The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding).
A Cochrane review [Abstract] 1 included 34 studies (25 RCTs and 9 controlled clinical trials) with a total of 14 932 subjects, mainly undergoing surgery or admitted with trauma. Most of the participants had a high-risk procedure or condition.
The incidences of pulmonary embolism (PE) and deep vein thrombosis (DVT) were lower in the intermittent pneumatic leg compression (IPC) + pharmacological prophylaxis group compared with IPC only. The addition of an anticoagulant to IPC increased the risk of any bleeding and incidence of major bleeding compared to IPC alone (table T1). Tests for subgroup differences between orthopaedic and non-orthopaedic surgery participants were not possible for PE incidence as no PE events were reported in the orthopaedic subgroup. No difference was detected between orthopaedic and non-orthopaedic surgery participants for DVT incidence.
| Outcome | Relative effect (95% CI) | Assumed risk - IPC | Corresponding risk - IPC + pharmacological prophylaxis (95% CI) | Participants (studies) |
|---|---|---|---|---|
| IPC=intermittent pneumatic leg compression; PE=pulmonary embolism; DVT=deep vein thrombosis; * early postoperative period | ||||
| Incidence of PE* | OR 0.51 (0.29 to 0.91) | 16 per 1000 | 7 per 1000 (4 to 12) | 5 462 (19 studies) |
| Incidence of DVT* | OR 0.51 (0.36 to 0.72) | 38 per 1000 | 20 per 1000 (14 to 28) | 5 394 (18 studies) |
| Incidence of bleeding* | OR 6.02 (3.88 to 9.35) | 10 per 1000 | 55 per 1000 (36 to 83) | 4 634 (13 studies) |
| Incidence of major bleeding* | OR 5.77 (2.81 to 11.83) | 3 per 1000 | 19 per 1000 (10 to 39) | 4 133 (12 studies) |
Compared with pharmacological prophylaxis alone, the use of combined IPC and pharmacological prophylaxis modalities reduced the incidence of PE and incidence of DVT (table T2). Increased bleeding side effects were not observed for IPC when it was added to anticoagulation.No difference was detected between the orthopaedic and non-orthopaedic surgery participants for PE incidence or for DVT incidence.
| Outcome | Relative effect (95% CI) | Assumed risk - pharmacological prophylaxis | Corresponding risk - IPC + pharmacological prophylaxis (95% CI) | Participants (studies) |
|---|---|---|---|---|
| IPC=intermittent pneumatic leg compression; PE=pulmonary embolism; DVT=deep vein thrombosis; * early postoperative period | ||||
| Incidence of PE* | OR 0.46 (0.30 to 0.71) | 18 per 1000 | 9 per 1000 (6 to 13) | 6 737(15 studies) |
| Incidence of DVT* | OR 0.38 (0.21 to 0.70) | 93 per 1000 | 37 per 1000 (21 to 67) | 6 151 (17 studies) |
| Incidence of bleeding* | OR 0.87 (0.56 to 1.35 | 74 per 1000 | 65 per 1000 (43 to 98) | 1 314 (6 studies) |
| Incidence of major bleeding* | OR 1.21 (0.35 to 4.18) | 11 per 1000 | 13 per 1000 (4 to 44) | 908 (5 studies) |
Primary/Secondary Keywords