Can Intermittent Pneumatic Compression Reduce the Incidence of Venous Thrombosis in Critically Ill Patients: A Systematic Review and Meta-Analysis

Abstract

Venous thromboembolism (VTE) is a common complication for critically ill patients. Intermittent pneumatic compression (IPC) is recommended for patients with high risk of bleeding. We aim to evaluate the effectiveness of IPC for thromboprophylaxis in critically ill patients. We searched PubMed, Embase, and ClinicalTrials for randomized controlled trials (RCTs) and observational studies that evaluated IPC in critically ill patients. RevMan 5.3 software was used for the meta-analysis. A total of 10 studies were included. The IPC group significantly reduced the VTE incidence compared with no thromboprophylaxis group (risk ratio [RR]: 0.35, confidence interval [CI]: 0.18-0.68, P = .002) and the IPC group also showed lower VTE incidence than the graduated compression stockings (GCS) group (RR: 0.47, CI: 0.24-0.91, P = .03). There were no significant differences between using IPC and low-molecular-weight heparin (LMWH) for VTE incidence (RR: 1.26, CI: 0.72-2.22, P = .41), but LMWH showed significantly more bleeding events. Intermittent pneumatic compression as an adjunctive treatment did not further reduce VTE incidence (RR: 0.55, CI: 0.24-1.27, P = .16). Intermittent pneumatic compression can reduce the incidence of VTE for critically ill patients, which is better than GCS and similar to LMWH, but it has no significant advantage as an adjunct therapy for thromboprophylaxis.

Recommendations from the ICM-VTE: General

“…Rationale: Venous thromboembolism (VTE) constitutes a major interdisciplinary challenge in health care 1707 . It represents a common complication for hospitalized patients that could prolong hospital stay and significantly cause increased morbidity and mortality 1707-1710 . Critically ill patients and those that underwent major surgical interventions are at a particularly increased risk of VTE, i.e., DVT and pulmonary embolism (PE) 1708,1711 .…”

A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind?

“…IPC was found to reduce VTE, whereas GCS had no such benefit. Previous meta-analyses have also found IPC to be more effective in critically ill and medically unwell patients [ 51 , 52 ].…”

Mechanical prophylaxis for venous thromboembolism prevention in obese individuals

“…12,19 Previous meta-analyses of hospitalized and of critically ill patients have also suggested IPC to have greater efficacy than GCS. 3,20 The location of IPC device placement also appears to impact the prevention of DVT, and haemodynamic studies have shown variation in venous blood flow depending on the method and brand of IPC system in place. [21][22][23] Thus, comparing the efficacy of various aspects of GCS and IPC use in obese patients will also be required to truly assess the role of mechanical prophylaxis in this population.…”