until the participants were fully mobile. Of these 20 trials, 10 included patients undergoing general surgery six included patients undergoing orthopaedic surgery three individual trials included patients undergoing neurosurgery, cardiac surgery, and gynaecological surgery, respectively and only one trial included medical patients. In the control group the vein diameter increased to 2.9 mm (interquartile range 2.3-4.0 mm) during the operative procedure.We included 20 RCTs involving a total of 1681 individual participants and 1172 individual legs (2853 analytic units). After application of a stocking the median diameter in this group fell to 1.6 mm (interquartile range 1.3-2.8 mm) and then decreased slightly at the end of the operation. The median vein diameter in both groups was the same at the start of the operative procedures (control, 2.6 mm, interquartile range 2.1-3.3 mm stocking, 2.6 mm, interquartile range 2.1-3.7 mm). In half the patients a graduated compression anti-embolism stocking was applied to the limb under study at the start of the operation, immediately after initial measurements of vein diameter. A medial gastrocnemius vein was studied using ultrasound imaging during the operations. We have investigated 40 patients receiving surgical treatment on the abdomen or neck. Our previous work has shown that the deep veins of the lower limb distend in patients undergoing surgical procedures. Recent work has suggested that venous distension plays a role in initiating the process. The mechanisms by which graduated compression stockings prevent deep vein thrombosis are not completely understood.
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