From the Guidelines
Compression stockings are generally contraindicated for patients with severe thrombocytopenia (platelet count of 32) and leukopenia (WBC of 1.1). These abnormal blood values suggest a serious underlying hematological condition that requires medical attention before considering compression therapy. The low platelet count significantly increases bleeding risk, as platelets are essential for blood clotting. When compression stockings are applied, they exert pressure on the skin and underlying tissues, which could potentially cause bruising or bleeding in patients with severe thrombocytopenia. Additionally, the low white blood cell count indicates an impaired immune system, raising concerns about infection risk if any skin damage occurs.
Key Considerations
- The patient's severe thrombocytopenia and leukopenia increase the risk of bleeding and infection, respectively, making compression stockings a potentially hazardous option.
- According to the guidelines from the American Society of Hematology 2018 1, intermittent pneumatic compression, but not graduated compression stockings, are recommended for patients with bleeding risk.
- The use of mechanical prophylaxis, including graduated compression stockings, should be weighed against the risks and benefits, particularly in patients with thrombocytopenia (platelet count <20,000/mcL) or skin ulceration 1.
- A hematology consultation is recommended to determine the underlying cause of these blood abnormalities and to guide treatment.
Recommendations
- Before considering compression stockings, the patient should receive treatment to address these abnormal blood values.
- Once the platelet count improves to at least 50,000/μL and the underlying condition is being treated, compression stockings might be reconsidered if clinically indicated for other conditions such as venous insufficiency or edema prevention.
- Alternative methods of thromboprophylaxis, such as intermittent pneumatic compression devices, may be considered in patients with contraindications to pharmacologic prophylaxis or in conjunction with pharmacologic agents in patients at very high risk of VTE 1.
From the Research
Compression Stockings in Patients with Thrombocytopenia and Leukopenia
- There are no direct studies that address the use of compression stockings in patients with thrombocytopenia (platelet count 32) and leukopenia (White Blood Cell (WBC) count 1.1) 2, 3, 4, 5, 6.
- However, studies have shown that mechanical prophylaxis, such as intermittent pneumatic compression (IPC) and graduated compression stockings (GCS), can be effective in preventing venous thromboembolism (VTE) in patients at high risk of bleeding 2.
- One study found that IPC associated with GCS was not superior to GCS alone in preventing VTE in ICU patients at high risk of bleeding, but the study did not specifically address patients with thrombocytopenia and leukopenia 2.
- Another study found that fondaparinux, a synthetic anticoagulant, was effective in preventing VTE in high-risk trauma patients, but the study did not address the use of compression stockings in patients with thrombocytopenia and leukopenia 4.
- Studies have also shown that pneumatic compression stocking prophylaxis can be effective in preventing DVT and PE in patients undergoing spinal surgery, but these studies did not specifically address patients with thrombocytopenia and leukopenia 5, 6.
Key Findings
- Mechanical prophylaxis, such as IPC and GCS, can be effective in preventing VTE in patients at high risk of bleeding 2.
- Fondaparinux can be effective in preventing VTE in high-risk trauma patients 4.
- Pneumatic compression stocking prophylaxis can be effective in preventing DVT and PE in patients undergoing spinal surgery 5, 6.
- However, there is limited evidence to support the use of compression stockings in patients with thrombocytopenia and leukopenia.
Considerations
- The use of compression stockings in patients with thrombocytopenia and leukopenia should be approached with caution, as there is limited evidence to support their use in this population 2, 3, 4, 5, 6.
- Further studies are needed to determine the safety and efficacy of compression stockings in patients with thrombocytopenia and leukopenia.