Research quality in the study of mechanical methods of deep vein thrombosis prophylaxis

Abstract

There is a lack of good-quality recent clinical data to support the use of mechanical methods to prevent deep vein thrombosis. Recommendations and meta-analyses have to rely on old data from evaluations of devices that are no longer available, with diagnostic methods that are obsolete. The aim of this narrative review is to examine the reasons why better recent evidence is not available, and how this will affect innovation in mechanical deep vein thrombosis prophylaxis. Analysis of recent published trials shows great variability in techniques and technologies, which complicates evaluation of the effectiveness of properties of intermittent pneumatic compression, graduated compression stockings, and electrical stimulation devices. Negative controlled trials have become difficult to conduct, and low rates of deep vein thrombosis have left many comparative trials of devices underpowered. There is a risk that if new approaches to enable clinical research are not developed that technological advancement of mechanical prophylaxis will be inhibited.

Obesity and the Risk of Venous Thromboembolism after Major Lower Limb Orthopaedic Surgery: A Literature Review

“…55 Practical difficulties with trial design, device types and usage, co-administered drugs, and outdated DVT diagnostic methods are some of the factors limiting ongoing and robust research on mechanical devices. 56…”

“…55 Practical difficulties with trial design, device types and usage, co-administered drugs, and outdated DVT diagnostic methods are some of the factors limiting ongoing and robust research on mechanical devices. 56 Pharmacological Thromboprophylaxis in Obesity: Dosing Principles and Current Evidence Current major VTE prophylaxis guidelines for orthopaedic surgery recommend standardized doses of medications without adjustments for BMI or age 50,57 despite an associated increased VTE risk. Recommendations for appropriate thromboprophylaxis in orthopaedic patients with obesity are limited and conflicting (►Table 1).…”