Intermittent pneumatic compression on top of pharmacological thromboprophylaxis in intensive care: added value or added cost?

The use of intermittent pneumatic compression to prevent venous thromboembolism in neurosurgical patients-A systematic review and meta-analysis

OBJECTIVE

The incidence of venous thromboembolism (VTE) remains high despite the use of low-molecular weight heparin (LMWH) and compression stocking (CS). We aimed to evaluate the use of IPC as VTE prophylaxis in neurosurgical patients.

PATIENTS AND METHODS

We conducted meta-analysis to assess the use of IPC as VTE prophylaxis in neurosurgical patients from several databases.

RESULTS

There was a total of 7.515 subjects from 5 studies. Reduction in VTE incidence was demonstrated by the IPC group (OR 0.40 [0.31, 0.52], p < 0.001; I²: 44 %). IPC was shown to reduce the incidence of deep venous thrombosis (DVT) (OR 0.43 [0.32, 0.57], p < 0.001; I²: 0 %) compared to the control group. Incidence of pulmonary embolism (PE) was lower (OR 0.42 [0.25, 0.70], p < 0.001; I²: 80 %) in IPC. Upon sensitivity analysis, PE was significantly lower in IPC (OR 0.24 [0.13, 0.45], p < 0.001; I²: 0 %). Subgroup analysis on patients undergoing neurosurgical intervention (operation) and receiving LMWH + CS shows a markedly reduced incidence of VTE (OR 0.37 [0.28, 0.50], p < 0.001; I²: 3 %), DVT (OR 0.39 [0.28, 0.54], p < 0.001; I²: 0 %), and PE (OR 0.22 [0.11, 0.43], p < 0.001; I²: 0 %) in IPC.

CONCLUSION

Intermittent pneumatic compression was associated with less VTE in neurosurgical patients, especially in those who received neurosurgical interventions, however, the certainty of evidence remained inadequate for creating a strong recommendation and further randomized controlled trials are needed before drawing a definite conclusion.