Sequential compression device trial#

The authors reported no effect on the primary outcome or on any secondary outcome, and no effect when conducting sensitivity analyses. This was matched by the control group, which received chemoprophylaxis alone consistently for 7 days. Most important, the patients in the intervention group wore SCDs for a median of 7 days and 22 hours per day.

Sequential compression device trial#

The trial was extraordinarily well conducted in its review of the data. Secondary outcomes included prevalent proximal DVT, all DVT, pulmonary embolism, various composites, and safety measures. The primary outcome was incident proximal lower-extremity deep vein thrombosis (DVT). Lower-extremity ultrasound surveillance was performed twice weekly. The patients in both groups were fairly sick, with a mean Acute Physiology and Chronic Health Evaluation (APACHE) score of 20 and 66% receiving mechanical ventilation. Physiology tells us that their anticoagulant effect does not persist beyond removal, so continuous use is required for protection against VTE. Detractors believe that there are few high-quality trials that demonstrate efficacy, and also that application is poor (ie, even when they're ordered, patients don't wear them, and doctors and nurses don't enforce their use). Proponents of SCDs support their use on the basis of a favorable side-effect profile and low bleeding risk. Some guidelines recommend them for specific patient groups, while others recommend against them. Among the available forms, sequential compression devices (SCDs), also known as pneumatic compression devices, are the best studied and most commonly used. With this shift came a renewed interest in mechanical prophylaxis. However, in 2011, when studies questioned the efficacy and risk-benefit of chemoprophylaxis, it fell out of favor as the default strategy. The rationale was threefold: Most patients would have VTE risk factors and benefit from chemoprophylaxis individualized risk stratification was cumbersome and risk scores lacked external validation and we needed to optimize administration of this proven preventive therapy and force providers to justify not using it.

Prior to 2011, guidelines tacitly endorsed defaulting to chemoprophylaxis for VTE in most hospitalized patients. When it comes to chemoprophylaxis to combat venous thromboembolism (VTE), the pendulum has swung both ways.