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

J Shalhoub, J Norrie, C Baker, A. W. Bradbury, K Dhillon, T Everington, M S Gohel, Z Hamady, F Heatley, J Hudson, B J Hunt, R. Lawton, G Stansby, A Stephens-Boal, S. Toh, D Warwick, A H Davies (Corresponding Author)

Research output: Contribution to journalArticle

3 Citations (Scopus)
17 Downloads (Pure)

Abstract

Background:
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 each year in England alone.

Objective:
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.

Methods:
A 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 for 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].
Original languageEnglish
Pages (from-to)880–885
Number of pages6
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume53
Issue number6
Early online date7 Apr 2017
DOIs
Publication statusPublished - 1 Jun 2017

Fingerprint

Compression Stockings
Low Molecular Weight Heparin
Venous Thromboembolism
Randomized Controlled Trials
Biomedical Technology Assessment
National Institutes of Health (U.S.)
England
Quality of Life
Hemorrhage
Costs and Cost Analysis
Mortality
Research

Keywords

  • Randomised controlled trial
  • venous thromboembolism
  • deep vein thrombosis
  • graduated compression stockings
  • low molecular weight heparin
  • thromboprophylaxis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Graduated Compression Stockings as an Adjunct to Low Dose Low Molecular Weight Heparin in Venous Thromboembolism Prevention in Surgery : A Multicentre Randomised Controlled Trial. / Shalhoub, J; Norrie, J; Baker, C; Bradbury, A. W.; Dhillon, K; Everington, T; Gohel, M S ; Hamady, Z ; Heatley, F; Hudson, J; Hunt, B J; Lawton, R.; Stansby, G; Stephens-Boal, A; Toh, S.; Warwick, D; Davies, A H (Corresponding Author).

In: European Journal of Vascular and Endovascular Surgery, Vol. 53, No. 6, 01.06.2017, p. 880–885.

Research output: Contribution to journalArticle

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 2017, 'Graduated Compression Stockings as an Adjunct to Low Dose Low Molecular Weight Heparin in Venous Thromboembolism Prevention in Surgery: A Multicentre Randomised Controlled Trial', European Journal of Vascular and Endovascular Surgery, vol. 53, no. 6, pp. 880–885. https://doi.org/10.1016/j.ejvs.2017.02.013
Shalhoub, J ; Norrie, J ; Baker, C ; Bradbury, A. W. ; Dhillon, K ; Everington, T ; Gohel, M S ; Hamady, Z ; Heatley, F ; Hudson, J ; Hunt, B J ; Lawton, R. ; Stansby, G ; Stephens-Boal, A ; Toh, S. ; Warwick, D ; Davies, A H. / Graduated Compression Stockings as an Adjunct to Low Dose Low Molecular Weight Heparin in Venous Thromboembolism Prevention in Surgery : A Multicentre Randomised Controlled Trial. In: European Journal of Vascular and Endovascular Surgery. 2017 ; Vol. 53, No. 6. pp. 880–885.
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abstract = "Background: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 each year in England alone.Objective: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.Methods:A 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 for 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].",
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T1 - Graduated Compression Stockings as an Adjunct to Low Dose Low Molecular Weight Heparin in Venous Thromboembolism Prevention in Surgery

T2 - A Multicentre Randomised Controlled Trial

AU - Shalhoub, J

AU - Norrie, J

AU - Baker, C

AU - Bradbury, A. W.

AU - Dhillon, K

AU - Everington, T

AU - Gohel, M S

AU - Hamady, Z

AU - Heatley, F

AU - Hudson, J

AU - Hunt, B J

AU - Lawton, R.

AU - Stansby, G

AU - Stephens-Boal, A

AU - Toh, S.

AU - Warwick, D

AU - Davies, A H

N1 - The GAPS trial is funded by the National Institute for Health Research Health Technology Assessment in the UK [14/140/61]. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.

PY - 2017/6/1

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N2 - Background: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 each year in England alone.Objective: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.Methods:A 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 for 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].

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KW - deep vein thrombosis

KW - graduated compression stockings

KW - low molecular weight heparin

KW - thromboprophylaxis

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JO - European Journal of Vascular and Endovascular Surgery

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SN - 1078-5884

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