Effectiveness of intermittent pneumatic compression devices for venous thromboembolism prophylaxis in high-risk surgical and medical patients
CONTEXT: Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious potential complication in hospitalized patients. Thromboprophylaxis regimens include pharmacological and mechanical options such as intermittent pneumatic compression devices...
| Main Authors: | , |
|---|---|
| Corporate Authors: | , , |
| Format: | eBook |
| Language: | English |
| Published: |
Washington, D.C.
Department of Veterans Affairs
June 2015, 2015
|
| Series: | Evidence-based synthesis program
|
| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | CONTEXT: Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious potential complication in hospitalized patients. Thromboprophylaxis regimens include pharmacological and mechanical options such as intermittent pneumatic compression devices (IPCDs). There are a wide variety of IPCDs available, but it is uncertain if they vary in effectiveness or ease of use. OBJECTIVE: To systematically review the literature on the comparative effectiveness of IPCDs for selected outcomes (mortality, VTE, symptomatic or asymptomatic DVT, major bleeding, ease of use, and adherence) in post-operative surgical and high-risk medical patients. DATA SOURCES AND STUDY SELECTION: We searched MEDLINE (via PubMed), Embase, CINAHL, and Cochrane CENTRAL from January 1, 1995, to October 30, 2014, for peer-reviewed, English-language randomized controlled trials (RCTs). Chief limitations of the literature were the paucity of head-to-head comparisons between IPCDs in surgical and medical patients, and the identification of primarily asymptomatic DVTs of uncertain clinical importance. CONCLUSIONS: IPCDs are appropriate for VTE thromboprophylaxis when used in accordance with current clinical guidelines. The current evidence base to guide selection of a specific device or type of device is limited. When choosing a specific IPCD, focusing on device flexibility, acceptability by nursing staff and patients, and the most frequently studied devices, as well as on cost, can help direct selection of appropriate IPCDs. Comparative effectiveness studies are urgently needed to address current gaps in evidence All searches used terms for IPCDs and the conditions of interest, along with validated search terms for RCTs. We also used terms to identify relevant observational studies on ease of use and adherence. Bibliographies of identified articles were further reviewed. To assess for possible publication bias, we searched ClinicalTrials.gov to identify completed but unpublished studies meeting our eligibility criteria. DATA SYNTHESIS: Eighteen RCTs and 3 observational studies were eligible; most were conducted in patients undergoing joint replacement surgery. Our review considered 3 types of evidence: 1) head-to-head comparisons of IPCDs; 2) indirect comparisons of IPCDs to a common comparator (eg, foot vs calf devices, each compared to anticoagulation); and 3) data on ease of use or adherence from patients or staff. The methodological quality of the included studies was variable and generally suboptimal. The most commonly studied devices were the Kendall SCD" and A-V Impulse System". Only 3 trials compared different IPCDs directly. One showed lower VTE rates for a VenaFlow(r) compared to the Kendall SCD, but 2 other studies showed no difference between the PlexiPulse(r) and the Kendall SCD. IPCDs were comparable to anticoagulation for major clinical outcomes (VTE: risk ratio [RR] 1.39; 95% confidence interval [CI], 0.73 to 2.64). Limited data suggest that concurrent use of anticoagulation with IPCD may lower the risk of VTE compared to anticoagulation alone (RR 0.27; 95% CI 0.05 to 1.64) and that IPCD compared to anticoagulation may lower the risk of major bleeding (RR 0.33; 95% CI 0.07 to 1.51). Subgroup analyses did not show significant differences by device location, mode of inflation, or risk of bias elements. Overall, there were no consistent associations between specific brand-name IPCDs or sleeve location and ease of use or adherence. |
|---|---|
| Item Description: | Title from PDF title page |
| Physical Description: | 1 PDF file (v, 57 pages) illustrations |