Leg Compression and Pharmacologic Prophylaxis for Venous Thromboembolism Prevention in High-Risk Patients

Background: It has been suggested that combined modalities are more effective than single modalities in preventing venous thromboembolism (VTE; defined as deep venous thrombosis [DVT] and pulmonary embolism [PE], or both) in high-risk patients. Objectives: To assess the effectiveness of intermittent pneumatic compression (IPC) combined with pharmacologic prophylaxis versus single modalities in preventing DVT in high-risk patients. Search Strategy: The authors searched the Peripheral Vascular Disease Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant studies. They also searched the reference lists of relevant articles to identify additional trials. Selection Criteria: Randomized controlled trials (RCTs) and controlled clinical trials of combined IPC and pharmacologic interventions used to prevent VTE in high-risk patients. All patients in the trials selected were surgical or trauma patients. Data Collection and Analysis: Data extraction was undertaken independently by two review authors using data extraction sheets. Main Results: The authors identified 11 studies, six of which were RCTs. The trials included 7,431 patients. Compared with compression alone, the use of combined modalities reduced significantly the incidences of symptomatic PE (from about 3 to 1 percent; odds ratio [OR] = 0.39; 95% confidence interval [CI], 0.25 to 0.63) and DVT (from about 4 to 1 percent; OR = 0.43; 95% Cl, 0.24 to 0.76). Compared with pharmacologic prophylaxis alone, the use of combined modalities significantly reduced the incidence of DVT (from 4.21 to 0.65 percent; OR = 1.6; 95% Cl, 0.07 to 0.34), but the included studies were underpowered in regard to PE. The comparison of compression plus anticoagulant prophylaxis versus compression plus aspirin showed a nonsignificant reduction in PE and DVT in favor of the former group. Repeat analysis restricted to the RCTs confirmed the above findings. Authors' Conclusions: Compared with compression alone, combined prophylactic modalities decrease significantly the incidences of PE and DVT. Compared with pharmacologic prophylaxis alone, combined modalities significantly reduced the incidence of DVT, but the effect on PE is unknown. The results of the current review support the use of combined modalities, especially in high-risk patients. More studies are needed on their role in PE prevention compared with pharmacologic prophylaxis alone.