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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
INTERMITTENT PNEUMATIC COMPRESSION IN THE PREVENTION OF DVT IN MAJOR ORTHOPAEDIC SURGERY
Minerva Ortopedica e Traumatologica 2006 October;57(5):459-62
Prophylaxis of deep venous thrombosis with Foot-Pump A/V Impulse System
Pizzoli A. L., Rossi N., Bortolazzi R., Renzi Brivio L.
Divisione di Ortopedia e Traumatologia Ospedale C. Poma, Mantova
Routine prophylaxis for deep venous thrombosis (DVT) after majour orthopaedic surgery is mandatory for all moderate to high risk patients, even if many times the protocols are controversial. For these patients a triple regimen should be adopted based on mechanical methods, pharmacological therapy and other measures as hydratation and early mobilisation. Among mechanical methods pneumatic compression with foot pumps seems to be the best option in association to low molecular weight heparins (LMWH). In those patients with high risk of complications related to the pharmachological prophylaxis (surgical or neuraxial bleeding or heparin-induced thrombocytopenia) foot pump, associated to graduated elastic compression stockings (GECS), is the most effective treatment option. More-over, as demonstrated in many prospective study, the patients treated with foot pump present significantly less wound drainage, wound bleeding, bruising and oozing and less swelling of the limb when compared with patients treated only with LMWH. Nevertheless, we should consider that impulse foot pump cannot have an extended use because of some limits in patient’s tolerance, costs and reliability after hospital discharge. For these reasons the use of this device must be considered as temporary association or temporary alternative to LMWH.