Evidence-based compression: prevention of stasis and deep vein thrombosis

Abstract

Objective: To summarize the currently published scientific evidence for the venous flow effects of mechanical devices, particularly intermittent pneumatic compression, and the relation to prevention of deep vein thrombosis (DVT).

Summary background data: While intermittent pneumatic compression is an established method of DVT prophylaxis, the variety of systems that are available can use very different compression techniques and sequences. In order for appropriate choices to be made to provide the optimum protection for patients, the general performance of systems, and physiological effects of particular properties, must be analyzed objectively.

Methods: Medline was searched from 1970 to 2002, and all relevant papers were searched for further appropriate references. Papers were selected for inclusion when they addressed specifically the questions posed in this review.

Results: All the major types of intermittent compression systems are successful in emptying deep veins of the lower limb and preventing stasis in a variety of subject groups. Compression stockings appear to function more by preventing distension of veins. Rapid inflation, high pressures, and graded sequential intermittent compression systems will have particular augmentation profiles, but there is no evidence that such features improve the prophylactic ability of the system.

Conclusions: The most important factors in selecting a mechanical prophylactic system, particularly during and after surgery, are patient compliance and the appropriateness of the site of compression. There is no evidence that the peak venous velocity produced by a system is a valid measure of medical performance.

FIGURE 1. A: Venous blood flow velocity in the posterior tibial vein during compression by a foot cuff (velocity [cm/s] vs. time [1 second per vertical dotted line]). B: Venous blood flow velocity in the femoral vein during compression by a foot cuff (velocity [cm/s] vs. time [1 second per vertical dotted line]).

FIGURE 2. A: Venous blood flow velocity in the femoral vein during compression by a three-bladder graduated sequential thigh-length cuff (velocity [cm/s] vs. time [1 second per vertical dotted line]). B: Venous blood flow velocity in the femoral vein during compression by a two-bladder uniform thigh-length cuff (velocity [cm/s] vs. time [1 second per vertical dotted line]).

FIGURE 3. Venous blood flow velocity in the femoral vein during compression by a two-bladder graduated sequential thigh-length cuff (velocity [cm/s] vs. time [1 second per vertical dotted line]).