Venous Thrombo-embolism prophylaxis: Intermittent pneumatic compression

Abstract

Pulmonary embolism (PE) is the most preventable cause of hospital deaths in Europe. Autopsy-proven fatal pulmonary emboli were found in 2.5% of 200 hospitalized medical patients followed-up prospectively. The number of venous thrombo-embolism (VTE) related deaths throughout the Europe (543,454) is more than double the amount of deaths attributed to AIDS, breast cancer, prostate cancer and transport accidents combined (209,926). Only 58.5% of surgical patients and 39.5% of medical patients receive the appropriate thrombo-prophylaxis for their conditions. An ideal VTE prophylaxis for any given patient should be (1) risk adjusted, (2) targeted, (3) personalized and (4) effective. Intermittent pneumatic compression (IPC) devices are best suited for: (1) ICU patients who are either bleeding or have a high bleeding risk; (2) low risk elective general abdominal or pelvic surgery patients; (3) high risk elective general abdominal or pelvic surgery patients who have a high bleeding risk. In high risk elective general abdominal or pelvic surgery patients who are not at high risk for major bleeding, combined prophylaxis (IPC+LMWH) are recommended. Combined modalities target virtually all aspects of the Virchow's triad: (1) IPC and stockings prevent “stasis”, (2) stockings prevent “endothelial damage”, (3) IPC increases fibrinolysis, and LMWH exert anti-thrombotic effects to prevent “hypercoagulability”. In patients undergoing major surgery, IPC devices have a broader area of application due to fewer contra-indications and similar efficacy as compared to LMWH. Whenever indicated, every effort should be undertaken to provide a combined prophylaxis method.