title: Can combined (mechanical and pharmacological) modalities prevent fatal VTE?
abstract: OBJECTIVE
  The aim of this paper was to perform a systemic review and meta-analysis of the efficacy of combined modalities (intermittent pneumatic leg compression and pharmacological prophylaxis, treatment group) against single modalities alone (control group) in preventing pulmonary embolism (PE), including fatal PE and deep-vein thrombosis (DVT) in high-risk patients.
  
  
  METHODS
  Databases searched included the Cochrane Central Register of Controlled Trials, the Specialized Register of the Peripheral Vascular Diseases Group, MEDLINE and EMBASE.
  
  
  RESULTS
  Seventeen studies, six of them randomized controlled trials (RCTs), which enrolled a total of 9998 patients in a variety of specialties were identified. Sixteen of the included studies evaluated the role of combined modalities on the incidence of symptomatic PE. These showed a reduction in symptomatic PE from 2.83% (122/4313) in the control group to 0.86% (33/3838) in the treatment group. Odds ratio was 0.34, 95% Confidence interval (CI) 0.23 to 0.50. Fatal PE was reduced from 0.56% (11/1972) in the control group to 0.07% (1/1377) in the treatment group (results were available in 10 studies). Odds ratio was 0.37 (95% CI; 0.09 to 1.48). Fourteen studies investigated the role of combined modalities on the incidence of DVT. These showed a reduction in DVT from 6.18% (200/3238) in the control group to 2.05% (63/3074) in the treatment group. Odds ratio was 0.31, 95% CI 0.23 to 0.43.
  
  
  CONCLUSIONS
  Combined prophylactic modalities decrease significantly the incidence of PE and DVT, compared to single modalities, but the reduction seen in fatal PE did not reach statistical significance. Further research on the role of combined modalities in reducing DVT and PE is necessary.
authors.affiliation: Department of Vascular Surgery, University Hospital of Patras, Greece.
authors.forename: S K
authors.initials: SK
authors.lastname: Kakkos
authors.forename: J A
authors.initials: JA
authors.lastname: Caprini
authors.forename: G
authors.initials: G
authors.lastname: Geroulakos
authors.forename: A N
authors.initials: AN
authors.lastname: Nicolaides
authors.forename: G P
authors.initials: GP
authors.lastname: Stansby
authors.forename: I A
authors.initials: IA
authors.lastname: Tsolakis
authors.forename: D J
authors.initials: DJ
authors.lastname: Reddy
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D048228:Intermittent Pneumatic Compression Devices; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents