Randomized controlled trial of heparin plus graduated compression stocking for the prophylaxis of deep venous thrombosis in general surgical patients

Background: A randomized controlled study was undertaken to compare heparin with heparin plus graduated compression stockings (Brevet Tx, Seton Healthcare) in the prophylaxis of deep vein thrombosis (DVT) following abdominal surgery. Methods: Sixty high‐risk patients were recruited if they met at least two of the following criteria identified as predisposing to DVT: age greater than 39 years, malignancy, varicose veins, cardiac disease or hypertension, diabetes mellitus, obesity or previous thromboembolic episode. All patients received subcutaneous heparin and were randomized to receive Brevet Tx to either the right or left leg before surgery. The stocking was worn for 2 weeks after surgery. The patients underwent duplex imaging before surgery, and at 3, 6 and 14 days after operation. All scans were performed by one sonographer. The policy was to perform a venogram where a positive result was indicated by duplex scanning. Results: Fifty‐six patients completed the study. Six patients (11 per cent) suffered a DVT in the non‐stockinged leg, but none in the stockinged leg ( P = 0·016, McNemar's test). The DVTs occurred on days 3, 6, 7, 8, 9 and 12 following surgery. Conclusion: Brevet Tx in addition to low‐dose subcutaneous heparin significantly reduced the incidence of DVT in high‐risk patients undergoing abdominal surgery. © 1999 British Journal of Surgery Society Ltd