Effect of Intermittent Compression of the Arms on Deep Venous Thrombosis in the Legs

Knight, Martin; Dawson, Robin

doi:10.1016/s0140-6736(76)92029-8

Cited by 126 publications

(44 citation statements)

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“…Current prophylactic regimes include pharmacological methods such as aspirin, warfarin, and LMWH, and mechanical approaches such as intermittent pneumatic compression devices. 1,3,5,6,11,[13][14][15][16][17][18][21][22][23][24][25]27,29,[32][33][34][35][36]38 Aspirin (acetylsalicyclic acid). This is a non-steroidal antiinflammatory agent.…”

Section: Discussionmentioning

confidence: 99%

“…They are intended to decrease stasis by augmenting venous flow in the lower legs and also have a fibrinolytic effect. 27 Various types of pneumatic device have been tested in TKA including a single-chamber calf-length sleeve, multichamber thigh-length stockings, and more recently foot pump devices. 11,15,18,21,23,36 Westrich and Sculco 23 compared the efficacy of the PlexiPulse device (NuTech, San Antonio, Texas) combined with aspirin with aspirin alone.…”

Section: Discussionmentioning

confidence: 99%

“…Without prophylaxis after TKA, the overall incidence of deep-venous thrombosis (DVT) is between 40% and 84%, with proximal thrombosis being observed in 8% to 24% of patients. 2,3,[7][8][9]11,14,[17][18][19][20]22,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Propagation of calf thrombosis to more proximal thrombi has been demonstrated by Doouss 4 and Kakkar et al, 26 and most recently by Grady-Benson et al 8 who used serial venous Dopper flow measurements to document a propagation rate of 24% in the calf. Therefore prophylaxis after TKA is essential to prevent thromboembolic disease.…”

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confidence: 99%

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Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty

Westrich

Haas

Mosca

et al. 2000

The Journal of Bone and Joint Surgery. British volume

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We performed a meta-analysis of the English literature to assess the efficacy of four common regimes for thromboembolic prophylaxis after total knee arthroplasty: aspirin, warfarin, low-molecular-weight heparin (LMWH) and pneumatic compression. We reviewed 136 articles and abstracts published between January 1980 and December 1997. Papers not using routine venography and a lung scan or angiography to detect deep-venous thrombosis (DVT) and pulmonary emboli (PE) respectively, were excluded. Of the 136 studies, 23 with 6001 patients were selected.The incidence of DVT was 53% (1701/3214) in the aspirin group, 45% (541/1203) in the warfarin group, 29% (311/1075) in the LMWH group, and 17% (86/509) in the pneumatic compression device group. Intermittent pneumatic compression devices and LMWH were significantly better than warfarin (p < 0.0001) or aspirin (p < 0.0001) in preventing DVT.The incidence of asymptomatic PE was 11.7% in the aspirin group (222/1901), 8.2% (101/1229) in the warfarin group and 6.3% (24/378) in the pneumatic compression group. No studies with LMWH used routine lung scans. Warfarin and pneumatic compression were significantly better than aspirin in preventing asymptomatic PE (p < 0.05).The incidence of symptomatic PE was 1.3% (23/1800) in the aspirin group, 0.4% (2/559) in the warfarin group, 0.5% (2/416) in the LMWH group and 0% (0/177) in the pneumatic compression group. No statistically significant difference was noted between the above prophylatic regimes due to the very small incidence of symptomatic PE. measurements to document a propagation rate of 24% in the calf. Therefore prophylaxis after TKA is essential to prevent thromboembolic disease. Current prophylactic methods include pharmacological regimes such as aspirin, warfarin, and low molecularweight heparin (LMWH) and mechanical techniques such as intermittent pneumatic compression devices. 1,3,5,6,11,13-18,21-25,27,29,32-38. While pharmacological prophylaxis may be useful for the prevention of thromboembolic disease, associated morbidity such as haemorrhagic complications, routine phlebotomy, excessive cost, and dosing by injection after discharge may limit its use. 1,3,6,11,13,17,18,[22][23][24]29,[32][33][34][35][37][38][39] Pneumatic compression devices offer prophylaxis without such associated morbidity, but compliance by patients and nurses is essential. In addition, the type and duration of prophylaxis after hospital discharge are controversial.To determine the relative benefit of different types of prophylaxis after TKA, we performed a meta-analysis to assess the effectiveness of four commonly used regimes of thromboembolic prophylaxis: aspirin, warfarin, LMWH and intermittent pneumatic compression devices. A metaanalysis is a technique which follows a set of statistical methods that can integrate the results of individual studies. Thus, a quantitative summary of studies with an increase in statistical power and an improvement of the estimated size of an effect can be presented.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty

Westrich

Haas

Mosca

et al. 2000

The Journal of Bone and Joint Surgery. British volume

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“…Interestingly, intermittent pneumatic compression of the arms during and after surgery has been reported to reduce the incidence of deep vein thrombosis in the legs to half of that in control patients (18). Although evidence exists that this compression may be associated with both local mechanical and systemic effects.…”

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confidence: 99%

Intermittent pneumatic compression of legs increases microcirculation in distant skeletal muscle

Liu

Chen

Seaber

et al. 1999

Journal Orthopaedic Research

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Intermittent pneumatic compression has been established as a method of clinically preventing deep vein thrombosis, but the mechanism has not been documented. This study observed the effects of intermittent pneumatic compression of legs on the microcirculation of distant skeletal muscle. The cremaster muscles of 80 male rats were exposed, a specially designed intermittent pneumatic-compression device was applied to both legs for 60 minutes, and the microcirculation of the muscles was assessed by measurement of the vessel diameter in three categories (10-20, 21-40, and 41-70 microm) for 120 minutes. The results showed significant vasodilation in arterial and venous vessels during the application of intermittent pneumatic compression, which disappeared after termination of the compression. The vasodilation reached a maximum 30 minutes after initiation of the compression and could be completely blocked by an inhibitor of nitric oxide synthase, NG-monomethyl-L-arginine (10 micromol/min). A 120-minute infusion of NG-monomethyl-L-arginine, beginning coincident with 60 minutes of intermittent pneumatic compression, resulted in a significant decrease in arterial diameter that remained at almost the same level after termination of the compression. The magnitude of the decrease in diameter in the group treated with intermittent pneumatic compression and NG-monomethyl-L-arginine was comparable with that in the group treated with NG-monomethyl-L-arginine alone. The results imply that the production of nitric oxide is involved in the positive influence of intermittent pneumatic compression on circulation. It is postulated that the rapid increase in venous velocity induced by intermittent pneumatic compression produces strong shear stress on the vascular endothelium, which stimulates an increased release of nitric oxide and thereby causes systemic vasodilation.

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“…Currently IPC is used worldwide for thromboprophylaxis in patients with strokes, after arthroplasty and a number of other operative invasions, in medical emergency,and applicable, firstly, in cases when administration of anticoagulants is dangerous due to the development of haemorrhage (Geerts & Selby, 2003;Gordon et al, 2012). As a rule, IPC is performed on the lower extremities, though some publications present positive results for the upper extremities compression (Knight & Dawson, 1976). Despite the fact that legs weigh more than arms, it was proved that forearm veins have considerably more t-PA than leg veins (Pandolfi et al, 1968).…”

Section: Potential Methods For the Correction Of Hemostasis And Fibrimentioning

confidence: 99%

The Means of Progress in Improving the Results of in vitro Fertilization Based on the Identification and Correction of the Pathology of Hemostasis

Момот¹,

Lydina²,

Цывкина³

et al. 2012

Enhancing Success of Assisted Reproduction

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Effect of Intermittent Compression of the Arms on Deep Venous Thrombosis in the Legs

Cited by 126 publications

References 6 publications

Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty

Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty

Intermittent pneumatic compression of legs increases microcirculation in distant skeletal muscle

The Means of Progress in Improving the Results of in vitro Fertilization Based on the Identification and Correction of the Pathology of Hemostasis

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