Effectiveness of intermittent pulsatile elastic stockings for the prevention of calf and thigh vein thrombosis in patienis undergoing elective knee surgery

Hull, Russell D.; Delmore, Terry; Hirsh, Jack; Gent, Michael; Armstrong, Peter; Lofthouse, Robert A.; MacMILLAN, Angus E.; Blackstone, I.; Reed-Davis, R; Detwiler, R.C.

doi:10.1016/0049-3848(79)90267-6

Cited by 140 publications

(46 citation statements)

References 8 publications

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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%

“…References from these papers were also reviewed as well as the proceedings and abstracts from Orthopaedic Transactions and the haematological abstracts in Thrombosis and Haemostasis. 3,6,11,[15][16][17][18][19][20][21]23,31,32,34,[39][40][41][42][43][44][45][46][47] If an explanation of the data was required the authors of the papers were contacted.…”

Section: Methodsmentioning

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: Methodsmentioning

confidence: 99%

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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“…The majority of trials assessing compression methods were conducted in a surgical setting: 14 were orthopaedic, 24,33,34,36,40,48,49,[51][52][53]59,60,63,64 16 general, 23,25,26,28,29,32,[37][38][39]41,42,44,50,54,61,62 six neurosurgical or after spinal surgery, 31,43,[55][56][57][58] three gynaecological 30,45,46 and one mixed surgical, 47 with only two trials 27,35 conducted among 257 medical patients at high risk of venous thromboembolism. After subdividing these trials into those assessing monotherapy and those assessing adjunctive therapy, the specific type of surgical or medical setting did not appear to influence the effectiveness of mechanical compression [heterogeneity 2 for monotherapy (on 5 df) = 4.6; p > 0.1, and heterogeneity 2 for adjunctive therapy (on 2 df) = 3.7; p > 0.1, not significant (NS); Figure 2].…”

Section: Description Of Trialsmentioning

confidence: 99%

“…In 19 trials [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] among 2255 patients assessing IPC as monotherapy, IPC produced a highly significant 66% (7) reduction in DVT [112/1108 (10.1%) IPC vs 268/1147 (23.4%) control, 2p < 0.00001; Figure 5a]. There was marginal evidence of heterogeneity of effect among these trials ( 2 on 16 df = 28.4; p = 0.03), but this was generated chiefly by one trial.…”

Section: Intermittent Pneumatic Compressionmentioning

confidence: 99%

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Roderick¹,

Ferris²,

Wilson³

et al. 2005

Health Technol Assess

268

151

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“…Routine postoperative venography has shown an incidence of isolated calf thrombi of between 23.8% and 60% and of proximal thrombi berween 3% and 20%. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Since pulmonary embolism is one of the most feared complications, the recognition of deep-vein thrombosis (DVT) in the lower limb has been considered to be an absolute indication for anticoagulation. 4,6,[15][16][17] Not all deep-venous thrombi, however,…”

mentioning

confidence: 99%

Incidence and natural history of deep-vein thrombosis after total knee arthroplasty

Kim¹,

Kim²

2002

The Journal of Bone and Joint Surgery. British volume

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W e have evaluated prospectively the incidence and location of deep-vein thrombosis (DVT), the risk factors for pulmonary embolism, and the natural history of thrombosis after total knee replacement (TKR) in patients who did not receive prophylactic or therapeutic treatment for DVT.We studied 227 patients who underwent primary TKR; 116 had one-stage bilateral and 111 unilateral procedures. Coagulation assays, the full blood count and blood typing tests for the serum chemical profile were undertaken in all patients on three separate occasions. Bilateral simultaneous or unilateral venograms were carried out at six or seven days after operation. Perfusion lung scanning was undertaken before and at seven or eight days after operation. Bilateral simultaneous or unilateral venograms were repeated six months after operation in all patients who had thrombi.In Thromboembolic disease is a potentially serious complication of total knee replacement (TKR). Routine postoperative venography has shown an incidence of isolated calf thrombi of between 23.8% and 60% and of proximal thrombi berween 3% and 20%.

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Effectiveness of intermittent pulsatile elastic stockings for the prevention of calf and thigh vein thrombosis in patienis undergoing elective knee surgery

Cited by 140 publications

References 8 publications

Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty

Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Incidence and natural history of deep-vein thrombosis after total knee arthroplasty

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