Alternative physical treatments for deep venous thrombosis prophylaxis in surgical patients: a systematic review (original) (raw)
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Journal of Vascular Surgery, 2001
modalities, the incidence of venous thromboembolism is still unacceptable in high-or very high-risk groups, as defined by means of clinical risk factors, necessitating an individual protective strategy. 1,2 A history of deep venous thrombosis (DVT) constitutes a well-known risk factor for its postoperative recurrence, 3 and venous stasis has been considered to be a major pathophysiological risk factor. 4,5 DVT sequelae of venous occlusion, valve destruction, or both lead to a short refill time, impaired calf muscle pump function, incomplete venous emptying, and increased ambulatory venous pressure. 6,7 These hemodynamic alterations tend to aggravate in the long term, resulting in the development of the postthrombotic syndrome. This progressively deteriorating venous stasis constitutes a major predisposing factor for DVT, in addition to any coexisting hematological cause. 8,9 Similarly, patients with varicose veins have also been reported to have an increased incidence of postoperative DVT, 9-12 probably for the same hemodynamic reasons. Venous thromboembolism is common among patients who are hospitalized and carries a significant morbidity rate in both the short term (pulmonary embolism, fatal or not) and the long term (post-thrombotic syndrome). Although most cases are now preventable by using mechanical, pharmacological, or combined prophylactic 915
Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis
New England Journal of Medicine
BACKGROUND Whether adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in a lower incidence of deep-vein thrombosis than pharmacologic thromboprophylaxis alone is uncertain. METHODS We randomly assigned patients who were considered adults according to the local standards at the participating sites (≥14, ≥16, or ≥18 years of age) within 48 hours after admission to an intensive care unit (ICU) to receive either intermittent pneumatic compression for at least 18 hours each day in addition to pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin (pneumatic compression group) or pharmacologic thromboprophylaxis alone (control group). The primary outcome was incident (i.e., new) proximal lower-limb deep-vein thrombosis, as detected on twice-weekly lowerlimb ultrasonography after the third calendar day since randomization until ICU discharge, death, attainment of full mobility, or trial day 28, whichever occurred first. RESULTS A total of 2003 patients underwent randomization-991 were assigned to the pneumatic compression group and 1012 to the control group. Intermittent pneumatic compression was applied for a median of 22 hours (interquartile range, 21 to 23) daily for a median of 7 days (interquartile range, 4 to 13). The primary outcome occurred in 37 of 957 patients (3.9%) in the pneumatic compression group and in 41 of 985 patients (4.2%) in the control group (relative risk, 0.93; 95% confidence interval [CI], 0.60 to 1.44; P = 0.74). Venous thromboembolism (pulmonary embolism or any lower-limb deep-vein thrombosis) occurred in 103 of 991 patients (10.4%) in the pneumatic compression group and in 95 of 1012 patients (9.4%) in the control group (relative risk, 1.11; 95% CI, 0.85 to 1.44), and death from any cause at 90 days occurred in 258 of 990 patients (26.1%) and 270 of 1011 patients (26.7%), respectively (relative risk, 0.98; 95% CI, 0.84 to 1.13). CONCLUSIONS Among critically ill patients who were receiving pharmacologic thromboprophylaxis, adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone.
The Use of Intermittent Pneumatic Compression in Orthopedic and Neurosurgical Postoperative Patients
Annals of Surgery, 2016
The objective of this systematic review and meta-analysis was to carry out an up-to-date evaluation on the use of compression devices as deep vein thrombosis (DVT) prophylaxis methods in orthopedic and neurological patients. Summary of Background Data: There is an increased risk of DVT with surgery, particularly in patients who are not expected to mobilize soon after their procedures, such as orthopedic and neurosurgical patients. Compression devices are often employed for DVT prophylaxis in these patients. However, the true efficacy of these devices and the standardization of use with these devices are yet to be established. Methods: Medline, CINAHL, Embase, Google Scholar, and the Cochrane library electronic databases were searched to identify randomized controlled trials and observational studies reporting on the use of compression devices for DVT prevention. Results: Nine studies were included for review and meta-analysis. Use of an intermittent pneumatic compression device alone is neither superior nor inferior to chemoprophylaxis. Conclusions: In the absence of large randomized multicenter trials comparing the use of intermittent pneumatic compression or chemoprophylaxis alone to a combination of both treatments, the current evidence supports the use of a combined approach in high-risk surgical patients.
2005
BACKGROUND Our aim was to evaluate the efficacy and safety of intermittent pneumatic compression methods (IPC) in the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in high-risk patients followed in our intensive care unit (ICU) for whom anticoagulation is contraindicated due to high risk of bleeding. MATERIALS AND METHODS This prospective study was conducted between October 2001 and June 2002 at the Trauma and Surgical Emergency Service of Istanbul Medical Faculty. Thirty eight surgical ICU patients who used IPC devices for prophylaxis of venous thromboembolisim were evaluated retrospectively.. RESULTS There were 27 male (71%) and 11 female patients (29%) with a mean age of 49.69 ± 18.61 years. Their diagnoses were as follows; 21 multi-trauma, 11 major abdominal surgery, 11 severe gastrointestinal bleeding. None of the patients had manifested DVT by venous duplex scans. A leg swelling was present in one patient without evidence of DVT by duplex scans. Symptomatic and fatal pulmonary embolism were not detected. Asymptomatic pulmonary embolism was detected by spiral thorax CT examination in one patient (2.6%). CONCLUSIONS IPC seems to be an effective and a safe modality in preventing both DVT and PE in high-risk ICU patients with severe trauma and for those undergoing major surgery
BMJ Open, 2021
IntroductionLeg immobilisation in a cast or an orthosis after lower limb injuries is associated with a high risk of complications of venous thromboembolism (VTE) and hampered healing. Current pharmacoprophylaxes of VTE are inefficient and associated with adverse events. Intermittent pneumatic compression (IPC) could represent a novel, efficient and safe VTE-prophylactic alternative that may enhance injury healing. The aim of STOP leg clots is to assess the efficacy of adjuvant IPC-therapy on reduction of VTE incidence and improvement of healing in lower leg immobilised outpatients.Methods and analysisSTOP leg clots is a multicentre randomised controlled superiority trial. Eligible patients (700 patients/arm) with either an acute ankle fracture or Achilles tendon rupture will be randomised to either addition of IPC during lower-leg immobilisation or to treatment-as-usual. The primary outcome will be the total VTE incidence, that is, symptomatic and asymptomatic deep venous thrombosis...
Ulus Travma Acil …, 2005
BACKGROUND Our aim was to evaluate the efficacy and safety of intermittent pneumatic compression methods (IPC) in the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in high-risk patients followed in our intensive care unit (ICU) for whom anticoagulation is contraindicated due to high risk of bleeding. MATERIALS AND METHODS This prospective study was conducted between October 2001 and June 2002 at the Trauma and Surgical Emergency Service of Istanbul Medical Faculty. Thirty eight surgical ICU patients who used IPC devices for prophylaxis of venous thromboembolisim were evaluated retrospectively.. RESULTS There were 27 male (71%) and 11 female patients (29%) with a mean age of 49.69 ± 18.61 years. Their diagnoses were as follows; 21 multi-trauma, 11 major abdominal surgery, 11 severe gastrointestinal bleeding. None of the patients had manifested DVT by venous duplex scans. A leg swelling was present in one patient without evidence of DVT by duplex scans. Symptomatic and fatal pulmonary embolism were not detected. Asymptomatic pulmonary embolism was detected by spiral thorax CT examination in one patient (2.6%). CONCLUSIONS IPC seems to be an effective and a safe modality in preventing both DVT and PE in high-risk ICU patients with severe trauma and for those undergoing major surgery
Chest, 2013
Original Research V TE, including DVT and pulmonary embolism (PE), is a common complication of critical illness 1 and is associated with signifi cant morbidity and mortality. 1,2 Thromboprophylaxis given to all critically ill patients has become the standard of care and is supported by clinical practice guidelines. 3 It also has been incorporated into public reporting, regulatory agency priorities, and national quality initiative priorities. According to the "National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism," VTE is considered the most common preventable cause of hospital deaths in the United States. 4 The Agency for Healthcare Research and Quality has prioritized thromboprophylaxis as the number one patient safety practice among nearly 70 practices. 5 The Centers for Medicare & Medicaid Services has designated VTE that is not present on admission but subsequently occurs during the hospital stay as a hospital-acquired Background: A limited amount of data exist regarding the effect of intermittent pneumatic compression (IPC) and graduated compression stockings (GCS) on the incidence of VTE in the ICU setting. The objective of this study was to examine the association of mechanical thromboprophylaxis with IPC or GCS with the risk of VTE and hospital mortality among critically ill medicalsurgical patients. Methods: In this prospective cohort study of patients admitted to the ICU of a tertiary-care medical center between July 2006 and January 2008, we used multiple propensity scores adjustment to examine the association of IPC and GCS with VTE. The primary outcome was incident VTE, including DVT and pulmonary embolism. The following data were collected: patient demographics, admission physiologic data, VTE risk factors, pharmacologic thromboprophylaxis, and mechanical thromboprophylaxis. Results: Among 798 patients enrolled in the study, incident VTE occurred in 57 (7.1%). The use of IPC was associated with a signifi cantly lower VTE incidence compared with no mechanical thromboprophylaxis (propensity scores adjusted hazard ratio, 0.45; 95% CI, 0.22-0.95; P 5 .04). GCS were not associated with decreased VTE incidence. No signifi cant interaction was found between the mechanical thromboprophylaxis group and the type of prophylactic heparin used (P 5 .99), recent trauma (P 5 .66), or recent surgery (P 5 .07) on VTE risk. Conclusions: The use of IPC, but not GCS, was associated with a signifi cantly lower VTE risk. This association was consistent regardless of the type of prophylactic heparin used and was not modifi ed by trauma or surgical admission.
Trials, 2016
Background: Venous thromboembolism (VTE) remains a common problem in critically ill patients. Pharmacologic prophylaxis is currently the standard of care based on high-level evidence from randomized controlled trials. However, limited evidence exists regarding the effectiveness of intermittent pneumatic compression (IPC) devices. The Pneumatic compREssion for preventing VENous Thromboembolism (PREVENT trial) aims to determine whether the adjunct use of IPC with pharmacologic prophylaxis compared to pharmacologic prophylaxis alone in critically ill patients reduces the risk of VTE. Methods/Design: The PREVENT trial is a multicenter randomized controlled trial, which will recruit 2000 critically ill patients from over 20 hospitals in three countries. The primary outcome is the incidence of proximal lower extremity deep vein thrombosis (DVT) within 28 days after randomization. Radiologists interpreting the scans are blinded to intervention allocation, whereas the patients and caregivers are unblinded. The trial has 80 % power to detect a 3 % absolute risk reduction in proximal DVT from 7 to 4 %.