Graduated compression stockings as prophylaxis for flight-related venous thrombosis: systematic literature review

Aim. This paper reports a systematic review whose objective was to evaluate the effectiveness of graduated compression stockings as prophylaxis for flight‐related venous thrombosis, including deep vein thrombosis and superficial venous thrombosis, after air travel in the general population. Background. Despite the extended history of the use of graduated compression stockings, their application to prevent flight‐related thrombosis was not explored until flight‐related thrombosis was perceived as a preventable illness. Even now, their effectiveness in preventing flight‐related thrombosis remains unresolved. Methods. Generic terms including stocking/s, sock/s, or hosiery/hosieries were used to search a variety of electronic databases. Based on the selection criteria, decisions regarding inclusion and exclusion of primary studies were made. Using a meta‐analysis software program, relative risk for the incidence of deep vein thrombosis, superficial venous thrombosis, and intention‐to‐treat analysis was calculated. Results. A total of nine randomized controlled trials were included. In the treatment group, two of 1237 participants developed deep vein thrombosis in comparison with 46 of 1245 in the control group. The weighted relative risk for deep vein thrombosis was 0·08, with fixed 95% confidence interval 0·03–0·23. In the treatment group, four of 826 participants developed superficial venous thrombosis in comparison with seven of 823 in the control group. The weighted relative risk for superficial venous thrombosis was 0·67. with fixed 95% confidence interval 0·24–1·87 (non‐significant difference). Using intention‐to‐treat analysis, the risk for participants in the treatment group was 0·53 times as great as that for those in the control group. Conclusions. This review demonstrates the effectiveness of medium compression pressure, below‐knee graduated compression stockings in preventing flight‐related deep vein thrombosis but not superficial venous thrombosis in low‐medium‐ or high‐risk participants.