Knee versus Thigh Length Graduated Compression Stockings for Prevention of Deep Venous Thrombosis: A Systematic Review

Department of Vascular Surgery, Royal Free Hospital and University College Medical School, Royal Free Campus, Pond Street, Hampstead, London, NW3 2QG, UK.
European Journal of Vascular and Endovascular Surgery (Impact Factor: 2.49). 01/2007; 32(6):730-6. DOI: 10.1016/j.ejvs.2006.06.021
Source: PubMed

ABSTRACT Graduated compression stockings are a valuable means of thrombo-prophylaxis but it is unclear whether knee-length (KL) or thigh length (TL) stockings are more effective. The aim of this review was to systematically analyse randomised controlled trials that have evaluated stocking length and efficacy of thromboprophylaxis.
A systematic review of the literature was undertaken. Clinical trials on hospitalised populations and passengers on long haul flights were selected according to specific criteria and analysed to generate summated data.
14 randomized control trials were analysed. Thirty six of 1568 (2.3%) participants randomised to KL stockings developed a deep venous thrombosis, compared with 79 of 1696 (5%) in the TL control/thigh length group. Substantial heterogeneity was observed amongst trials. KL stockings had a significant effect to reduce the incidence of DVT in long haul flight passengers, odds ration 0.08 (95%CI 0.03-0.22). In hospitalised patients KL stockings did not appear to be far worse than TL stockings, odds ratio 1.01 (95%CI 0.35-2.90). For combined passengers and patients, there was a benefit in favour of KL stockings, weighted odds ratio 0.45 (95% CI 0.30-0.68).
KL graduated stockings can be as effective as TL stockings for the prevention of DVT, whilst offering advantages in terms of patient compliance and cost.

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    • "Knee-length and thigh-length compression elastic stockings have similar physiological effects in decreasing venous stasis of the lower limb, but the former are easier to apply and are more comfortable (Benko et al, 2001). A recent systematic review of knee versus thigh length graduated compression stockings for the prevention of DVT concluded that knee length were as effective as thigh length stockings and offer advantages in terms of patient compliance and cost (Sajid et al, 2006). To our knowledge, the effectiveness of knee versus thigh length stocking at the time of acute DVT or to prevent or treat PTS have not been directly compared. "
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    ABSTRACT: Despite considerable progress in the diagnosis and treatment of deep-vein thrombosis (DVT) of the lower extremities, one of every 2-3 patients will develop within 2 years post-thrombotic sequelae, which are severe in approximately 10% of cases and produce considerable socio-economic consequences. Among factors potentially related to the development of the post-thrombotic syndrome (PTS) are older age, obesity, a history of previous ipsilateral DVT, iliac-femoral location of the current thrombosis, failure to promptly recover from the acute symptoms and insufficient quality of oral anticoagulant therapy. Based on recent findings, the lack of vein recanalization within the first 6 months after DVT appears to be an important predictor of PTS, while the role of venous reflux is controversial. According to the results of recent clinical studies, the prompt administration of adequate compression elastic stockings in patients with symptomatic DVT has the potential to halve the frequency of PTS, and when carefully supervised and instructed to wear proper elastic stockings, more than 50% of patients have the potential to either remain stable or improve during long-term follow-up. Nevertheless, due to limitations in current therapies, the management of PTS is demanding and often frustrating. Further research is required to optimize the prevention and management of this common and burdensome complication of DVT.
    British Journal of Haematology 03/2009; 145(3):286-95. DOI:10.1111/j.1365-2141.2009.07601.x · 4.71 Impact Factor
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    ABSTRACT: xviii, 210 p. : ill. (some col.) ; 30 cm. PolyU Library Call No.: [THS] LG51 .H577P ITC 2009 Yao Skin is the largest organ of human body that acts as the interface between the internal tissues of the body and the external environment to provide barrier function and protection. Clothing, called 'the second skin', covers most parts of the body, most of time, in majority of the places not only providing additional shield for the body but also creating a portable living microclimate for its survival. Chinese ancient wisdoms identified clothing as the first most essential item for human living and health. However, how the skin and 'the second skin' interact with each other to serve the protective and biological functions is indeed a mystery and a scientific understanding of the phenomenon is still in its infancy. The aim of this research is to fill the knowledge gaps and establish a theoretical framework for delineating the effects of clothing on skin physiology. This aim has been achieved through a systematic study to establish theoretical framework based on a thorough literature review and by undertaking a series of wear trials in mildly cold and hot environmental conditions, as well as under solar exposure. A theoretical framework of effects of clothing on skin physiology was developed by considering the potential mechanisms involved in physics, biochemistry, physiology, neuropsychology and immunology. A set of hypotheses were then proposed to explain the possible physiological interactions between clothing and skin. This theoretical framework and hypotheses were further tested by a series of wear trials conducted in mildly cold and hot environmental conditions as well as under solar exposure. A parallel cross-over blinded wear trial was designed and conducted in mildly cold condition to study the influence of clothing material on skin physiology. It is found that stratum corneum water content (SCWC) level is significantly higher when one wears cotton garment rather than polyester garments. Clothing material seems to significantly influence subjective sensation of coldness and stress level. Cotton fabric, with higher moisture sorption capacity and lower thermal diffusivity, has a positive effect on SCWC. Perception of coldness has a negative effect on SCWC. To identify the effects of fabric moisture and liquid water transport properties on the skin physiology in the context of daily wear, a parallel blinded wear trial was carried out in a mildly cold environment. The results suggested that hygroscopicity of fabric significantly influences SCWC and transepidermal water loss (TEWL) in mildly cold condition. Additionally, hygroscopicity of fabric tended to influence sebum, although no significant effect on skin surface acidity has been noted. Generally speaking hydrophilicity of fabric did not significantly affect skin physiology in mildly cold environment. To explore the mechanisms of the effects of fabric properties on skin physiological status in daily wear in mildly cold condition, statistical methods such as factor analysis and Hierarchical Linear Regression (HLR) were applied to obtain the relationships between fabric properties and skin physiological parameters such as SCWC, TEWL, sebum and skin surface acidity. A framework was developed to describe the clothing-body interactions among fabric physical properties, sensory responses, skin physiological and neuropsychological responses in mild cold environment. It was found that hygroscopic fabric significantly increases SCWC and TEWL and decreases sebum in mildly cold condition. Fabric transport capability significantly reduces skin surface acidity by promoting heat release and reducing heat accumulation. Fabric transport capability seems to increase the overall comfort sensation and reduces stress. Meanwhile, fabric shearing resistance reduces overall comfort sensation and increases stress level. Fabric compressibility and overall moisture management capacity (OMMC) appear to enhance overall comfort sensation. Overall comfort sensation is positively related to SCWC and TEWL, while stress level is positively related to sebum. To study effects of clothing on skin physiological response in hot environment, a cross-over blinded wear trial was also conducted, the results were analyzed statistically by using Repeated Measure-ANOVA, and its mechanisms were explored by using HLR. It was found that fabric transport capability, shearing resistance and compressibility influence human thermoregulation by affecting heat release, and microclimate humidity. Fabrics with higher transport capability significantly reduce core and skin temperature by promoting heat release from the human body to the external environment. Fabric with higher shearing resistance increases skin temperature. A framework was thus developed to describe the clothing-body interactions in terms of fabric physical properties, skin physiological, neuropsychological and thermophysiological responses in a typical hot environment. To investigate the effects of UV blocking fabric on skin physiology, another parallel wear trial was carried out under solar exposure. It was found that that fabric with UV blocking capability reduces the acute effects of solar exposure, inhibits melanin content and erythem level as well as protects circadian rhythmicity, and increases stratum corneum hydration under UV radiation. To reiterate, in this study, the clothing-body interactions in mild cold and hot environments as well as under solar exposure have been investigated. Two comprehensive frameworks have been developed to describe the mechanisms of the ways in which physical properties of fabric influence skin physiology, thermophysiology and neuropsychology. The outcomes of this research should contribute towards developing a scientific understanding on how clothing affects skin physiological health, comfort and protection of the body under different environmental conditions. Ph.D., Institute of Textiles and Clothing, The Hong Kong Polytechnic University, 2009
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