The effectiveness of graduated compression stockings for prevention of venous thromboembolism in orthopedic and abdominal surgery patients requiring extended pharmacologic thromboprophylaxis.

OBJECTIVE: There is an increasing evidence base to support the use of extended pharmacologic thromboprophylaxis in selected surgical patients to prevent venous thromboembolism (VTE). The benefit of graduated compression stockings (GCS) in addition to extended pharmacologic thromboprophylaxis is unclear. The aim of this study was to systematically review the evidence relating to the effectiveness of using GCS in conjunction with extended pharmacologic thromboprophylaxis to prevent VTE in surgical patients. METHODS: A literature search of MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in April 2017. The review protocol was published on PROSPERO (CRD42017062655). Randomized controlled trials (RCTs) were eligible if one of the study arms included patients receiving extended pharmacologic thromboprophylaxis alone (>21 days) or in conjunction with GCS. Data on deep venous thrombosis (DVT), pulmonary embolism (PE), and VTE-related death were compiled. Pooled proportions of the VTE rates were determined using random-effects meta-analysis. RESULTS: The systematic search identified 1291 studies, of which 19 studies were eligible for inclusion. No RCT directly compared extended pharmacologic thromboprophylaxis alone with GCS plus extended pharmacologic thromboprophylaxis. A total of 9824 patients from 16 RCTs were treated with extended pharmacologic thromboprophylaxis, of whom 0.81% (95% confidence interval [CI], 0.5-1.20) were diagnosed with symptomatic DVT and 0.2% (95% CI, 0.12-0.36) with PE. Three trials included 337 patients who received extended pharmacologic thromboprophylaxis in conjunction with GCS. In this group, 1.61% (95% CI, 0.03-5.43) had symptomatic DVT with no reported PE. Similar VTE rates were observed when studies in orthopedic and abdominal surgery were analyzed separately. CONCLUSIONS: There is insufficient evidence to recommend GCS in conjunction with extended pharmacologic prophylaxis to prevent VTE in patients undergoing orthopedic and abdominal surgery. A clinical trial directly investigating this important subject is needed.

Lessons from Metabonomics on the Neurobiology of Stroke.

The application of metabonomic science to interrogate stroke permits the study of metabolite entities, small enough to cross the blood-brain barrier, that provide insight into neuronal dysfunction, and may serve as reservoirs of biomarker discovery. This systematic review examines the applicability of metabolic profiling in ischemic stroke research. Six human studies utilizing metabolic profiling to analyze biofluids from ischemic stroke patients have been included, employing 1H-NMR and/or mass spectrometry to analyze plasma, serum, and/or urine in a targeted or untargeted fashion. Three are diagnostic studies, and one investigates prognostic biomarkers of stroke recurrence following transient ischemic attack. Two studies focus on metabolic distinguishers of depression or cognitive impairment following stroke. Identified biomarkers from blood and urine predominantly relate to homocysteine and folate, branched chain amino acid, and lipid metabolism. Statistical models are well fitted and reproducible, with excellent validation outcomes, demonstrating the feasibility of metabolic profiling to study a complex disorder with multicausal pathology, such as stroke.