A Cochrane review included 22 studies (15 RCTs and 7 controlled clinical trials) with a total of 9 137 subjects. The included studies evaluated orthopedic patients (n = 12), urology patients (n = 2), cardiothoracic patients (n = 1), neurosurgery patients (n = 1), trauma patients (n = 1) or general surgery, gynecology and other types of patients (n = 5). Most of the participants had a high-risk procedure or condition.
The incidence of deep vein thrombosis (DVT) was lower in the intermittent pneumatic leg compression (IPC) + pharmacological prophylaxis group compared with IPC only but there was no statistically significant difference in the incidence of pulmonary embolism (PE). The addition of an anticoagulant to IPC increased the risk of any bleeding and incidence of major bleeding compared to IPC alone (table ). No difference between the type of surgery subgroups such as orthopedic and non-orthopedic participants for DVT incidence were found. Tests for differences between type of surgery subgroups were not possible for PE 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 | ||||
| Incidence of PE | OR 0.49 (0.18 to 1.34) | 8 per 1000 | 4 per 1000 (1 to 10) | 3 017 (12 studies) |
| Incidence of DVT | OR 0.52 (0.33 to 0.82) | 41 per 1000 | 22 per 1000 (14 to 34) | 2 934 (11 studies) |
| Incidence of bleeding | OR 5.04 (2.36 to 10.77) | 7 per 1000 | 33 per 1000 (16 to 67) | 2 155 (7 studies) |
| Incidence of major bleeding | OR 6.81 (1.99 to 23.28) | 1 per 1000 | 6 per 1000 (2 to 22) | 2 155 (7 studies) |
Compared with pharmacological prophylaxis alone, the use of combined IPC and pharmacological prophylaxis modalities reduced the incidence of symptomatic PE (table ). There was no difference in the incidence of DVT. Increased bleeding side effects were not observed for IPC when it was added to anticoagulation. No difference was detected between the type of surgery subgroups 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 | ||||
| Incidence of PE | OR 0.39 (0.23 to 0.64) | 29 per 1000 | 12 per 1000 (7 to 19) | 3 544 (10 studies) |
| Incidence of DVT | OR 0.42 (0.18 to 1.03) | 62 per 1000 | 27 per 1000 (12 to 64) | 2 866 (11 studies) |
| Incidence of bleeding | OR 0.8 (0.3 to 2.14 | 81 per 1000 | 66 per 1000 (26 to 159) | 244 (3 studies) |
| Incidence of major bleeding | OR 1.21 (0.35 to 4.18) | 41 per 1000 | 49 per 1000 (15 to 150) | 244 (3 studies) |
Comment: The quality of evidence is downgraded by imprecise results (few outcome events).