Thigh length versus knee length stockings in the prevention of deep vein thrombosis. Cost effectiveness and efficacy of below knee against above knee graduated compression stockings in the prevention of deep vein thrombosis. Randomized clinical trial of low molecular weight heparin with thigh-length or knee-length antiembolism stockings for patients undergoing surgery.
Above-knee graduated compression stockings are effective in preventing postoperative deep vein thrombosis, but are more expensive and less acceptable than below-knee stockings. One hundred and fourteen patients undergoing major abdominal surgery were randomly allocated to wear above-knee or below-knee graduated compression stockings. Deep vein thromboses were diagnosed by isotope uptake in three of 56 patients (5.4 per cent) in the above-knee group and one of 58 patients (1.7 per cent) in the below-knee group. These differences are not statistically significant. Results suggest that below-knee stockings are as effective as above-knee in the prevention of postoperative deep vein thrombosis. nan This was a randomized clinical trial to determine the efficacy and safety of a 'blanket' protocol of low molecular weight heparin (LMWH) and the best length of antiembolism stocking, for every patient requiring surgery under general anaesthesia.
                Of 426 patients interviewed, 376 agreed to be randomized to receive one of three types of stocking: thigh-length Medi thrombexin climax (Medi UK, Hereford, UK), knee-length thrombexin climax and thigh-length Kendall T.E.D. (Tyco Healthcare UK, Redruth, UK). All patients received LMWH thromboprophylaxis. Duplex ultrasonography was used to assess the incidence of postoperative deep vein thrombosis (DVT).
                No postoperative DVT occurred in 85 patients at low or moderate risk. Nineteen DVTs occurred, all in the 291 high-risk patients: two with the Medi thigh-length stockings, 11 with the Medi knee-length stockings (odds ratio 0.18 (95 per cent confidence interval 0.04 to 0.82); P = 0.026) and six with the Kendall T.E.D. thigh-length stockings. No patient developed a pulmonary embolism. Stocking groups were similar for age, sex, thromboembolic risk, type of operation and compliance. One significant bleeding complication occurred.
                A single protocol comprising LMWH and thigh-length stockings abolished DVT in low- and moderate-risk patients, and reduced the rate of DVT to 2 per cent in high-risk patients.
                Copyright 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
This review found that there is insufficient high quality evidence to determine whether or not KL and TL GCS differ in their effectiveness in terms of reducing the incidence of deep vein thrombosis (DVT) in hospitalised patients.  A major multicentre RCT is required to address this issue. In the meantime, the decision on which type of stocking to use in clinical practice is likely to be influenced by factors such as patient compliance, ease of use and cost implications.