Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma

Ginzburg, Enrique; Cohn, Stephen M.; Lopez, J. E.; Jackowski, J.; Brown, Mark D.; Hameed, S. Morad

doi:10.1002/bjs.4309

Cited by 105 publications

(74 citation statements)

References 14 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

1,853

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

1,853

744

View full text Add to dashboard Cite

show abstract

“…Numerous studies have shown that ICDs are as effective as pharmacological treatment in the prevention of DVT and PE after joint replacement surgery (Santori et al 1994, Westrich and Sculco 1996, Salvati et al 2000, Ginzburg et al 2003. Thus, the side effects associated with a specific treatment modality become pivotal issues in determining the more preferable among the various options.…”

Section: Discussionmentioning

confidence: 99%

“…Intermittent pneumatic compression devices (ICDs) have been shown to be as effective in prevention of DVT and pulmonary embolism (PE) as coumadin, heparin and low molecular weight heparin (LMWH) and are free of the side effects of excessive bleeding (Santori et al 1994, Westrich and Sculco 1996, Salvati et al 2000, Ginzburg et al 2003. In fact, ICDs have almost no side effects and are very well tolerated by patients.…”

mentioning

confidence: 99%

A miniature and mobile intermittent pneumatic compression device for the prevention of deep-vein thrombosis after joint replacement

Ben‐Galim

Steinberg

Rosenblatt

et al. 2004

Acta Orthopaedica Scandinavica

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“…Early use of LMWH for DVT prophylaxis in the presence of intraabdominal solid organ injury (liver, spleen, kidney) may also be safe (6, 61). A properly placed and managed intermittent pneumatic compression device could provide thromboprophylaxis of comparable efficacy to that of LMWH, in patients with moderate and severe injury (65).…”

Section: Traumamentioning

confidence: 99%