LIFENOX study - TED stockings good enough for VTE prophylaxis in medical patients?

Good discussion at the lunchtime meeting today about the recent study, reported in the NEJM, on the use of low-molecular weight heparin vs. placebo in medically ill patients - the LIFENOX study.[1]

"The use of enoxaparin plus elastic stockings with graduated compression, as compared with elastic stockings with graduated compression alone, was not associated with a reduction in the rate of death from any cause among hospitalized, acutely ill medical patients."

All the patients (who were medical inpatients with CCF or severe infection with one risk factor for venous thromboembolism or had a diagnosis of cancer) had TED stockings and either enoxaparin or placebo. The authors wondered if the TED stockings did a good enough job of preventing VTE.

A Now@NEJM blog about the study provides a good overview and which points out:

"Although elastic stockings with graduated compression have been shown to be effective in reducing the risk of deep-vein thrombosis in moderate-risk surgical patients and other medical patient populations, the use of stockings  did not prevent the occurrence of deep-vein thrombosis in patients recuperating from severe, disabling stroke who  were participants in the Clots in Legs or Stocking after Stroke trial (CLOTS)."

Another interesting point about the study is that it involved sites less commonly seen in publications - China, India, Korea, Malaysia, Mexico, the Philippines, and Tunisia.

1. Kakkar AK, Cimminiello C, Goldhaber SZ, Parakh R, Wang C, Bergmann J-F. Low-molecular-weight heparin and mortality in acutely ill medical patients. N. Engl. J. Med. 2011 Dec;365(26):2463-2472. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22204723