Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation: a prospective randomised trial of acute ruptures of the Achilles tendon.
Deep vein thrombosis is a common complication of immobilising the lower limb after surgery. We hypothesised that intermittent pneumatic compression (IPC) therapy in outpatients who had undergone surgical repair of acute ruptures of the Achilles tendon could reduce the incidence of this problem. A total of 150 patients who had undergone surgical repair of the Achilles tendon were randomised to either treatment with IPC for six hours per day (n = 74) under an orthosis or treatment as usual (n = 74) in a plaster cast without IPC. At two weeks post-operatively, the incidence of deep vein thrombosis was assessed using blinded, double-reported compression duplex ultrasound. At this point, IPC was discontinued and all patients were immobilised in an orthosis for a further four weeks. At six weeks post-operatively, a second compression duplex ultrasound scan was performed. At two weeks, the incidence of deep vein thrombosis was 21% in the treated group and 37% in the control group (p = 0.042). Age over 39 years was found to be a strong risk factor for deep vein thrombosis (odds ratio (OR) = 4.84, 95% confidence interval (CI) 2.14 to 10.96). Treatment with IPC, corrected for age differences between groups, reduced the risk of deep vein thrombosis at the two-week point (OR = 2.60; 95% CI 1.15 to 5.91; p =0.022). At six weeks, the incidence of deep vein thrombosis was 52% in the treated group and 48% in the control group (OR 0.94, 95% CI 0.49 to 1.83). IPC appears to be an effective method of reducing the risk of deep vein thrombosis in the early stages of post-operative immobilisation of outpatients. Further research is necessary to elucidate whether it can confer similar benefits over longer periods of immobilisation and in a more heterogeneous group of patients.
Karolinska Institutet, Stockholm, 171 76, Sweden.
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Domeij-Arverud
Karolinska Institutet, Stockholm, 171 76, Sweden.
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Labruto
Karolinska Institutet, Stockholm, 171 76, Sweden.
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Latifi
Karolinska Institutet, Stockholm, 171 76, Sweden.
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Nilsson
Tiohundra Hospital, SE-761 29, Norrtälje, Sweden.
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Edman
Karolinska Institutet, Stockholm, 171 76, Sweden.
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Ackermann
D000125:Achilles Tendon / Q000293:injuries*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects*; D048228:Intermittent Pneumatic Compression Devices; D007866:Leg; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000009:adverse effects*; D011446:Prospective Studies; D012306:Risk; D012421:Rupture / Q000601:surgery; D016037:Single-Blind Method; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D055815:Young Adult
deep venous thrombosis; intermittent pneumatic calf compression; lower limb immobilisation; Achilles tendon rupture; orthosis