Efficacy of intermittent compression devices for thromboembolic prophylaxis in major abdominal surgery: a systematic review and meta‐analysis

Abstract

Background: The benefits of mechanical prophylaxis for the prevention of venous thromboembolism (VTE) in abdominal and pelvic surgery are uncertain, with different guidelines stating that graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCDs) can be used either alone or in combination. To review the efficacy of IPCDs in preventing VTE following abdominal and pelvic surgery. Methods: A systematic review was conducted, identifying relevant literature reporting clinical trials conducted in abdominopelvic surgery, comparing the effect of IPCDs alone or in combination with no prophylaxis, GCS and chemical prophylaxis. The review identified studies reported from 1966 to 2022 in Medline, Embase, PubMed and Cochrane databases for randomized controlled trials. Results: Thirteen RCTs involving 1914 participants were identified. IPCDs were superior to placebo (OR VTE 0.39; 95% CI 0.20-0.76) but not superior to other forms of prophylaxis (OR 0.83; 95% CI 0.30-2.27) or to GCS alone (OR 0.9; 95% CI 0.24-3.36). The addition of IPCDs to GCS compared with GCS alone was beneficial (OR 0.45; 95% CI 0.23-0.91) as was the addition of IPCDs to standard perioperative chemoprophylaxis (OR 0.25; 95% CI 0.09-0.74). The overall quality and reliability of trials were low, with high risk of bias. Conclusions: IPCDs are more effective than placebo in reducing VTE rates but are not more effective than other forms of thrombo-prophylaxis (chemical or mechanical) following abdominal and pelvic surgery. There is poor quality evidence to suggest that they might have a role as additional prophylaxis when combined with GCS and chemical prophylaxis.

Should intermittent pneumatic compression devices be standard therapy for the prevention of venous thromboembolic events in major surgery? Protocol for a randomised clinical trial (IMPOSTERS)

“…The optimal combination of VTE prophylaxis in major surgery is unknown. Currently, there is no evidence in major surgery to support the use of IPCDs as an adjunct to LMWH and GCSs during and postsurgery 4. Despite this, their use has become commonplace for patients recovering from surgery 5…”

“…Early comparisons of VTE prevention (usually using unfractionated or LMWH) with a placebo or no intervention were undertaken decades ago, when surgical techniques, anaesthesia, and postoperative management were very different. 4 Enhanced recovery after surgery programmes have changed many aspects of perioperative care for patients undergoing major surgery. Older trials are no longer clinically relevant or applicable.…”

“…Currently, there is no evidence in major surgery to support the use of IPCDs as an adjunct to LMWH and GCSs during and postsurgery. 4 Despite this, their use has become commonplace for patients recovering from surgery. 5 Since the 1960s, thromboembolism guidelines have been repeatedly revised, with new evidence emerging mainly for anticoagulation therapies rather than mechanical prophylaxis.…”

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

“…Only four studies evaluated major bleeding by International Society on Thrombosis and Haemostasis (ISTH) criteria and these suggested a lower bleeding rate: RR 0.33 (95% CI 0.07 to 1.51) for IPC alone compared with pharmacological prophylaxis. 10 The effectiveness of IPC versus placebo was studied in a recent meta-analysis, 11 in major abdominal surgery. IPC was superior to placebo for the prevention of DVT but did not show superiority over other individual modes of thromboprophylaxis.…”

Venous thromboembolic prophylaxis: current practice of surgeons in Australia and New Zealand for major abdominal surgery

“…As an additional means of prevention, graduated compression stockings (GCS) and/or intermittent pneumatic compression devices (IPCD) should be worn [ 6 ]. A recent meta-analysis for the use of IPCD in major abdomainl surgery [ 11 ] indicated that IPCDS appear to be efficacious in preventing VTE formation. Their comparative efficacy with respect to other forms of thrombo-prophylaxis is limited and is poorly studied.…”