Combined leg compression and anticoagulants effective in preventing venous thromboembolism

Clinical question: 
Compared with single modalities, how effective is intermittent pneumatic leg compression combined with pharmacological prophylaxis in preventing venous thromboembolism (VTE) in high-risk patients?
Bottom line: 
Compared with compression alone, combined prophylactic modalities significantly decrease the incidence of VTE, ie, symptomatic pulmonary embolism (PE) and deep vein thrombosis (DVT). Compared with pharmacological prophylaxis alone, combined modalities significantly reduce the incidence of DVT but the effect on PE could not be determined because of the lack of events in the included studies. Anticoagulants used in the trials included aspirin, warfarin, unfractionated heparin, low molecular weight heparin and fondaparinux.
Caveat: 
Most patients had either a high-risk procedure or condition. The surgical procedures were orthopaedic, urological, cardiothoracic, gynaecological or general surgical. The magnitude of the reduction in VTE may be less for patients at moderate risk.
Context: 
DVT and PE are possible complications of surgery and trauma. These complications extend hospital stay and are associated with long term disability and death. Mechanical intermittent pneumatic leg compression reduces venous stasis while anticoagulants reduce blood clotting.
Review CD#: 
CD005258
PEARLS No: 
148
Date: 
November, 2008
Authored by: 
Brian R McAvoy