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A Journal on Angiology
Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,899
International Angiology 2011 April;30(2):115-22
Can combined (mechanical and pharmacological) modalities prevent fatal VTE?
Kakkos S. K. 1, Caprini J. A. 2, Geroulakos G. 3, Nicolaides A. N. 4, Stansby G. P. 5, Tsolakis I. A. 1, Reddy. D. J. 6
1 Department of Vascular Surgery, University Hospital of Patras, Patras, Greece;
2 Northshore University HealthSystem, Evanston, IL, USA;
3 Imperial College, London, UK;
4 University of Cyprus, Nicosia, Cyprus;
5 University of Newcastle upon Tyne, Newcastle upon Tyne, UK;
6 Wayne State University, Detroit, Michigan, USA
AIM: The aim of this paper was to perform a systemic review and meta-analysis of the efficacy of combined modalities (intermittent pneumatic leg compression and pharmacological prophylaxis, treatment group) against single modalities alone (control group) in preventing pulmonary embolism (PE), including fatal PE and deep-vein thrombosis (DVT) in high-risk patients.
METHODS: Databases searched included the Cochrane Central Register of Controlled Trials, the Specialized Register of the Peripheral Vascular Diseases Group, MEDLINE and EMBASE.
RESULTS: Seventeen studies, six of them randomized controlled trials (RCTs), which enrolled a total of 9 998 patients in a variety of specialties were identified. Sixteen of the included studies evaluated the role of combined modalities on the incidence of symptomatic PE. These showed a reduction in symptomatic PE from 2.83% (122/4313) in the control group to 0.86% (33/3838) in the treatment group. Odds ratio was 0.34, 95% Confidence interval (CI) 0.23 to 0.50. Fatal PE was reduced from 0.56% (11/1972) in the control group to 0.07% (1/1377) in the treatment group (results were available in 10 studies). Odds ratio was 0.37 (95% CI; 0.09 to 1.48). Fourteen studies investigated the role of combined modalities on the incidence of DVT. These showed a reduction in DVT from 6.18% (200/3238) in the control group to 2.05% (63/3074) in the treatment group. Odds ratio was 0.31, 95% CI 0.23 to 0.43.
CONCLUSION: Combined prophylactic modalities decrease significantly the incidence of PE and DVT, compared to single modalities, but the reduction seen in fatal PE did not reach statistical significance. Further research on the role of combined modalities in reducing DVT and PE is necessary.