Adding mechanical to pharma prophylaxis does not cut DVT incidence
Background: Critically ill patients have a high risk of venous thromboembolism (VTE) during their hospitalizations, and it is standard of care to prophylax against this complication by either pharmacological or mechanical means.
Dr. Adith Sekaran
Study design: Prospective, randomized, controlled trial (Pneumatic Compression for Preventing Venous Thromboembolism [PREVENT]).
Setting: Multicenter study involving 20 ICUs in Saudi Arabia, Canada, Australia, and India.
Synopsis: The study monitored 2,003 medical and surgical ICU patients on pharmacological thromboprophylaxis (unfractionated or low-molecular-weight heparin) after receiving either adjunctive pneumatic compression or pharmacological thromboprophylaxis alone. The primary outcome was incident (newly diagnosed) proximal lower-limb DVT detected by twice-weekly venous ultrasonography until ICU discharge, death, attainment of full mobility, or trial day 28, whichever occurred first. Key secondary outcomes included the occurrence of any lower-limb DVTs and pulmonary embolism. Intermittent pneumatic compression was used a median of 22 hours daily. The incidence of proximal lower limb DVT did not differ in the two groups and was relatively low (4%) in the control group. There were also no differences in the groups in the composite VTE, death at 28 days, or any other secondary outcomes studied.
The main limitation of the study was the low incidence of primary outcomes in the control group, which reduced the power of the study.
Bottom line: Based on the PREVENT trial, adjunctive intermittent pneumatic compression provided no additional benefit to pharmacological prophylaxis in the prevention of incident proximal lower-limb DVT.
Citation: Arabi Y et al. Adjunctive intermittent pneumatic compression for venous thromboprophylaxis. N Eng J Med. 2019 Feb 18. doi: 10.1056/NEJMoa1816150.
Dr. Sekaran is a hospitalist at Massachusetts General Hospital.
