Different types of intermittent pneumatic compression devices for preventing venous thromboembolism in patients after total hip replacement
ABSTRACT BACKGROUND: Total hip replacement (THR) is an effective treatment for reducing pain and improving function and quality of life in patients with hip disorders. While this operation is very successful, deep vein thrombosis (DVT) and pulmonary embolism (PE) are significant complications after THR. Different types of intermittent pneumatic compression (IPC) devices have been used for thrombosis prophylaxis in patients following THR. Available devices differ in compression garments, location of air bladders, patterns of pump pressure cycles, compression profiles, cycle length, duration of inflation time and deflation time, or cycling mode such as automatic or constant cycling devices. Despite the widely accepted use of IPC for the treatment of arterial and venous diseases, the relative effectiveness of different types of IPC systems as prophylaxis against thrombosis after THR is still unclear. OBJECTIVES: To assess the comparative effectiveness and safety of different IPC devices with respect to the prevention of venous thromboembolism in patients after THR. SEARCH METHODS: The Cochrane Peripheral Vascular Diseases Group Trials Search Coordinator searched the Specialised Register (May 2012), CENTRAL (2012, Issue 4), MEDLINE (April Week 3 2012) and EMBASE (Week 17 2012). Clinical trial databases were searched for details of ongoing and unpublished studies. Reference lists of obtained articles were also screened. There were no limits imposed on language or publication status. SELECTION CRITERIA: Randomized and quasi-randomized controlled studies were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. Disagreement was resolved by discussion or, if necessary, referred to a third review author. MAIN RESULTS: Only one quasi-randomized controlled study with 121 study participants comparing two types of IPC devices met the inclusion criteria. The authors found no cases of symptomatic DVT or PE in either the calf-thigh compression group or the plantar compression group during the first three weeks after the THR. The calf-thigh pneumatic compression was more effective than plantar compression for reducing thigh swelling during the early postoperative stage. The strength of the evidence in this review is weak as only one trial was included and it was classified as having a high risk of bias. AUTHORS' CONCLUSIONS: There is a lack of evidence from randomized controlled trials to make an informed choice of IPC device for preventing venous thromboembolism (VTE) following total hip replacement. More research is urgently required, ideally a multicenter, properly designed RCT including a sufficient number of participants. Clinically relevant outcomes such as mortality, imaging-diagnosed asymptomatic VTE and major complications must be considered.
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ABSTRACT: The review of literature on thromboprophylaxis in nonhaemophilia patients undergoing orthopaedic surgery and on thromboprophylaxis in people with haemophilia undergoing orthopaedic surgery leads us to the conclusion that we cannot currently recommend thromboprophylaxis extensively in haemophilia patients undergoing orthopaedic surgery. This sharply contrasts with what the literature recommends for nonhaemophilia patients, that is to say mixed pharmacological and mechanical thromboprophylaxis. However, if we detect several risk factors for thromboembolism in a haemophiliac patient who is to undergo orthopaedic surgery, we should carry out the same type of thromboprophylaxis recommended for nonhaemophilia patients. Such risk factors are the following: orthopaedic surgery, increased age, previous thromboembolism, varicose veins, general anaesthesia, malignancy (cancer), factor V (Leiden) mutation, obesity, and the oral contraceptive pill (in women with von Willebrand disease).Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 06/2014; 25(4):300-302. DOI:10.1097/MBC.0000000000000011 · 1.25 Impact Factor
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ABSTRACT: The International Compression Club, a collaboration of medical experts and industry representatives, was founded in 2005 to develop consensus reports and recommendations regarding the use of compression therapy in the treatment of acute and chronic vascular disease. During the recent meeting of the International Compression Club, member presentations were focused on the clinical application of intermittent pneumatic compression in different disease scenarios as well as on the use of inelastic and short stretch compression therapy. In addition, several new compression devices and systems were introduced by industry representatives. This article summarizes the presentations and subsequent discussions and provides a description of the new compression therapies presented.10/2014; DOI:10.1016/j.jvsv.2014.02.006
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