Prevention Effects of Graduated Compression Stockings and Intermittent Pneumatic Compression on Deep Vein Thrombosis in SICU Patients: Pilot Study*

Huang

Clin Appl Thromb Hemost

et al. 2020

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.

Section: Resultsmentioning

confidence: 99%

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

Huang

Clin Appl Thromb Hemost

et al. 2020

“…preventing DVT is controversial. Some studies concluded a signi cant preventive effect on DVT[14,[15][16][17][18][19][20][21][22][23][24][25][26]., while others believed that graded compression stockings did not have additional bene ts compared to conventional measures [16][27, 28].…”

Section: Discussionmentioning

confidence: 99%

“…GCS usage was an independent risk factor and could signi cantly decrease DVT risk in patients after TKA.preventing DVT is controversial. Some studies concluded a signi cant preventive effect on DVT[14,[15][16][17][18][19][20][21][22][23][24][25][26]., while others believed that graded compression stockings did not have additional bene ts compared to conventional measures [16][27, 28].In the current study, we evaluated the effect of GCS on decreasing the incidence of postoperative DVT in patients after primary total knee arthroplasty.…”

mentioning

confidence: 99%

Graded compression stockings significantly decreased the risk of deep vein thrombosis after total knee arthroplasty

Qin

Yao

et al. 2022

Preprint

Objectives: To evaluate the effect of GCS on decreasing the incidence of postoperative DVT in patients after primary total knee arthroplasty.Method: A total of 226 patients who received primary TKA in Nanjing Drum Tower Hospital from Jan 1, 2018, to Jan 1, 2021 were enrolled. Depending on the presence of postoperative DVT, we divided the patients into 2 groups: the non-DVT group (n=192) and the DVT group (n=34). Parameters were compared using χ2 or t test between two groups. Binary logistic regression analysis was used to determine risk factors.Results: The incidence of postoperative DVT was 15% (n=34) in patients after TKA. Age, preoperative D-dimer and GCS usage were all associated with postoperative DVT. Compared to the non-DVT group, there was a significant increase in age (71.06±7.25 vs. 67.82±7.61, p=0.022) and preoperative D-dimer (1.51±2.21 vs. 0.92±1.39, p=0,042) in the DVT group. Moreover, the rate of GCS usage in the DVT group was significantly lower than that in the non-DVT group (23.5% vs. 48.4%, p=0.007). After adjusting for age, gender, preoperative D-dimer, and GCS usage by binary logistic regression analysis, GCS usage (OR = 2.950, 𝑃 = 0.013, 95% CI [1.261-6.901]) was an independent risk factor for postoperative DVT in patients after TKA.Conclusion: The overall prevalence of DVT was 15% in the current study, with 20.8% in non-GCS usage patients and 7.9% in GCS usage patients. GCS usage was an independent risk factor and could significantly decrease DVT risk in patients after TKA.

“…Medical elastic stockings are a physical therapy measure that produce a stepped decrease in pressure from the ankle, which reduces blood viscosity, promotes blood return, increases flow rate, reduces blood stasis, and protects the vascular endothelium, thereby achieving the effect of preventing DVT (16). However, its application effect is still under discussion; some studies (8,(10)(11)(12) have shown an obvious preventive effect on DVT, while some studies (9,13,14) believe the preventive effect is not significantly different from that of conventional measures. In this study, a total of 3,116 orthopedic surgery patients in 7 articles were screened for a meta-analysis, and the study results showed that in the random effect mode, the OR of DVT was [0.59, 95% CI: (0.34, 1.03)] when elastic stockings were used versus no elastic stockings, but the statistic value was Z=1.84, P=0.09, suggesting that the difference was not statistically significant; that is, elastic stockings had no significant preventive effect on DVT.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of elastic stockings for prevention of thrombosis after orthopedic surgery

et al. 2021

Background: To investigate the preventive effect of elastic stockings on deep vein thrombosis (DVT) after orthopedic surgery by literature search and meta-analysis.Methods: PubMed, Embase and Cochrane were selected as the search database platforms to search the literature of randomized controlled trials related to elastic stockings and DVT published from 2008 to date.Revman 5.3.5 software was used for statistical analysis of the data to obtain forest and funnel plots.Results: In this study, 90 studies were initially screened and 7 were finally included, covering a total of 3,116 patients. Meta-analysis showed that the 7 studies had statistical heterogeneity (I 2 =32%, P=0.18), so a random effect model was used. The obtained statistic was [odds ratio (OR) =0.59, 95% confidence interval (CI): (0.34, 1.03)], the statistical effect size was Z=1.84, P=0.07, and the difference was not statistically significant, so a stepwise sensitivity analysis was performed by the exclusion method. One study was excluded, and the remaining 6 showed homogeneity (I 2 =0%, P=0.46). They were analyzed by subgroup according to the type of operation: ankle surgery or hip and knee arthroplasty. The internal literatures of each subgroup were homogeneous: ankle surgery subgroup (I 2 =0%, P=0.43), hip and knee arthroplasty subgroup (I 2 =0%, P=0.88). Therefore, fixed effect mode analysis was used, and the effect size of elastic stockings after ankle surgery was Z=3.65, P=0.0003, while the effect size of elastic stockings in the hip and knee arthroplasty subgroup was Z=1.23, P=0.22.Discussion: Elastic stockings had an obvious preventive effect on DVT in patients undergoing ankle surgery, but not in patients undergoing lumbar, knee or spinal surgery. It is necessary to combine anticoagulant drugs and other physical therapies to prevent DVT.