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 Graduated compression as an Adjunct to Pharmacoprophylaxis in Surgery

When a person is in hospital for an operation, they often spend a lot of time in bed, putting them at risk of deep vein thrombosis (DVT). DVT is where a blood clot develops in a deep vein in one or both of the legs, causing pain, swelling and long term complications such as leg ulcers. If a DVT is not treated, then there is a risk that part of the blood clot could break off and become stuck in one of the lungs, blocking blood supply (pulmonary embolism, PE). Together, these two conditions are known as venous thromboembolism (VTE), which is a leading cause of death and disability worldwide. The importance to preventing patients from developing VTE is widely recognized. The main strategies in place involve anticoagulant medications (which thin the blood so it cannot form the harmful clots) and mechanical devices such as elasticated compression stockings (which apply continuous pressure to the legs, helping to maintain bloodflow). Evidence for using elastic stockings to prevent VTE has been challenged, with a lack of evidence for the additional benefits of elastic stockings over and above the benefit of blood-thinning. If elastic stockings reduce VTE over and above blood thinners, these benefits need to be weighed against the disadvantages, such as discomfort, restricting blood flow to the leg, blistering, cost and staff needing to help patients to put them on. 

The aim of this study is to look at whether patients who wear elastic stockings as well as taking anticoagulant medication have a lower chance of developing VTE than patients who take anticoagulant medications only. Participants are randomly allocated to one of two groups:
1) Graduated compression to wear during their hospital stay, as well as taking low molecular weight heparin OR
2) low molecular weight heparin only

Participants attend follow up appointments after 1 and 2-3 weeks, as well as 90 days after surgery, to have their legs scanned to check for the presence of any blood clots.

The following sites in England are involved in the GAPS Study:


This project is funded by the National Institute for Health Research HTA (project number 14/140/61). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.  For more information please visit




UK Clinical Trials Gateway:


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