title: Effectiveness of Intermittent Pneumatic Compression Devices for Venous Thromboembolism Prophylaxis in High-Risk Surgical Patients: A Systematic Review.
abstract: BACKGROUND
  Thromboprophylaxis regimens include pharmacologic and mechanical options such as intermittent pneumatic compression devices (IPCDs). There are a wide variety of IPCDs available, but it is uncertain if they vary in effectiveness or ease of use. This is a systematic review of the comparative effectiveness of IPCDs for selected outcomes (mortality, venous thromboembolism [VTE], symptomatic or asymptomatic deep vein thrombosis, major bleeding, ease of use, and adherence) in postoperative surgical patients.
  
  
  METHODS
  We searched MEDLINE (via PubMed), Embase, CINAHL, and Cochrane CENTRAL from January 1, 1995, to October 30, 2014, for randomized controlled trials, as well as relevant observational studies on ease of use and adherence.
  
  
  RESULTS
  We identified 14 eligible randomized controlled trials (2633 subjects) and 3 eligible observational studies (1724 subjects); most were conducted in joint arthroplasty patients. Intermittent pneumatic compression devices were comparable to anticoagulation for major clinical outcomes (VTE: risk ratio, 1.39; 95% confidence interval, 0.73-2.64). Limited data suggest that concurrent use of anticoagulation with IPCD may lower VTE risk compared with anticoagulation alone, and that IPCD compared with anticoagulation may lower major bleeding risk. Subgroup analyses did not show significant differences by device location, mode of inflation, or risk of bias elements. There were no consistent associations between IPCDs and ease of use or adherence.
  
  
  CONCLUSIONS
  Intermittent pneumatic compression devices are appropriate for VTE thromboprophylaxis when used in accordance with current clinical guidelines. The current evidence base to guide selection of a specific device or type of device is limited.
authors.affiliation: Division of Geriatrics, Duke University Medical Center, Durham, North Carolina; Durham Veterans Affairs Medical Center, GRECC, Durham, North Carolina.
authors.forename: Juliessa M
authors.initials: JM
authors.lastname: Pavon
authors.affiliation: Division of Hematology/Oncology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Soheir S
authors.initials: SS
authors.lastname: Adam
authors.affiliation: Center for Health Services Research in Primary Care, Durham VAMC, Durham, North Carolina.
authors.forename: Zayd A
authors.initials: ZA
authors.lastname: Razouki
authors.affiliation: Center for Health Services Research in Primary Care, Durham VAMC, Durham, North Carolina; Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: McDuffie
authors.affiliation: Orthopaedics, Durham Veterans Affairs Medical Center, Durham, North Carolina.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Lachiewicz
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.affiliation: Research Triangle Institute International, Durham, North Carolina.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Beadles
authors.affiliation: Division of Hematology/Oncology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.affiliation: Center for Health Services Research in Primary Care, Durham VAMC, Durham, North Carolina.
authors.forename: Avishek
authors.initials: A
authors.lastname: Nagi
authors.affiliation: Center for Health Services Research in Primary Care, Durham VAMC, Durham, North Carolina; Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
mesh_terms: D001178:Arthroplasty / Q000009:adverse effects*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
keywords: anticoagulation; intermittent pneumatic compression devices; joint arthroplasty; surgery; venous thromboembolism prophylaxis