Mechanical Compression Versus Subcutaneous Heparin Therapy in Postoperative and Posttrauma Patients: A Systematic Review and Meta‐Analysis

(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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“…28 Studies compared heparin with IPC (nine studies), foot pump (four studies), or ES (three studies). Sample sizes ranged from 51 to .…”

Section: Ivc Filter Vs No Ivc Filtermentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,821

744

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“…Indirect evidence from various orthopedic and nonorthopedic surgical populations was provided in a recent meta-analysis by Eppsteiner of 16 trials (3,887 patients) of various compression modalities tested against LDUH or LMWH. 51 Pooled results for mechanical compression compared with heparin failed to show or to exclude a benefi cial or detrimental effect for DVT (RR, 1.07; 95% CI, 0.72-1.61) or PE (RR, 1.03; 95% CI, 0.48-2.22). Mechanical compression was associated with a reduced risk of postoperative bleeding compared with heparin (RR, 0.47; 95% CI 0.31-0.70).…”

Section: Mechanical Compression Vs Heparinmentioning

confidence: 99%

“…51 However, as subgroup analysis in that meta-analysis suggested that LMWH may be more effective than compression, and taking into account that the baseline rate of bleeding is lower among medical patients (average from RCTs, 0.4%) than surgical patients, if the bleeding risk is temporary and if patients remain at high risk of VTE ( Table 2 ), pharmacologic thromboprophylaxis should be initiated once the bleeding risk has decreased.…”

Section: Mechanical Compression and Pharmacologicmentioning

confidence: 99%

Prevention of VTE in Nonsurgical Patients

Falck‐Ytter

Francis

Johanson

et al. 2012

Chest

1,753

485

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“…In addition, foot pumps were never reported to be utilized in the region. The effectiveness of mechanical VTE prophylaxis alone or in combination with pharmacologic prophylaxis has been shown in many studies to be the recommended method in high-risk patients as published in guidelines [12,16,17,18]. Mechanical prophylaxis was rarely used in high-risk patients in this study.…”

Section: Discussionmentioning

confidence: 91%

Assessment of Venous Thromboembolism Risk and Adequacy of Prophylaxis in Selected Acute Care Medical Centres in Arabian Gulf States: Results from the ENDORSE Study

Alsayegh

Kamaliddin²,

Sheshah³

et al. 2012

Med Princ Pract

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Objectives: To assess the prevalence of venous thromboembolism (VTE) risk in acutely ill surgical and medical patients in selected acute care centres in the Arabian Gulf States, and to determine the proportion of at-risk patients who received effective prophylaxis in accordance with 2004 American College of Chest Physicians (ACCP) guidelines. Materials and Methods: Eight hospitals from 3 countries (Kuwait, Kingdom of Saudi Arabia, and United Arab Emirates) contributed to the global ENDORSE (Epidemiological International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study. Medical records were reviewed for all the in-patients aged ≥40 years admitted to medical wards, and in patients aged ≥18 admitted to surgical wards. The VTE risk and recommended prophylaxis were assessed according to the 2004 ACCP guidelines. Results: Of 1,291 evaluable patients, 801 were considered at risk of VTE; 391 (48.8%) surgical patients and 410 (51.2%) medical patients. Of the 801 patients, 322 (40.2%) received ACCP-recommended VTE prophylaxis; 159 (40.7%) of surgical patients and 163 (39.8%) of medical patients. Conclusions: The data showed that VTE prophylaxis was underutilized in high-risk hospitalized patients. We recommend that active measures should be implemented in acute care centres in these Arabian Gulf countries to ensure identification of patients at risk of VTE and institute the appropriate prophylaxis.

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Mechanical Compression Versus Subcutaneous Heparin Therapy in Postoperative and Posttrauma Patients: A Systematic Review and Meta‐Analysis

Cited by 69 publications

References 41 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonsurgical Patients

Assessment of Venous Thromboembolism Risk and Adequacy of Prophylaxis in Selected Acute Care Medical Centres in Arabian Gulf States: Results from the ENDORSE Study

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