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A roundup of information on compression stockings after stroke; quality of home INR testing; and cardiovascular risk in users of clopidogrel
The CLOTS-2 study was a randomized, multicenter, international, parallel-group study that included 3,114 patients hospitalized with acute stroke. Patients wore either knee-high or thigh–high compression stockings while hospitalized. Patients and their caregivers were not blinded to treatment, but the ultrasonographers who performed duplex ultrasonography to the study patients were blinded to treatment. Patients received either type of stocking, as well as routine care that could include antiplatelet or anticoagulant agents.
The primary outcome was popliteal or femoral vein DVT detected on either scan (first scan at day 7 to day 10; second scan completed 15 to 20 days after the first scan).
Study limitations included incomplete blinding; failure to obtain both scans for all enrolled patients; and early termination of the study. Nonetheless, more proximal DVTs occurred in patients who wore the knee-length compression stockings.
Even though the benefit is modest, an accompanying editorial suggested that the stockings might be a reasonable approach in stroke patients for whom anticoagulant therapy is contraindicated. However, some of the patients in this study received anticoagulants along with the compression stockings.
Sources: Dennis M, Sandercock P, Rudd A, et al. Thigh-Length versus below-knee stockings for deep venous thrombosis prophylaxis after stroke: A randomized trial. The CLOTS (Clots in legs or stockings after stroke) Trial collaboration. Ann Intern Med. 2010;153(9):553-562.
Kearon C, O'Donnell M. Should patients with stroke wear compression stockings to prevent venous thromboembolism? Ann Intern Med. 2010;153:610–611.