Choosing Wisely:

Don’t routinely use graduated compression stockings in surgical patients as mechanical prophylaxis for preventing venous thromboembolism (VTE) after surgery, but do consider using intermittent pneumatic compression devices.

Rationale and Comments: Thromboembolic disease is a significant cause of complications and mortality in hospitalized patients and a growing public health issue. Although anyone can develop a VTE, research shows that half of the VTE events in the outpatient setting are directly linked to a recent hospitalization. Many of these events can be prevented through pharmacological and/or mechanical VTE prophylaxis. Current guidelines that recommend mechanical devices demonstrate a preference for intermittent pneumatic compression-pc devices with no recommendations for graduated compression stockings, except for women at high risk for VTE after cesarean delivery. These intermittent pneumatic compression-pc devices minimize adverse effects to skin, promote patient comfort, and permit clinician assessment compared to graduated compression stockings.
Sponsoring Organizations:
  • American Academy of Nursing
  • Sources:
  • Cochrane Database of Systematic Reviews
  • American College of Physicians guidelines
  • American College of Chest Physicians guidelines
  • Disciplines:
  • Surgical
  • References: • Dunn N, Ramos R. Preventing venous thromboembolism: the role of nursing with intermittent pneumatic compression. Am J Crit Care. 2017; 26(2):164-167.
    • Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ; American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 suppl):7S-47S.
    • Kakkos SK, Caprini JA, Geroulakos N, Stansby G, Reddy DJ, Ntouvas I. Combined intermittent compression and pharmacologic prophylaxis for prevention of venous thromboembolism. Cochrane Database of Systematic Review. 2016, Issue 9. No: CD005258.
    • Qaseem A, Chou R, Humphrey LL, Starkey M, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;155(9):625-32.
    • Raskob GE, Silverstein R, Bratzler DW, Heit JA, White RH. Surveillance for deep vein thrombosis and pulmonary embolism: recommendations from a national workshop. Am J Prev Med. 2010;38(4 Ssuppl):S502-9.

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