Imperial College London
Alternate

MrJosephShalhoub

Faculty of Medicine, Department of Surgery & Cancer

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

j.shalhoub Website

 
 
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Location

 

Charing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Shalhoub:2020:10.1136/bmj.m1309,
author = {Shalhoub, J and Lawton, R and Hudson, J and Baker, C and Bradbury, A and Dhillon, K and Everington, T and Gohel, M and Hamady, Z and Hunt, B and Stansby, G and Warwick, D and Norrie, J and Davies, A},
doi = {10.1136/bmj.m1309},
journal = {BMJ: British Medical Journal},
title = {Graduated compression stockings as an adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): a randomised controlled trial},
url = {http://dx.doi.org/10.1136/bmj.m1309},
volume = {369},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objectives: Does the use of GCS offer any adjuvant benefit when pharmaco-thromboprophylaxis is used for VTE prophylaxis?Design: Open, multicentre, randomised, controlled, non-inferiority trial.Setting:Seven National Health Service tertiary hospitals in the United Kingdom.Participants: 1905 elective surgical inpatients, aged >18 years assessed as being at moderate or high risk of VTE were eligible and consented to participate. Intervention: Participants were randomly assigned (1:1) to receive either low molecular weight heparin (LMWH) pharmaco-thromboprophylaxis alone or LMWH pharmaco-thromboprophylaxis and graduated compression stockings (GCS).Outcome measures: The primary endpoint was a combination of imaging confirmed asymptomatic and symptomatic lower limb deep vein thrombosis and/or symptomatic pulmonary embolism within 90 days of surgery. Secondary outcome measures were quality of life, compliance with stockings and LMWH, GCS-related lower limb complications, bleeding complications, adverse reactions to LMWH, and all-cause mortality.Results: Between May 2016 and January 2019, 1905 participants were randomised, of which 1858 were included in the intention-to-treat analysis (17 identified as ineligible post-randomisation and 30 did not undergo surgery). A primary-outcome event occurred in 16/937 (1.7%) patients in the LMWH alone arm compared to 13/921 (1.4%) in the LMWH and GCS arm. The risk difference between LMWH and LMWH and GCS was 0.30% (95% confidence interval [CI} -0.65% to 1.26%). As the 95% CI did not cross the non-inferiority margin of 3.5% (p-value <0.001 for non-inferiority), LMWH alone was confirmed as being non-inferior.Conclusions: For elective surgical patients at moderate or high risk of VTE, administration of pharmaco-thromboprophylaxis alone is non-inferior to a combination of pharmaco-thromboprophylaxis and graduated compression stockings. These findings indicate that graduated compression stockings may be unnecessary in most elective su
AU  - Shalhoub,J
AU  - Lawton,R
AU  - Hudson,J
AU  - Baker,C
AU  - Bradbury,A
AU  - Dhillon,K
AU  - Everington,T
AU  - Gohel,M
AU  - Hamady,Z
AU  - Hunt,B
AU  - Stansby,G
AU  - Warwick,D
AU  - Norrie,J
AU  - Davies,A
DO  - 10.1136/bmj.m1309
PY  - 2020///
SN  - 0959-535X
TI  - Graduated compression stockings as an adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): a randomised controlled trial
T2  - BMJ: British Medical Journal
UR  - http://dx.doi.org/10.1136/bmj.m1309
UR  - http://hdl.handle.net/10044/1/78966
VL  - 369
ER  -
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