Prediction and prophylaxis of postoperative thromboembolis—a comparison between peroperative calf muscle stimulation with groups of impulses and dextran 40

Abstract

The effects of peroperative electrical calf muscle stimulation with groups of impulses giving a short lasting tetanus of the calf muscles on postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) were compared with that of dextran 40 given per and postoperatively. The incidence of DVT and PE during the first 4-6 postoperative days was recorded. The diagnosis of DVT was based on the 125I-fibrinogen uptake test and phlebography and of PE on pre- and postoperative perfusion pulmonary scintigram and chest X-ray examination. Both methods reduced the incidence of PE. Calf muscle stimulation reduced the DVT incidence in patients with malignant disease while the reduction in DVT incidence for the whole group only was significant in the stimulation as well as the dextran 40 group. Mean values for preoperatively determined levels of antithrombin III, beta-thromboglobulin, fibrinopeptide A, plasminogen and ability to release fibrinolytic activity during venous stasis did not differ between those patients who developed or those who did not develop postoperative DVT or PE. However, antithrombin III levels below 80 per cent appeared to predispose to postoperative thromboembolism. The two prophylactic methods have similar effects on the incidence of postoperative thromboembolism. The stimulation method has certain advantages due to its safety and simplicity.

Neuromuscular electrical stimulation for thromboprophylaxis: A systematic review

“…However, the incidence of DVT in patients with malignant disease was significantly lower Williams et al 23 Geko T-1 1 70-560 ms 2 7 N R Izumi et al 24 SEN-52901 10 NR NR 100 Jawad et al 25 Geko T-1 1 70-560 ms 2 7 N R Warwick et al 35 Geko T-1 1 0-400 ms 2 7 N R Broderick et al 36 Duo Williams et al 23 Izumi et al 24 Jawad et al 25 Goyal et al 26 Velmahos et al 27 Merli et al 29 Bostrom et al 30 Lindströ m et al 28 Doran et al 31 Doran and White 32…”

“…The study addresses an appropriate and clearly focused question 23 Izumi et al 24 Jawad et al 25 Goyal et al 26 Velmahos et al 27 Merli et al 29 Bostrom et al 30 Lindströ m et al 28 Doran et al 31 Doran and White 32…”

Deep Vein Thrombosis: Risk Factors and Prevention in Surgical Patients

“…44 It is simple, cheap and free from side effects, and can be combined with Pharmacological agents. 45 Another method, pneumatic compression of the calf, involves encasing the legs in a plastic material and rhythmically alternating the pressure to squeeze the calf muscles and increase venous return. In practice an electrical pump inflates each legging alternately so that compression at 40-45 mmHg for 1 min is achieved, followed by a relaxation for 1min.…”

“…It is an established DVT prophylaxis agent. 45 Dextrans are allergenic and should be used with caution.…”

NICE guidelines on reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients undergoing surgery

“…Browse and Negus (1970) reported that electrical stimulation reduces the risk of DVT by 59%, in patients' own experimental and control legs. There is no evidence that ES reduces incidence of PE (Lindstrom et al, 1982). Nicolaides et al (1983) claim that ES is less effective in reducing of DVT, compared with GCSs and IPCDs.…”