The Effects of Intermittent Pneumatic Compression during Cesarean Delivery on Fibrinolysis

Abstract

Markers of fibrinolysis were not significantly altered by IPCs in this study of low-risk pregnant women. Further research regarding the mechanism and efficacy of IPCs in pregnant women is warranted.

Haematological Effects of Intermittent Pneumatic Compression for Deep Vein Thrombosis Prophylaxis

“…The trials are of two types: defined short-term use of IPC (10 minutes to 2 hours) in healthy volunteers 10,16,17,31,33,34,36,37,[44][45][46][47] and patients, 10,12,14,15,18,19,21,23,34,36 and longer-term and often variable or less well defined use during and postsurgery. [6][7][8][9]11,13,20,22,[24][25][26][27][28][29][30]32,35,[38][39][40][41][42][43][48][49][50][51][52] All the trials took blood samples pre-and post-intervention, but only a minority had a true control group,…”

“…Both activity and antigen levels of each have been measured, but there is no consistent pattern of changes noted in the trials of this review. The activity of tPA has been shown to decrease 21,32,46 and increase 26,34,35,45,47,52 with IPC, and no significant change has been found in several other studies. 12,37,38,40,41 Antigen levels of tPA have not been found to change [29][30][31]33,41 in four reports, and to reduce in two others.…”

“…Where PAI-1 activity did reduce, as would be expected for increased fibrinolytic activity, there was only one case where tPA activity also increased. 52 Similarly, for the PAI-1 increases there was only one case of expected tPA decrease. 50 A single example of PAI-2 measurement 52 during caesarean delivery also found an increase.…”

“…32,36,39,49 Two trials 39,49 have shown an increase in PF 1 þ 2. Thrombin-anti-thrombin complex (TAT) has been shown to increase in three trials 39,49,50 (although not in another 52 ), which would be consistent with increased thrombin generation. There have also been examples of reductions in anti-thrombin III 39,48 (AT III), but another did not show a change.…”

“…12,37,38,40,41 Antigen levels of tPA have not been found to change [29][30][31]33,41 in four reports, and to reduce in two others. 32,34 Three of these studies had a control group, 32,45,52 and there was still no consistency in the response, with two 45,52 demonstrating tPA activity rising in both IPC and control groups, but only one with the greater change in the IPC group. 52 Most investigations of PAI-1 activity or antigen have not shown significant changes, 33,37,38,40,41,45,47 but reductions in activity 31,34,52 and antigen, 34 and increases 32,35,50 in activity have also been reported.…”