Calf-Thigh Sequential Pneumatic Compression Compared with Plantar Venous Pneumatic Compression to Prevent Deep-Vein Thrombosis after Non-Lower Extremity Trauma

Elliott, C. Gregory; Dudney, T M; Egger, Marlene J.; Orme, James F.; Clemmer, Terry P.; Horn, Susan D.; Weaver, Lindell K.; Handrahan, Diana; Thomas, Francis T.; Merrell, Steven W.; Kitterman, N; Yeates, Sarah E.

doi:10.1097/00005373-199907000-00006

Cited by 66 publications

(31 citation statements)

References 29 publications

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“…Unfortunately, only three trials in patients with trauma reported major bleeding complications in four groups that did not receive pharmacologic prophylaxis. [189][190][191] In these groups, the pooled (random-effects) risk of major bleeding was 0.7% (95% CI, 0.2%-1.7%). This is likely to represent a lower boundary for the baseline risk of bleeding because patients judged to be at increased risk for bleeding were excluded from most trials of thromboprophylaxis.…”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Mamentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,857

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Mamentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,857

744

View full text Add to dashboard Cite

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“…To our knowledge, elastic stockings have never been evaluated in trauma patients, while a number of well-conducted trials have demonstrated an acceptable effi cacy of IPC in the prevention of VTE in patients with severe trauma [4,12,15,16] . The potential role of the prophylactic inferior vena cava (IVC) fi lter is still controversial and there are no randomized trials demonstrating a clear benefi t of IVC insertion in trauma patients.…”

Section: Imberti /Agenomentioning

confidence: 99%

A Survey of Thromboprophylaxis Management in Patients with Major Trauma

Imberti

Ageno²

2005

Pathophysiol Haemos Thromb

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Background: Venous thromboembolism (VTE) is a common life-threatening complication of major trauma. Although clinical guidelines clearly suggest routine VTE prevention with low-molecular-weight heparin (LMWH) in this specific group of patients, there is still a lack of strong recommendations regarding the timing and the modality of heparin administration and the role of mechanical prophylaxis. We tested the hypothesis that there is significant practice variation in thromboprophylaxis management of patients with major trauma among intensive care unit (ICU) specialists. Methods: Two hundred Italian ICU specialists, representing 200 ICU throughout the country, were contacted by telephone and were asked (1) whether they routinely prescribe pharmacological antithrombotic prophylaxis in patients with major trauma, whether prophylaxis is prescribed to all patients or to selected patients, and the type of prophylaxis and the timing of administration and (2) whether they recommend physical prevention, whether this is prescribed to all patients or to selected patients, and the type of physical prophylaxis. Results: In patients with major trauma, 85% of the interviewed ICU specialists answered that they prescribe pharmacological prophylaxis for VTE. 37.6% of them prescribe prophylaxis only to selected patients based on the level of risk, 87.7% prescribe low-molecular-weight heparin, and 42.4% start prophylaxis immediately after hospitalization. Only 61% of the interviewed specialists prescribe physical prophylaxis; 82.8% of them use elastic stockings, 9.8% intermittent pneumatic compression, and 7.4% other mechanical devices. Physical prophylaxis is prescribed to all patients by 41%, and by 59% only in case of contraindication to pharmacological prevention. Inferior vena cava (IVC) filter insertion is considered by 47% when anticoagulation is contraindicated; 91.4% of them recommend the IVC filter only if deep vein thrombosis (DVT) has been diagnosed. Conclusions: Even when there are clinical guidelines, prescription of VTE prevention in patients with major trauma is underused and timing and modality of prophylaxis are rather heterogeneous. When anticoagulation is contraindicated, IVC filters are commonly recommended only in the presence of DVT.

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“…1 1 A more recent study demonstrated that low-molecular-weight heparin prophylaxis was superior to foot compression in the prevention of postoperative thrombosis in orthopedic patients. 1 3 Elliott et al 6 reported that calf-thigh sequential pneumatic compression prevents deep-vein thrombosis more effectively than does plantar venous IPC after major trauma without lower extremity injuries. Other investigators, however, have reported that there are no differences in the effects of calf and thigh length pneumatic compression systems and intermittent plantar compression on prevention of venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%