A systematic review including 15 RCTs with a total of 2171 subjects was abstracted in DARE 1. In comparison with no prophylaxis, intermittent pneumatic compression (IPC) devices significantly reduced the risk of deep vein thrombosis (DVT) by 60% (RR 0.40, 95% CI 0.29 to 0.55) in postoperative patients (from general, gynaecological, oncologic, neurosurgery, or orthopaedic surgery populations). No significant reduction in the incidence of pulmonary embolism was observed. The duration of follow-up ranged from 1 to 14 days post-operatively, or until patients were fully ambulatory. 50% of the included studies initiated IPC perioperatively, 25% pre-operatively and 25% post-operatively.
Five trials, involving 487 patients, testing mechanical pumping devices in prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing surgery for hip fracture, were included in a Cochrane review 2 (abstract , review [Abstract]). Mechanical pumping devices may protect against DVT (16/221 (7%) versus 52/229 (22%); RR 0.31; 95%CI 0.19 to 0.51) and pulmonary embolism (5/238 (2.1%) versus 16/249 (6.4%); RR 0.40; 95% CI 0.17 to 0.96). Data were insufficient to establish any effect on the incidence of fatal pulmonary embolism and overall mortality. Problems with skin abrasion and compliance were reported.
Comment: The quality of evidence is downgraded by limitations in study and review quality (inadequate or unclear allocation concealment, lack of blinding and flawed methodology in some studies, and limitations in the review process) and by reporting bias (there was some evidence of publication bias).
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