Adjunctive Intermittent Pneumatic Compression in Hospitalized Patients Receiving Pharmacologic Prophylaxis for Venous Thromboprophylaxis: A Systematic Review and Meta-Analysis

Objectives This study assessed the effect of adjunctive intermittent pneumatic compression (IPC) on venous thromboembolism incidence in hospitalized patients receiving pharmacologic thromboprophylaxis. Methods We searched Medline, Embase, and the Cochrane Central Register with no language restrictions from inception until May 15, 2019, for randomized clinical trials comparing adjunctive IPC in pharmacologic thromboprophylaxis and pharmacologic thromboprophylaxis for venous thromboembolism. Two researchers extracted data from published reports independently. A meta-analysis was conducted to calculate the risk ratio (RR) using random-effects models. Primary outcomes were deep venous thrombosis (DVT) and pulmonary embolism (PE). Results Eight trials with a total of 7,354 participants were eligible for analysis. Addition of IPC to pharmacologic prophylaxis compared to pharmacologic prophylaxis alone reduced the risk of DVT by 43% (RR 0.57, 95% confidence interval [CI] 0.35-0.93; I2 = 0%), with benefit only seen in surgical patients (RR 0.30, 95% CI 0.15-0.59; I-2 = 0%) and not in medical patients (RR 0.80, 95% CI 0.60-1.07; I-2 = 0%; p for interaction = .008). Addition of IPC reduced the risk for PE by 54% (RR 0.46, 95% CI 0.30-0.72; I-2 = 0%), with benefit only seen in surgical patients (RR 0.40, 95% CI 0.24-0.65; I-2 = 0%) and not in medical patients (RR 0.82, 95% CI 0.32-2.26; I-2 = 0%; p for interaction = .18) Conclusions Addition of IPC to pharmacologic prophylaxis confers moderate benefit on venous thromboembolism, with benefit confined to surgical patients. For medical patients, there was a trend toward reduced DVT with adjunctive IPC, which warrants further investigation. Clinical Relevance Venous thromboembolism is not unusual among hospitalized patients despite pharmacologic thromboprophylaxis. Nursing personnel should use adjunctive IPC in surgical patients receiving pharmacologic thromboprophylaxis to prevent venous thromboembolism.