POEMs

Patient-Oriented Evidence That Matters

Pneumatic Compression in Addition to Pharmacologic Thromboprophylaxis Does Not Further Reduce DVT Risk

 

Am Fam Physician. 2019 Oct 1;100(7):440-441.

Clinical Question

Does the addition of intermittent pneumatic compression to pharmacologic thromboprophylaxis further decrease the risk of deep venous thrombosis (DVT) in critically ill patients?

Bottom Line

This study found no benefit to the addition of intermittent pneumatic compression to pharmacologic anticoagulation for the prevention of proximal DVT in critically ill patients. Although this finding was consistent across per-protocol and sensitivity analyses, the study itself was underpowered because of a low incidence of DVT in the control group. The possibility of a clinically important effect of the intervention, either benefit or harm, is not completely excluded. (Level of Evidence = 1b–)

Synopsis

Current guidelines recommend pharmacologic thromboprophylaxis in all critically ill patients. In this international multicenter study, researchers investigated whether the addition of mechanical thromboprophylaxis with intermittent pneumatic compression would further reduce the risk of DVT in these patients. Adult patients expected to be in the intensive care unit (ICU) for at least 72 hours were randomized, using concealed allocation, to receive pneumatic compression (n = 991) or pharmacologic thromboprophylaxis alone (n = 1,012). Both groups received pharmacologic thromboprophylaxis with unfractionated heparin or low-molecular-weight heparin. In the pneumatic compression group, patients also received intermittent compression to both lower limbs for at least 18 hours per day. Although sequential compression devices with thigh-length sleeves were preferred, nonsequential devices and knee-length sleeves, as well as foot pumps, were permitted. In the control group, pneumatic compression was only permitted during times when pharmacologic thromboprophylaxis was interrupted. Proximal venous ultrasonography of the lower limbs was performed 48 hours after randomization and then twice weekly if DVT was clinically suspected. The two groups were balanced at baseline: the mean age

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

 

 

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