Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism

Kakkos, Stavros K.; Caprini, Joseph A.; Geroulakos, George; Nicolaides, Andrew; Stansby, Gerard; Reddy, Daniel J.; Ntouvas, Ioannis

doi:10.1002/14651858.cd005258.pub3

Cited by 106 publications

(96 citation statements)

References 56 publications

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“…Studies show that perioperative administration of heparin does not significantly alter bleeding tendency by any measured parameter [25][26][27][28][29][30]. This analysis confirms previous conclusions and supports the usage of subcutaneous heparin, even in emergency neurosurgical patients.…”

Section: Scufh>24 H N=35 (P) Total Patients N=223supporting

confidence: 86%

Bleeding Risk and Thromboprophylaxis in Neurosurgical Patients after Emergency Procedure

Cagliani¹,

Ritter²,

Nelson³

et al. 2017

Intensive & Crit Care

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Purpose: We aimed to evaluate its safety in the emergency neurosurgical population at a tertiary hospital center. Methods:Retrospective analyses of prospectively-collected data were performed on patients ad-mitted to the surgical intensive care unit (SICU) after emergency neurosurgical procedure. We examined patient demographic and clinical information, survival outcomes, and rates of heparin induced thrombocytopenia and pulmonary embolism in patients who received subcutaneous unfractionated heparin (SCUFH) compared to those who did not. Results: We identified 223 emergency neurosurgical patients, of which 100 received no anticoagulation (44.84%) and 123 received SCUFH (55.16%). In the SCUFH group, 88 patients received chemoprophylaxis within 24 h and 35 after 24 h. A statistically significant difference was noted with the admission APACHE II score of patients receiving SCUFH to those who did not, but APACHE III and SAPS on admission were shown to have no difference in outcome. Conclusion:Administration of SCUFH in the emergency neurosurgical population does not increase the risk of bleeding post-operatively and continues to be a safe and effective chemoprophylaxis agent against VTE.

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Section: Scufh>24 H N=35 (P) Total Patients N=223supporting

confidence: 86%

Bleeding Risk and Thromboprophylaxis in Neurosurgical Patients after Emergency Procedure

Cagliani¹,

Ritter²,

Nelson³

et al. 2017

Intensive & Crit Care

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“…The study established that most leg-immobilized patients exhibit around 40% relative risk reduction in the incidence of DVT while using adjuvant IPC. This DVT-preventive effect of IPC was also seen in the majority of the patient subgroups analyzed and is corroborated by conclusions of several Cochrane reviews of surgical patients receiving adjuvant IPC during bed immobilization (8,9). The findings of this article seem to extend the DVT protective indications of IPC from inpatient care to become true also for care of many outpatients, especially for leg immobilized patients after an ATR.…”

Section: Discussionsupporting

confidence: 81%

Which leg immobilized patient gains the most from Intermittent Pneumatic Compression in DVT-prevention?

Juthberg

Edman

Ackermann

2019

Muscle Ligaments and Tendons J

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Background and method. Following Achilles tendon rupture (ATR)-surgery, patients using intermittent pneumatic compression (IPC) of the calf, compared to a plaster casted control-group (CTRL), exhibit reduced risk of deep venous thrombosis (DVT). Based on data from a randomized controlled trial (RCT), we investigated which dichotomized subgroups (based on age, sex, BMI and time to surgery (TTS)) within the IPC-(n= 66) and CTRL-group (n= 70) that were most likely to sustain a DVT, and which patients that had most benefit from postoperative IPC. Results. Age ≥39y (OR 6.06, p<0.001) and TTS >66h (OR 2.3, p=0.031) significantly increased the risk of DVT, but not sex or BMI. IPC-treatment significantly reduced the DVT-risk (OR 0.46, p=0.042), with more pronounced effect when considering age and TTS (OR 0.40, p=0.032). Although non-significant, females (OR 1.44, p=0.78) and patients with low BMI (OR 1.16, p=0.84) seemed to exhibit less DVT-preventive effect of IPC. Conclusion. Patients with age >38y and TTS>66h are at increased DVT-risk during post-operative leg immobilization, while adjuvant IPC shows good DVT-preventive effects among most patients, especially in those with high DVT-risk. Further trials are however warranted, to examine the low DVT-preventive effects of IPC discovered among females and patients with low BMI.

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“…30 Over the years, several meta-analyses have been published on this topic. [31][32][33] Different choices were made concerning the studies that were included, such as the diagnostic strategy used for PTS, the emphasis placed on the assessment of compliance to therapy, and the methodological quality of the studies. These differences have hampered the synthesis of evidence; heterogeneity is high in all published meta-analyses.…”

Section: One Standard Treatment For All Patientsmentioning

confidence: 99%

Prevention and treatment of the post‐thrombotic syndrome

Cate‐Hoek

2018

Research and Practice in Thrombosis and Haemostasis

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Essentials Post thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) with limited treatment options.Uniformity of the diagnostic strategy and the use of risk prediction models might improve treatment outcomes.Extending knowledge on the pathophysiology and improving therapeutic options is paramount for progress. PTS management should evolve to a multimodal approach with treatment tailored to individual patients' needs. Post thrombotic syndrome (PTS) is a common chronic complication of deep vein thrombosis of the leg (DVT). Treatment options are limited therefore emphasis is placed on its prevention. Several risk factors have been recognized, but were so far not used for risk stratification or translation into prediction models. Early interventions did not yet result in more successful preventive treatment strategies; for the acute phase of DVT there is equipoise on the value of elastic compression, as well as on catheter directed thrombolysis. There are no drugs specifically targeted at PTS prevention. The use of anticoagulant medication such as direct oral anticoagulants (DOACs) might decrease PTS incidence, but this needs to be corroborated. Both research into more effective treatment options as well as future PTS management may benefit from a uniform diagnostic strategy and the use of prediction rules to better allocate treatment and thereby increase treatment efficacy.

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Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism

Cited by 106 publications

References 56 publications

Bleeding Risk and Thromboprophylaxis in Neurosurgical Patients after Emergency Procedure

Bleeding Risk and Thromboprophylaxis in Neurosurgical Patients after Emergency Procedure

Which leg immobilized patient gains the most from Intermittent Pneumatic Compression in DVT-prevention?

Prevention and treatment of the post‐thrombotic syndrome

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