Pulmonary embolism · Thromboprophylaxis in critical illness
Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Intermittent pneumatic compression added to pharmacological thromboprophylaxis |
| Control | Pharmacological thromboprophylaxis alone |
| Population | 2003 critically ill patients already receiving pharmacological thromboprophylaxis |
| Follow-up | ICU stay to 28 days |
| Primary endpoint | Incident proximal lower-limb deep-vein thrombosis |
| Result | Compression was applied for a median of 22 hours daily (IQR 21 to 23) over a median of 7 days. Adding it did not significantly reduce the incidence of proximal lower-limb deep-vein thrombosis compared with pharmacological prophylaxis alone. |
| Secondary endpoints | Any deep-vein thrombosis, pulmonary embolism, mortality |
Among critically ill patients who were receiving pharmacologic thromboprophylaxis, adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone.
The trial authors, in the published abstract
Well-delivered — 22 hours a day for a week — which is what makes the negative result convincing rather than a failure of adherence. Mechanical prophylaxis retains a role where anticoagulation is contraindicated; adding it on top is simply cost and nursing time.
Arabi YM, Al-Hameed F, Burns KEA, et al. Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis. N Engl J Med 2019 Apr 4;380(14):1305-1315.