Log in to MyACC
Adjunctive Intermittent Pneumatic Compression for VTE Prophylaxis
Study Questions:
Does the addition of intermittent pneumatic compression to pharmacological thromboprophylaxis reduce the incidence of deep-vein thrombosis (DVT) in critically ill patients?
Methods:
The authors randomly assigned adult patients within 48 hours of admission to an intensive care unit (ICU) to receive either intermittent pneumatic compression for 18+ hours a day in addition to pharmacologic prophylaxis (combination group) or to pharmacologic prophylaxis only (control group). The primary outcome was incident proximal lower limb DVT as detected on twice-weekly screening ultrasound studies through ICU discharge, death, attainment of full mobility, or day 28 (whichever occurred first).
Results:
The authors randomized 2,003 patients, with intermittent pneumatic compression being applied for a median of 22 hours (interquartile range [IQR], 21-23) per day for a median of 7 days (IQR, 4-13). A proximal DVT was found in 37/957 (3.9%) patients in the combination group and 41/985 (4.2%) of the control group (relative risk [RR], 0.93; 95% confidence interval [CI], 0.60-1.44). All-cause mortality occurred in 258/990 (26.1%) and 270/1,011 (26.7%) patients in the combination and control groups, respectively (RR, 0.98; 95% CI, 0.84-1.13).
Conclusions:
The authors concluded that critically ill patients who are receiving pharmacologic DVT prophylaxis do not have a lower risk of DVT or all-cause death when also using intermittent pneumatic compression.
Perspective:
Venous thromboembolism is a common complication for critically ill patients that increases healthcare utilization and the risk of death. Studies in other populations (e.g., stroke patients) suggested that combination intermittent pneumatic compression and pharmacologic thromboprophylaxis might reduce the incidence of DVT. However, this prospective, randomized trial of critically ill patients found no benefit for combination DVT prophylaxis. Some may criticize the use of screening ultrasound for DVT instead of symptomatic DVT and the relatively younger age of the participants (58-59 years old). Nonetheless, this trial supports the practice of many clinicians that once pharmacologic DVT prophylaxis is initiated, the addition of intermittent pneumatic compression is usually not necessary.
Clinical Topics: Anticoagulation Management, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and Venothromboembolism, Echocardiography/Ultrasound
Keywords: Anticoagulants, Critical Illness, Intermittent Pneumatic Compression Devices, Intensive Care Units, Patient Discharge, Primary Prevention, Risk, Ultrasonography, Vascular Diseases, Venous Thromboembolism, Venous Thrombosis
< Back to Listings
