The National Institute for Health and Clinical Excellence (NICE) guidelines recommend combined mechanical and pharmacological prophylaxis to reduce the risk of venous thromboembolism (VTE) in patients undergoing orthopaedic surgery. There is increasing evidence that anti-embolic stockings (AES) have little effect on reducing such risk. Articles in the MEDLINE, EMBASE, and Cochrane Library were reviewed. Studies on the use of pharmacological prophylaxis recommended in the 2010 NICE guidelines including low-molecular-weight heparin, unfractionated heparin, rivaroxaban, and dabigatran with and without AES in patients undergoing orthopaedic surgery were included. A total of 1171 trauma and elective orthopaedic patients in 4 studies were included; 587 received pharmacological prophylaxis alone, and 584 received a combination of pharmacological prophylaxis and above- or below-knee AES. Of the respective patients, 44 (7.5%) and 31 (5.3%) developed deep vein thrombosis (p=0.1587) and 7 (1.2%) and 9 (1.5%) developed pulmonary embolism (p=0.8493). The overall VTE rates did not differ significantly (p=0.2864). No death from VTE was reported. Addition of AES did not confer significant benefit in terms of reducing the risk of VTE in orthopaedic patients.
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