The addition of intermittent pneumatic compression (IPC) to pharmacological thromboprophylaxis for prevention of venous thromboembolism (VTE) in hospitalized patients is based upon low-quality evidence, according to a review published in Critical Care Explorations. The results suggest new studies are needed to inform guideline recommendations that currently support the additional use of IPC in these patients.
“[VTEs] are frequent complications in hospitalized patients and a leading cause of preventable death in hospital,” the researchers wrote in their report. “Pharmacologic prophylaxis is a standard of care to prevent VTE in patients at risk, the additional value of [IPC] is uncertain.”
The investigators conducted a systematic review and meta-analysis to evaluate the efficacy of adding IPC to pharmacologic prophylaxis for the prevention of VTE in hospitalized adults. They searched major literature databases and clinical trial registries from inception to July 2022 for randomized controlled trials (RCTs) comparing the use of IPC in addition to pharmacological thromboprophylaxis alone in hospitalized adults.
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With meta-analyses, the team calculated risk ratio (RR) of VTE, DVT, and pulmonary embolism (PE). They assessed the risk of bias and quality of evidence using recommended approaches for systematic reviews and meta-analyses and conducted prespecified subgroup analyses to explore potential sources of heterogeneity among the studies.
The researchers identified 17 RCTs, conducted between 1994 and 2019, that enrolled a total of 8796 participants, ranging from 48 to 2551 across studies. The patient populations included those with elective orthopedic surgery (7 trials), nonorthopedic surgery (5 trials), medical conditions (1 trial), trauma (1 trial), or multiple diagnoses (3 trials). They found that IPC was typically applied up to the thigh whereas pharmacological thromboprophylaxis was predominantly low-molecular-weight heparin.
The meta-analysis revealed that adjunctive IPC was associated with a decreased risk of VTE (15 trials; RR, 0.53; 95% CI, 0.35-0.81) and DVT (14 trials; RR, 0.52; 95% CI, 0.33-0.81), but not PE (7 trials; RR, 0.73; 95% CI, 0.32-1.68).
The researchers found that the quality of evidence was low, which they attributed to risk of bias and inconsistency. They observed no difference in all-cause mortality (moderate quality evidence) or adverse events (very low quality evidence) between IPC and control groups. In subgroup analyses, the team found that IPC appeared to be more effective in industry-funded trials compared with those funded by other sources (P =.01).
“Our results suggest there is low-quality evidence underpinning the addition of IPC to pharmacological thromboprophylaxis for prevention of VTE and DVT,” concluded the researchers.
They emphasized the need for further large high-quality randomized trials to support the use of adjunctive IPC in this setting and to identify patient subgroups for whom it could be beneficial.
Limitations of the study included the rarity of VTE events, which generated wide confidence limits for some results; potential publication bias, which could lead to an overestimation of the effect; and exclusion of unpublished results of some registered trials presented only as conference abstracts to date.
Reference
Duval C, Sirois C, Savoie-White FH, et al. Effect of intermittent pneumatic compression in addition to pharmacologic prophylaxis for thromboprophylaxis in hospitalized adult patients: a systematic review and meta-analysis. Crit Care Explor. 2022;4(10):e0769. doi:10.1097/CCE.0000000000000769
