Comparison of clinical and physiological efficacies of different intermittent sequential pneumatic compression devices in preventing deep vein thrombosis: a prospective randomized study

Abstract

Background: There are few comparative studies about the optimal method of pneumatic compression to prevent deep vein thrombosis (DVT). The aim of this prospective randomized study was to compare venous hemodynamic changes and their clinical influences between two graded sequential compression groups (an alternate sequential compression device [ASCD] vs. a simultaneous sequential compression device [SSCD]).

Methods: In total, 34 patients (68 limbs) undergoing knee and spine operations were prospectively randomized into two device groups (ASCD vs. SSCD groups). Duplex ultrasonography examinations were performed on the 4th and 7th postoperative days for the detection of DVT and the evaluation of venous hemodynamics. Continuous data for the two groups were analyzed using a two-tailed, unpaired t-test. Relative frequencies of unpaired samples were compared using Fisher exact test. Mixed effects models that might be viewed as ANCOVA models were also considered.

Results: DVT developed in 7 patients (20.6%), all of whom were asymptomatic for isolated calf DVTs. Two of these patients were from the ASCD group (11.8%) and the other five were from the SSCD group (29.4%), but there was no significant difference (p = 0.331). Baseline peak velocity, mean velocity, peak volume flow, and total volume flow were enhanced significantly in both device groups (p < 0.001). However, the degrees of flow and velocity enhancement did not differ significantly between the groups. The accumulated expelled volumes for an hour were in favor of the ASCD group.

Conclusions: Both graded sequential compression devices showed similar results both in clinical and physiological efficacies. Further studies are required to investigate the optimal intermittent pneumatic compression method for enhanced hemodynamic efficacy and better thromboprophylaxis.

Keywords: Hemodynamics; Intermittent pneumatic compression device; Venous thromboembolism; Venous thrombosis.

Fig. 1

Two types of sequential compression devices. (A, B) SCD Express devices (Tyco Healthcare, Kendall, MA, USA) for alternate sequential compression device group. SCD Express devices can provide alternate sequential compression with customized compression-relaxation cycles in accordance with an individual's separate venous refill times in lower limbs. (C, D) DVT-3000 devices (DS MAREF, Gunpo, Korea) for simultaneous sequential compression device group. DVT-3000 devices can provide simultaneous sequential compression of both legs.

Fig. 2

Comparison of hemodynamic data. Baseline peak velocity, mean velocity, total volume flow, and peak volume flow were enhanced significantly, which more than doubled in both device groups. Asterisk (^*) indicates significant difference between the baseline and the augmented values in the same group (all, p < 0.001).