Podcast: Combined intermittent pneumatic leg compression and medication for the prevention of deep vein thrombosis and pulmonary embolism

The single most common, preventable cause of in-hospital death is a hospital-acquired venous thromboembolism; making thi an important target for prevention when people are admitted to hospital. An updated Cochrane Review from September 2016 looks at the evidence for one of the possible interventions, a combination of intermittent pneumatic leg compression and drugs to prevent blood clots. Hayley Hassan, on behalf of the authors, tells us more.

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John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. The single most common, preventable cause of in-hospital death is a hospital-acquired venous thromboembolism; making thi an important target for prevention when people are admitted to hospital. An updated Cochrane Review from September 2016 looks at the evidence for one of the possible interventions, a combination of intermittent pneumatic leg compression and drugs to prevent blood clots. Hayley Hassan from the Cochrane Central Executive Team, on behalf of the authors, tells us more.

Hayley: A variety of methods have been used during the last 80 years to try to prevent hospital-acquired venous thromboembolism, including anticoagulants and leg compression using elastic stockings or intermittent pneumatic pressure. Mechanical intermittent pneumatic leg compression (IPC) reduces sluggish blood flow while drugs such as aspirin and anticoagulants, like low molecular weight heparin, reduce blood clotting. Unfortunately, the best preventive methods that are available today are effective in only approximately 70% of all cases when used on their own, and another way to address this problem is by combining different methods of prophylaxis or prolonging their use, particularly in high-risk patients.
We investigated whether combining IPC and anticoagulation is more effective than using either on its own, and whether the combination might be less safe, taking into account the possibility of an increased risk of bleeding. Overall, we found 22 trials with a total of more than 9000 participants, most of whom had either a high-risk procedure or condition, which included orthopedic surgery, urology, cardiothoracic, neurosurgery, trauma, general surgery and gynaecology.
Using data from 12 of the studies, with approximately 3100 patients, we found no obvious difference in venous thromboembolism between IPC alone and IPC plus anticoagulation. However, deep vein thrombosis, or DVT, was lower in the patients allocated to IPC combined with anticoagulation than for patients in the IPC alone group. On the other hand, adding anticoagulation to IPC increased the risk for any bleeding compared to IPC alone, from about 7 in every thousand patients to 40. Major bleeding followed a similar pattern, with an increase from 1 to 15 per thousand.
Compared with anticoagulation alone, the combination of IPC and anticoagulation reduced the incidence of pulmonary embolism in 10 studies with three and a half thousand patients; while DVT and bleeding weren’t found to be different.
In summary, this latest update of our Cochrane Review supports current guidelines, which recommend the use of combined modalities in hospitalised patients at risk of developing venous thromboembolism. However, uncertainties remain and will require resolving through more studies on the role of combined modalities.

John: If you’d like to read more about the current evidence on the combined modalities that have been studied to date, and watch out for future updates of this review, just go to Cochrane Library dot and search ‘pneumatic leg compression AND thromboembolism’ to find it.

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