Graduated compression stockings in prevention of venous thromboembolism among acutely ill medical patients aged over 75 years: a French national survey

Baptiste Gramont,1 Émilie Chalayer,1,2 Angélique Savall,3 Martin Killian,1 Thomas Celarier,1 Bernard Tardy21Department of Internal Medicine and Geriatrics, CHU, Saint Etienne, France; 2Centre d’Investigation Clinique, Inserm CIC-EC 1408, Saint Etienne, France; 3Department of Education and Research in General Practice, Jean Monnet University, Saint Etienne, FranceBackground: The thromboprophylactic efficacy of graduated compression stockings (GCS) has not yet been demonstrated in acutely ill medical patients, and guidelines vary considerably. Older acutely ill medical patients appear to constitute a distinctive population presenting high risks of both thrombosis and bleeding.Objective: To evaluate the practices and beliefs of a panel of French geriatricians regarding GCS management in acutely ill medical patients aged over 75 years.Methods: A survey was designed to study French geriatric practice concerning GCS use for thromboprophylaxis.Results: A total of 111 geriatricians answered the questionnaire. Among the responders, 46% declared frequent or very frequent prescription of GCS for preventing venous thromboembolism (VTE) in acutely ill, hospitalized medical patients, 54% declaring that they frequently re-evaluated GCS prescription during the patient’s hospitalization. The main reason reported for discontinuing GCS use was patient request. Regarding complications of GCS, 87% of responders declared having already noted adverse effects with the use of GCS, although 80% estimated the risk of complications to be low or very low. In the context considered, the efficacy of wearing GCS was believed to be high or very high for 73% of responders. GCS prescription was judged to be in accordance with evidence-based medicine for 69%.Conclusion: There is a gap between the frequent use of GCS to prevent VTE in older patients presenting an acute medical illness and the availability of data concerning their efficacy, safety, and management by nurses. Prospective trials including clinical and cost effectiveness are needed.Keywords: thromboprophylaxis, mechanical prophylaxis, thrombosis, geriatrics, elderly