Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma

• Published in: British journal of surgery 2003-11, Vol.90 (11), p.1338-1344
• Main Authors: Ginzburg, E., Cohn, S. M., Lopez, J., Jackowski, J., Brown, M., Hameed, S. M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anticoagulants - therapeutic use; Bandages; Biological and medical sciences; Blood and lymphatic vessels; Blood Loss, Surgical; Cardiology. Vascular system; Combined Modality Therapy; Diseases of the cardiovascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Treatment Outcome; Venous Thrombosis - prevention & control; Wounds and Injuries - complications
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.4309

Background: After trauma, up to 60 per cent of immobilized patients have been reported to develop a silent deep vein thrombosis (DVT). No large, prospective randomized trials have tested the efficacy of intermittent pneumatic compression (IPC) devices in these patients. Methods: A prospective randomized trial was performed of 442 patients who received thromboprophylaxis using either an IPC device or low molecular weight heparin (LMWH). Duplex imaging was performed on both legs on admission, and was repeated weekly thereafter until discharge, at 30 days or when there was a thrombotic event, whichever occurred first. Results: There were no significant differences in time spent in intensive care, or the proportion of patients with pelvic fractures, spinal cord or head injuries between the two groups. Six patients (2·7 per cent) developed a DVT in the IPC group and one (0·5 per cent) in the LMWH group (P = 0·122). Pulmonary embolism occurred in one patient in each group. There were 13 minor bleeding episodes (four in the IPC group and nine in the LMWH group) and eight major bleeding episodes (four in each group), none of which required operative intervention. Conclusion: The low rate of thromboembolic complications and the cost savings suggest that IPC might be used safely and effectively for thromboprophylaxis in trauma patients. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Equivalent in patients who did not have leg trauma