DVT Debunked: Patients on anticoagulants don’t need mechanical prophylaxis

Myth:

Patients on anticoagulants don't need mechanical prophylaxis to prevent venous thromboembolism (VTE).

Truth:

Research shows that two types of prophylaxis — chemical and mechanical — are better than one. Numerous studies following post-surgical patients have found that combining chemical and mechanical prophylaxis — and intermittent pneumatic compression (IPC) in particular — is the most effective way to reduce the risk of a potentially fatal blood clot.

Multi-modal is best

The following guidelines recommend dual modalities, including mechanical compression:

• CHEST (American College of Chest Physicians)
• AAOS (American Academy of Orthopaedic Surgeons)
• AORN (Association of periOperative Registered Nurses)
• ASMBS (American Society for Metabolic and Bariatric Surgery)
• ACFAS (American College of Foot and Ankle Surgeons)

1. Compression makes a difference

Many studies demonstrate the benefits of IPC — and of IPC in combination with chemical prophylaxis. Here are a few examples:

• A randomized clinical trial compared outcomes for 203 post-surgical patients at extremely high risk for VTE who received only stockings and heparin with those of 204 patients who also received IPC. After 30 days, the group that received IPC experienced a 0.5% incidence of VTE, while those who went without it had an 18% incidence.
  
  
• In a prospective study of patients who underwent esophagectomy for cancer, researchers compared outcomes for 118 patients who received only low molecular weight heparin (LMWH) to those of 195 patients who received LMWH and IPC. The researchers' analysis in the Journal of Surgical Oncology concluded that adding IPC reduces postoperative VTE.
  
  
• Another randomized trial compared deep vein thrombosis (DVT) rates for 1438 immobile, acute stroke patients who received IPC with 1438 similar patients who did not. Writing in the Lancet, researchers concluded that IPC effectively reduces DVT risk and possibly improves survival for such patients.

2. Tailor the treatment

A randomized, controlled study of 625 gynecological surgery patients showed the benefits of a tailored multi-modal approach. These patients received stockings alone or in combination with IPC and/or LMWH.

In Scientific Reports, the researchers concluded that the treatment regime should be tailored to the patient. For those with bleeding concerns, in particular, they recommend using stockings and IPC. For patients at very high risk of VTE, they recommended a combination of all three interventions, because this approach was linked to the lowest incidence of DVT.

3. Not all forms of mechanical prophylaxis are equal

After following 131 patients who had undergone total knee and hip replacements, researchers in a randomized study published in The Journal of Bone and Joint Surgery found that pairing LMWH with IPC more effectively prevented DVT than pairing the medication with stockings.