Background: Current treatment regimens that are designed to prevent
deep venous thrombosis in patients undergoing orthopaedic procedures rely
predominantly on drug prophylaxis alone. The purpose of this randomized
clinical study was to evaluate the effectiveness of a mechanical adjunct to
chemoprophylaxis that involves intermittent compression of the legs.
Methods: During a twenty-two month period, 1803 patients undergoing
a variety of orthopaedic procedures were prospectively randomized to receive
either chemoprophylaxis alone or a combination of chemoprophylaxis and
mechanical prophylaxis. Nine hundred and two patients were managed with
low-molecular-weight heparin alone, and 901 were managed with
low-molecular-weight heparin and intermittent pneumatic compression of the
calves for varying time periods. Twenty-four percent of the patients underwent
total hip or knee joint replacement. Screening for deep venous thrombosis was
performed on the day of discharge with duplex-color-coded ultrasound.
Results: In the chemoprophylaxis-only group, fifteen patients (1.7%)
were diagnosed with a deep venous thrombosis; three thromboses were
symptomatic. In the chemoprophylaxis plus intermittent pneumatic compression
group, four patients (0.4%) were diagnosed with deep venous thrombosis; one
thrombosis was symptomatic. The difference between the groups with regard to
the prevalence of deep venous thrombosis was significant (p = 0.007). In the
chemoprophylaxis plus intermittent pneumatic compression group, no deep venous
thromboses were found in patients who received more than six hours of
intermittent pneumatic compression daily.
Conclusions: Venous thrombosis prophylaxis with low-molecular-weight
heparin augmented with a device that delivers rapid-inflation intermittent
pneumatic compression to the calves was found to be significantly more
effective for preventing deep venous thrombosis when compared with a treatment
regimen that involved low-molecular-weight heparin alone.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.