Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): randomised controlled trial

RCT (n=1905 in UK) found pharmaco-thromboprophylaxis alone is non-inferior to its use in combination with graduated compression stockings (imaging confirmed lower limb DVT or PE with symptoms within 90 days of surgery occurred in 1.7% on LMWH vs. 1.4% on LMWH and GCS).

SPS commentary:

The researchers suggest from these findings that GCS might be unnecessary in most patients undergoing elective surgery and current guidelines based on historical data should be revised.


In a linked opinion, one of the researchers notes that the cost of purchasing and applying stockings to surgical inpatients at risk for VTE in England is estimated at £63.1 million per annum. She questions whether the risks and costs associated with their use both medically or health-economically are justified for DVT prevention. She adds that their data join a growing body of evidence that does not support the use of graduated compression stockings in this patient population. This is also supported by data from Salisbury NHS Foundation Trust where the policy has been not to use graduated compression stockings in elective surgical patients receiving thromboprophylactic dose low molecular weight heparin over the last five years and whose VTE outcomes are comparable to national figures. She calls for an urgent re-consideration of the need for stockings for this patient population, and particularly at a time when the NHS will be expected to find many innovative ways to reduce cost as a period of huge economic uncertainty looms.


British Medical Journal

Resource links:

Linked opinion