Supplementary Leg Compressions Don’t Reduce DVT Risk

Adjunctive intermittent pneumatic compression (IPC) does not provide additional protection against lower-limb deep vein thrombosis (DVT) in critically ill patients, according to a new study.

Researchers at King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS; Riyadh, Saudi Arabia), the University of Toronto (UT; Canada), the University of New South Wales (Sydney, Australia), and other institutions conducted a study involving 2,003 critically ill patients to examine if adding IPC to the study group (991 patients), supplemental to pharmacologic thromboprophylaxis (PTP) would result in a lower incidence of DVT that than PTP alone (1,012 controls).

The patients assigned to IPC received treatment within 48 hours of admission at one of 20 intensive care units (ICUs) for at least 18 hours each day, in addition to PTP with unfractionated or low-molecular-weight heparin. The primary outcome was incident proximal lower-limb DVT, as detected on twice-weekly lower-limb ultrasonography after the third calendar day after randomization, which continued until ICU discharge, death, attainment of full mobility, or trial day 28, whichever occurred first.

The results revealed that the odds of DVT were 3.9% with IPC and PTP, compared to 4.2% with PTP alone. In addition, the researchers found no benefit for added IPC when it came to rates of both DVT (10.4%) and pulmonary emboli (9.4%). The rates of death from any cause at the 90-day mark were 26.1% with IPC and 26.7% with PTP alone. In all scenarios, the results confer a non-significant difference among treatment modalities. The study was published on February 18, 2019, in the New England Journal of Medicine (NEJM).

“I was surprised; my hypothesis was that it would work. The results should change practice among those who still provide adjunct intermittent pneumatic compression, however surprising physicians may find these new results to be,” said lead author Yaseen Arabi, MD, chairman of the intensive care department at KSAU-HS. “The main issue is that it’s not needed. It might be useful in patients who are not receiving heparin or low-molecular-weight heparin.”

IPC is usually comprised of a pair of inflatable sleeves wrapped around the legs, secured by straps, and attached via flexible tubing to a small bedside electric pump. The sleeves may be short (or below knee), wrapping around just the lower leg, or long (thigh length) to wrap around the thigh as well. They are inflated one side at a time to compress the legs at intervals. Some types inflate sequentially, first around the lower leg and then the upper, to "milk" the blood from the leg and increase venous flow.

Related Links:
King Saud Bin Abdulaziz University for Health Sciences
University of Toronto
University of New South Wales