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Thromb Haemost 2005; 94(06): 1181-1185
DOI: 10.1160/TH05-04-0222
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Intermittent pneumatic compression and deep vein thrombosis prevention

A meta-analysis in postoperative patients
Jana Urbankova
1   Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
,
Rene Quiroz
1   Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
,
Nils Kucher
1   Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
,
Samuel Z. Goldhaber
1   Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
› Author Affiliations
Further Information

Publication History

Received 01 April 2005

Accepted after revision 05 September 2005

Publication Date:
07 December 2017 (online)

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Summary

Our objective was to overview the effectiveness of intermittent pneumatic compression (IPC) devices to prevent deep vein thrombosis (DVT) in postoperative patients, using meta-analysis methodology. We searched the Medline, metaRegister of Controlled Trials, and Cochrane database for studies published between 1970 and October 2004. Our inclusion criteria were: 1) randomized controlled trial of IPC versus no prophylaxis, 2) at least 20 patients per group, 3) at least one diagnostic DVT imaging test in all patients, and 4) clinical follow-up for at least the duration of hospitalization. A total of 2,270 patients were included in 15 eligible studies: 1,125 and 1,145 in the IPC and no prophylaxis group, respectively. The included studies formed a total of 16 treatment groups and were conducted in orthopedic (5), general surgical (4), oncologic (3), neurosurgical (3) and urologic (1) patient populations. In comparison to no prophylaxis, IPC devices reduced the risk of DVT by 60% (relative risk 0.40, 95% CI 0.29 – 0.56; p< 0.001). Contemporary randomized trials should be undertaken to test the utility of IPC in hospitalized medical patients as well as combined pharmacological plus IPC prophylaxis in both medical and surgical patients.

Keywords

Deep vein thrombosis - intermittent pneumatic compression - meta-analysis
 

  • References

  • 1 Goldhaber SZ. Pulmonary embolism. Lancet 2004; 363: 1295-305.
    CrossrefPubMedGoogle Scholar
  • 2 Geerts WH, Pineo GF, Heit JA. et al Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 338S-400S.
    CrossrefPubMedGoogle Scholar
  • 3 Goldhaber SZ, Turpie AG. Prevention of venous thromboembolism among hospitalized medical patients. Circulation 2005; 111: e1-3.
    CrossrefPubMedGoogle Scholar
  • 4 Normand SL. Meta-analysis: formulating, evaluating, combining, and reporting. Stat Med 1999; 18: 321-59.
    CrossrefPubMedGoogle Scholar
  • 5 Egger M, Davey Smith G, Schneider M. et al Bias in meta-analysis detected by a simple, graphical test. Br Med J 1997; 315: 629-34.
    CrossrefPubMedGoogle Scholar
  • 6 Begg CB, Berlin JA. Publication bias and dissemination of clinical research. J Natl Cancer Inst 1989; 81: 107-15.
    CrossrefPubMedGoogle Scholar
  • 7 Thompson SG. Why and how sources of heterogeneity should be investigated. In: Egger M, Davey Smith G, Altman DG. eds. Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ Publishing Group; 2001: 157-74.
    Google Scholar
  • 8 Thompson SG, Pocock SJ. Can meta-analyses be trusted?. Lancet 1991; 338: 1127-30.
    CrossrefPubMedGoogle Scholar
  • 9 Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG. eds. Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ Publishing Group; 2001
    Google Scholar
  • 10 Tobias A. Assessing the influence of a single study in meta-analysis. Stata Tech Bull 1999; 47: 15-7.
    PubMedGoogle Scholar
  • 11 Hills NH, Pflug JJ, Jeyasingh K. et al Prevention of deep vein thrombosis by intermittent pneumatic compression of calf. Br Med J 1972; 1: 131-5.
    CrossrefPubMedGoogle Scholar
  • 12 Hull R, Delmore TJ, Hirsh J. et al Effectiveness of intermittent pulsatile elastic stockings for the prevention of calf and thigh vein thrombosis in patients undergoing elective knee surgery. Thromb Res 1979; 16: 37-45.
    CrossrefPubMedGoogle Scholar
  • 13 Hull RD, Raskob GE, Gent M. et al Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement. JAMA 1990; 263: 2313-7.
    CrossrefPubMedGoogle Scholar
  • 14 Hartman JT, Pugh JL, Smith RD. et al Cyclic sequential compression of the lower limb in prevention of deep venous thrombosis. J Bone Joint Surg Am 1982; 64: 1059-62.
    CrossrefPubMedGoogle Scholar
  • 15 Roberts VC, Cotton LT. Prevention of postoperative deep vein thrombosis in patients with malignant disease. Br Med J 1974; 1: 358-60.
    CrossrefPubMedGoogle Scholar
  • 16 Turpie AG, Gallus A, Beattie WS. et al Prevention of venous thrombosis in patients with intracranial disease by intermittent pneumatic compression of the calf. Neurology 1977; 27: 435-8.
    CrossrefPubMedGoogle Scholar
  • 17 Turpie AG, Delmore T, Hirsh J. et al Prevention of venous thrombosis by intermittent sequential calf compression in patients with intracranial disease. Thromb Res 1979; 15: 611-6.
    CrossrefPubMedGoogle Scholar
  • 18 Coe NP, Collins RE, Klein LA. et al Prevention of deep vein thrombosis in urological patients: a controlled, randomized trial of low-dose heparin and external pneumatic compression boots. Surgery 1978; 83: 230-4.
    PubMedGoogle Scholar
  • 19 Skillman JJ, Collins RE, Coe NP. et al Prevention of deep vein thrombosis in neurosurgical patients: a controlled, randomized trial of external pneumatic compression boots. Surgery 1978; 83: 354-8.
    PubMedGoogle Scholar
  • 20 Butson AR. Intermittent pneumatic calf compression for prevention of deep venous thrombosis in general abdominal surgery. Am J Surg 1981; 142: 525-7.
    CrossrefPubMedGoogle Scholar
  • 21 Borow M, Goldson H. Postoperative venous thrombosis. Evaluation of five methods of treatment. Am J Surg 1981; 141: 245-51.
    CrossrefPubMedGoogle Scholar
  • 22 Gallus A, Raman K, Darby T. Venous thrombosis after elective hip replacement–the influence of preventive intermittent calf compression and of surgical technique. Br J Surg 1983; 70: 17-9.
    CrossrefPubMedGoogle Scholar
  • 23 Clarke-Pearson DL, Creasman WT, Coleman RE. et al Perioperative external pneumatic calf compression as thromboembolism prophylaxis in gynecologic oncology: report of a randomized controlled trial. Gynecol Oncol 1984; 18: 226-32.
    CrossrefPubMedGoogle Scholar
  • 24 Clarke-Pearson DL, Synan IS, Hinshaw WM. et al Prevention of postoperative venous thromboembolism by external pneumatic calf compression in patients with gynecologic malignancy. Obstet Gynecol 1984; 63: 92-8.
    PubMedGoogle Scholar
  • 25 Fisher CG, Blachut PA, Salvian AJ. et al Effectiveness of pneumatic leg compression devices for the prevention of thromboembolic disease in orthopaedic trauma patients: a prospective, randomized study of compression alone versus no prophylaxis. J Orthop Trauma 1995; 9: 1-7.
    CrossrefPubMedGoogle Scholar
  • 26 Clarke-Pearson DL, Synan IS, Dodge R. et al A randomized trial of low-dose heparin and intermittent pneumatic calf compression for the prevention of deep venous thrombosis after gynecologic oncology surgery. Am J Obstet Gynecol 1993; 168: 1146-53 discussion 1153–4.
    CrossrefPubMedGoogle Scholar
  • 27 Kamm RD. Bioengineering studies of periodic external compression as prophylaxis against deep vein thrombosis-part I: numerical studies. J Biomech Eng 1982; 104: 87-95.
    CrossrefPubMedGoogle Scholar
  • 28 Comerota AJ, Chouhan V, Harada RN. ET AL: The fibrinolytic effects of intermittent pneumatic compression: mechanism of enhanced fibrinolysis. Ann Surg 1997; 226: 306-13 discussion 313–4.
    CrossrefPubMedGoogle Scholar
  • 29 Kessler CM, Hirsch DR, Jacobs H. ET AL: Intermittent pneumatic compression in chronic venous insufficiency favorably affects fibrinolytic potential and platelet activation. Blood Coagul Fibrinolysis 1996; 7: 437-46.
    CrossrefPubMedGoogle Scholar
  • 30 Fauno P, Suomalainen O, Bergqvist D. ET AL: The use of fibrinogen uptake test in screening for deep vein thrombosis in patients with hip fracture. Thromb Res 1990; 60: 185-90.
    CrossrefPubMedGoogle Scholar
  • 31 Agnelli G, Radicchia S, Nenci GG. Diagnosis of deep vein thrombosis in asymptomatic high-risk patients. Haemostasis 1995; 25: 40-8.
    PubMedGoogle Scholar
  • 32 Paiement G, Wessinger SJ, Waltman AC. ET AL: Surveillance of deep vein thrombosis in asymptomatic total hip replacement patients. Impedance phlebography and fibrinogen scanning versus roentgenographic phlebography. Am J Surg 1988; 155: 400-4.
    CrossrefPubMedGoogle Scholar
  • 33 Kahn SR, Joseph L, Grover SA. et al A randomized management study of impedance plethysmography vs. contrast venography in patients with a first episode of clinically suspected deep vein thrombosis. Thromb Res 2001; 102: 15-24.
    CrossrefPubMedGoogle Scholar
  • 34 Gutt CN, Oniu T, Wolkener F. et al Prophylaxis and treatment of deep vein thrombosis in general surgery. Am J Surg 2005; 189: 14-22.
    CrossrefPubMedGoogle Scholar
  • 35 Collins R, Scrimgeour A, Yusuf S. et al Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med 1988; 318: 1162-73.
    CrossrefPubMedGoogle Scholar
  • 36 Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg 1988; 208: 227-40.
    CrossrefPubMedGoogle Scholar
  • 37 Morris RJ, Woodcock JP. Evidence-based compression: prevention of stasis and deep vein thrombosis. Ann Surg 2004; 239: 162-71.
    CrossrefPubMedGoogle Scholar
  • 38 Cornwell 3rd EE, Chang D, Velmahos G. et al Compliance with sequential compression device prophylaxis in at-risk trauma patients: a prospective analysis. Am Surg 2002; 68: 470-3.
    PubMedGoogle Scholar
  • 39 Haddad FS, Kerry RM, McEwen JA. et al Unanticipated variations between expected and delivered pneumatic compression therapy after elective hip surgery: a possible source of variation in reported patient outcomes. J Arthroplasty 2001; 16: 37-46.
    PubMedGoogle Scholar
  • 40 Comerota AJ, Katz ML, White JV. Why does prophylaxis with external pneumatic compression for deep vein thrombosis fail?. Am J Surg 1992; 164: 265-8.
    CrossrefPubMedGoogle Scholar