The Journal of Bone & Joint Surgery

The Journal of Bone & Joint Surgery, Volume 89, Issue 5

Scientific Articles | May 01, 2007

Rapid-Inflation Intermittent Pneumatic Compression for Prevention of Deep Venous Thrombosis

R. Eisele, MD¹; L. Kinzl, MD¹; T. Koelsch, MD¹

¹ Department of Trauma Surgery and Reconstructive Surgery, Trauma Center Weissenhorn, Guenzburgerstrasse 41, 89264 Weissenhorn, Germany. E-mail address for R. Eisele: r.eisele@stiftungsklinik-weissenhorn.de

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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Aircast Europe. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site () and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Investigation performed at the Department of Trauma Surgery and Reconstructive Surgery, Trauma Center Weissenhorn, Weissenhorn, Germany, and at the Department of Trauma Surgery, Hand and Reconstructive Surgery, University of Ulm, Ulm, Germany

The Journal of Bone and Joint Surgery, Incorporated

J Bone Joint Surg Am, 2007 May 01;89(5):1050-1056. doi: 10.2106/JBJS.E.00434

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Abstract

Background: Current treatment regimens that are designed to prevent deep venous thrombosis in patients undergoing orthopaedic procedures rely predominantly on drug prophylaxis alone. The purpose of this randomized clinical study was to evaluate the effectiveness of a mechanical adjunct to chemoprophylaxis that involves intermittent compression of the legs.

Methods: During a twenty-two month period, 1803 patients undergoing a variety of orthopaedic procedures were prospectively randomized to receive either chemoprophylaxis alone or a combination of chemoprophylaxis and mechanical prophylaxis. Nine hundred and two patients were managed with low-molecular-weight heparin alone, and 901 were managed with low-molecular-weight heparin and intermittent pneumatic compression of the calves for varying time periods. Twenty-four percent of the patients underwent total hip or knee joint replacement. Screening for deep venous thrombosis was performed on the day of discharge with duplex-color-coded ultrasound.

Results: In the chemoprophylaxis-only group, fifteen patients (1.7%) were diagnosed with a deep venous thrombosis; three thromboses were symptomatic. In the chemoprophylaxis plus intermittent pneumatic compression group, four patients (0.4%) were diagnosed with deep venous thrombosis; one thrombosis was symptomatic. The difference between the groups with regard to the prevalence of deep venous thrombosis was significant (p = 0.007). In the chemoprophylaxis plus intermittent pneumatic compression group, no deep venous thromboses were found in patients who received more than six hours of intermittent pneumatic compression daily.

Conclusions: Venous thrombosis prophylaxis with low-molecular-weight heparin augmented with a device that delivers rapid-inflation intermittent pneumatic compression to the calves was found to be significantly more effective for preventing deep venous thrombosis when compared with a treatment regimen that involved low-molecular-weight heparin alone.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article

Deep venous thrombosis is a common complication in patients undergoing a variety of orthopaedic procedures, and its prevalence can be reduced substantially through the use of prophylactic measures. Typically, these measures consist of anticoagulant drugs such as low-molecular-weight heparin, anti-inflammatory drugs, early postoperative physiotherapy, and compressive stockings. Intermittent pneumatic compression of the limbs has been postulated to reduce venous stasis by increasing the velocity of venous return^1-4. It has been shown to be effective not only for prophylaxis against deep venous thrombosis but also for the treatment of lymphedema, leg ulcers, posttraumatic swelling, congestive heart failure, and other conditions^5-10. Earlier intermittent pneumatic compression devices used low pressure and slow inflation of an air bladder that was applied to the leg. More recent devices produce graduated, sequential, rapid inflation of multiple air chambers within the applied cuffs. This latter approach has been shown to improve the hemodynamic response when compared with relatively slow, low-pressure inflation^11-14.

At our institution, the prevalence of deep venous thrombosis during the use of low-molecular-weight heparin for prophylaxis against deep venous thrombosis has been reported to range from 1.5% among patients with skeletal and soft-tissue trauma to 2.5% among those managed with elective orthopaedic surgery¹⁵. The positive effect of walking and weight-bearing on venous flow in the superficial femoral vein has been investigated previously^16,17. Because intermittent pneumatic compression can simulate the effects of walking and weight-bearing on the venous system, the present study was initiated to test the hypothesis that the results of chemoprophylaxis alone could be improved significantly if intermittent pneumatic compression was incorporated into the treatment regimen.

Materials and Methods

Materials and Methods | Results | Discussion | Appendix | References

The present study was approved by our institutional ethical review committee. Between January 2001 and October 2002, 1803 consecutive inpatients who were to undergo orthopaedic trauma surgery or elective orthopaedic surgery were recruited and ultimately enrolled in the study. The inclusion criteria included an age of between twenty and eighty-six years and a surgical site in an area other than the upper extremity. Approximately 24% (439) of the 1803 procedures involved total joint arthroplasty. Other major procedural categories included knee ligamentous and meniscal repair, tumor resection, and open fixation of traumatic fractures (Fig. 1). The remainder of the procedures primarily involved elective osteotomies to correct deformities of the femur, tibia, foot, and ankle and to treat high-impact contusion injuries of the lower extremity, pelvis, abdomen, spine, and chest. The exclusion criteria included a location of surgery that would interfere with the application of the pneumatic compression calf cuff. One otherwise eligible patient was excluded because of an existing acute deep venous thrombosis. None of the eligible patients declined to participate. The operative procedures were performed predominantly with the patient under general anesthesia. The deep venous thrombosis prophylaxis regimen was randomly assigned in the operating theater at the time of completion of surgery, and the randomization was stratified by age.

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Fig. 1: Histogram illustrating the category of surgery and the type of prophylaxis. A total of 902 patients were managed with chemoprophylaxis alone (white columns), and 901 patients were managed with chemoprophylaxis augmented with intermittent pneumatic compression (IPC) (black columns). The "Other" group comprised primarily patients who had osteotomies for the treatment of acquired deformities of the femur, tibia, foot, and ankle, and high-impact contusion injuries.

Nine hundred and two patients were managed with chemoprophylaxis alone, and 901 were managed with the same chemoprophylaxis regimen augmented with rapid-inflation intermittent pneumatic compression (Fig. 1). The perioperative regimen for all patients consisted of intravenous intraoperative and postoperative rehydration, analgesic drugs (Novaminsulfon [metamizole]; twenty drops administered three times per day), anti-inflammatory drugs (diclofenac; 50 mg administered three times per day), low-molecular-weight heparin (certoparin), and compression stockings18-20. Low-molecular-weight heparin was administered subcutaneously in doses of 3000 anti-factor Xa (aXa) units twelve hours before surgery and twelve hours after surgery. Subcutaneous low-molecular-weight heparin administration was continued with a single dose of 3000 aXa units daily during hospitalization.

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Fig. 2: Photograph showing the legs of a patient with intermittent pneumatic compression devices applied to both calves.

Patients in the intermittent pneumatic compression group had the intermittent pneumatic compression system applied to both calves in the recovery room shortly after the completion of surgery. The VenaFlow system (Aircast, Vista, California) uses calf cuffs containing two overlapping air chambers located posteriorly on the leg (Fig. 2). As the device cycles, the distal chamber inflates to 52 mm Hg over a 0.5-second period. During the last 0.2 second of this period, the proximal chamber inflates and reaches 45 mm Hg. After six seconds of inflation the cuff deflates, and the cycle is repeated every minute. A mean increase in peak venous flow velocity of 240% to 300% during the inflation of this device has been documented, compared with the 80% to 140% increase found with other intermittent pneumatic compression systems^21,22.

In the intermittent pneumatic compression group, 132 patients were assigned to receive compression for one to two hours daily; 154, for more than two to four hours daily; 394, for more than four to six hours daily; sixty-one, for more than six to eight hours daily; 101, for more than eight to ten hours daily, and fifty-nine, for more than ten hours daily. Thus, a total of 680 patients received intermittent pneumatic compression for six hours per day or less, and 221 patients received intermittent pneumatic compression for more than six hours a day. Intermittent pneumatic compression therapy was applied daily during the time that the patient was confined to bed postoperatively, and it was terminated at the time that the patient was able to walk. The average duration of application of postoperative intermittent pneumatic compression was three days (range, one to sixteen days).

On the day of discharge, all patients were screened for deep venous thrombosis in both legs with use of duplex-color-coded ultrasound^23-27. The personnel who performed the deep venous thrombosis screening were not blinded to the treatment regimens. Several variables were documented for each patient, including age, gender, risk factors, the location of surgery, whether or not deep venous thrombosis was detected with ultrasound (and, if it was detected, whether or not it was symptomatic), the duration of daily intermittent pneumatic compression, and the perceived comfort of the intermittent pneumatic compression cuffs. The patients were asked to report comfort on a visual analog scale of 1 to 10, with 1 being designated as very uncomfortable and 10 being designated as very comfortable. Symptomatic deep venous thromboses were defined as those accompanied by fever, swelling, or local pain (either spontaneous or in response to compression). Risk factors included a history of deep venous thrombosis, venous insufficiency, a body mass index of >30, an age of greater than forty years, and smoking.

Statistical Methods

Statistical comparison of the rates of deep venous thrombosis in the chemoprophylaxis-only group and intermittent pneumatic compression group was performed with use of the Fisher exact test. The level of significance was set at p < 0.05.

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Fig. 3: Bar graph illustrating the prevalence of deep venous thrombosis (DVT) in the chemoprophylaxis-only group (n = 902) and the intermittent pneumatic compression (IPC) group (n = 901). The difference between the groups was significant (p = 0.007)

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Fig. 4: Bar graph illustrating the prevalence of deep venous thrombosis for patients undergoing total hip arthroplasty (n = 306) and total knee arthroplasty (n = 133). IPC = intermittent pneumatic compression.

Results

Materials and Methods | Results | Discussion | Appendix | References

There was no significant difference between the groups when the number of thromboembolic risk factors per patient was analyzed (see Appendix).

In the chemoprophylaxis-only group, fifteen (1.66%) of the 902 patients were found to have a deep venous thrombosis (Fig. 3). These patients included eight women and seven men with a mean age of sixty-two years (range, twenty-six to eighty-six years). Ten deep venous thromboses were associated with hip and knee joint replacements; one, with anterior cruciate ligament reconstruction; two, with tumor resection; and two, with open fracture fixation. One tumor was located in the femur, and the patient underwent total femoral replacement with a modular prosthesis. The second tumor was located in the pelvis. The open fractures were located in the distal part of the femur and the pelvis and were treated with plate fixation. Five deep venous thromboses were located in the femoral vein and, of these, two were symptomatic. Ten deep venous thromboses were located in the calf and, of these, one was symptomatic.

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Fig. 5: Histogram illustrating the daily running time of the intermittent pneumatic compression (IPC) device. There were no deep venous thromboses (DVT) in patients who had intermittent pneumatic compression for six hours per day or more (p < 0.0006).

In the intermittent pneumatic compression group, four (0.44%) of the 901 patients were found to have a deep venous thrombosis. These patients included one female patient and three male patients with a mean age of sixty years (range, forty-two to seventy-six years). No deep venous thromboses were detected among patients managed with total hip replacement, and three deep venous thromboses were detected among patients managed with total knee replacement. The fourth deep venous thrombosis occurred in a patient who had undergone meniscal repair. Three of the deep venous thromboses (two of which were located in the calf and one of which was located in the thigh) were asymptomatic, and one (located in the calf) was symptomatic.

The difference between the chemoprophylaxis-only group and the intermittent pneumatic compression group with regard to the rate of deep venous thrombosis was significant (p = 0.007) (Fig. 3). Following total hip replacement, deep venous thrombosis was diagnosed in six of 116 patients in the chemoprophylaxis-only group compared with zero of 190 patients in the intermittent pneumatic compression group; this difference was also significant (p < 0.001) (Fig. 4). Following total knee replacement, deep venous thrombosis was diagnosed in four of fifty-four patients in the chemoprophylaxisonly group compared with three of seventy-nine patients in the intermittent pneumatic compression group; again, the difference was significant (p = 0.038) (Fig. 4).

There were no instances of deep venous thrombosis in patients who received intermittent pneumatic compression for six hours or more per day. In contrast, there were four instances of deep venous thrombosis in patients who had intermittent pneumatic compression for six hours per day or less. This difference was significant (p < 0.006). There were no significant differences in the prevalence of deep venous thrombosis when the group receiving intermittent pneumatic compression for more than two to four hours was compared with the group receiving intermittent pneumatic compression for more than four to six hours (Fig. 5).

The majority of patients found the cuffs comfortable. The mean comfort score was 7.6 (range, 1 to 10).

Discussion

Materials and Methods | Results | Discussion | Appendix | References

While most physicians accept the concept that early patient mobilization greatly enhances venous return, venous flow augmentation in recumbent patients after surgery was problematic until the advent of pneumatic devices that provide cyclic compression of the limbs.

A number of intermittent pneumatic compression devices are currently available. They vary with respect to the site of application, the rates of inflation and deflation, the pressure amplitude, and the chamber inflation sequence. Recently introduced intermittent pneumatic compression designs combine rapid inflation to relatively high pressures and graduated, sequential inflation of adjacent chambers in order to achieve optimal flow velocity and volume. Intermittent pneumatic compression of the calf has been shown to be superior to intermittent pneumatic compression of the foot^28-31. We believe that the device that we used in the present study incorporates the optimal characteristics to provide a level of venous flow enhancement that exceeds that achievable with other designs^21,22.

Rather than simulating contraction of the underlying muscles, intermittent pneumatic compression devices, when applied to the calf, produce their effect by simulating calf muscle stretching. Elongation of the calf muscles concomitant with dorsiflexion of the foot increases the flow in the superficial femoral vein fourfold¹⁶. It has been proposed that the kneading motion produced by rapid, sequential inflation such as that achieved with the device used in the present study is particularly effective because of the resulting shear stresses generated in the vascular endothelium^32,33.

The antithrombotic effect of intermittent pneumatic compression has been attributed to both the reduction of venous stasis and enhanced fibrinolysis. Intermittent pneumatic compression results in an increase in plasma tissue factor pathway inhibitor and a decline in the amount of FVIIa (activated factor VII of the coagulation cascade). Inhibition of the tissue factor pathway, the initiating mechanism of blood coagulation, is a possible mechanism for the antithrombotic effect^34-38.

In addition, nitric oxide release from the vascular endothelium has been shown to increase in response to intermittent pneumatic compression. Formerly known as endothelium-derived relaxing factor, it is an important inhibitor of the coagulation cascade. Endogenous nitric oxide synthase appears to be elevated only during the period during which intermittent pneumatic compression is applied39.

Because intermittent pneumatic compression has few contraindications and few deleterious side effects, we hypothesized that combining it with pharmacologic measures that have been shown to be effective for prophylaxis against deep venous thrombosis would confer additional protection to our patients. This combination has been shown to be effective in other clinical studies^40-42. While the present study did not address the use of intermittent pneumatic compression as a replacement for chemoprophylaxis, there is sufficient evidence to warrant exploring that possibility. The benefit of intermittent pneumatic compression described in the present study was most clear when its application exceeded six hours daily.

In the present study, a specific chemical prophylaxis regimen was compared with the same regimen augmented by a specific intermittent compression device. Additional studies will be required to determine whether these findings can be generalized to other chemoprophylaxis regimens and other intermittent compression devices⁴³.

On the basis of earlier work and the large randomized clinical study presented here, we believe that there are distinct advantages to augmenting chemoprophylaxis regimens with intermittent pneumatic compression, particularly among patients undergoing pelvis, knee, and hip surgery^44-48. Because it does not pose an increased risk of postoperative bleeding, intermittent pneumatic compression may be used safely to augment conventional prophylactic measures. The findings of the present study indicate that the use of a device that incorporated rapid inflation and graduated, sequential pneumatic compression in combination with chemoprophylaxis with low-molecular-weight heparin was effective for accomplishing these goals^49-51. The local comfort and ease of application of this intermittent pneumatic compression device are features that are likely to promote patient acceptance and compliance.

Appendix

Materials and Methods | Results | Discussion | Appendix | References

A figure showing the number of risk factors per patient is available with the electronic versions of this article, on our web site at jbjs.org (go to the article citation and click on "Supplementary Material") and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM). ?

References

Materials and Methods | Results | Discussion | Appendix | References

Anglen JO, Goss K, Edwards J, Huckfeldt RE. Foot pump prophylaxis for deep venous thrombosis: the rate of effective usage in trauma patients. Am J Orthop. 1998;27: 580-2.27580 1998 [PubMed]

Black PM, Baker MF, Snook CP. Experience with external pneumatic calf compression in neurology and neurosurgery. Neurosurgery. 1986;18: 440-4.18440 1986 [PubMed][CrossRef]

Bucci MN, Papadopoulos SM, Chen JC, Campbell JA, Hoff JT. Mechanical prophylaxis of venous thrombosis in patients undergoing craniotomy: a randomized trial. Surg Neurol. 1989;32: 285-8.32285 1989 [PubMed][CrossRef]

Carn RM, Miranda IP, Greene ER. Femoral vein flow velocity for devices used in the prevention of deep vein thrombosis. Orthop Trans. 1986;10: 384.10384 1986

Delis KT, Husmann MJ, Cheshire NJ, Nicolaides AN. Effects of intermittent pneumatic compression of the calf and thigh on arterial calf inflow: a study of normals, claudicants, and grafted arteriopaths. Surgery. 2001;129: 188-95.129188 2001 [PubMed][CrossRef]

Delis KT, Husmann MJ, Nicolaides AN, Wolfe JH, Cheshire NJ. Enhancing foot skin blood flux in peripheral vascular disease using intermittent pneumatic compression: controlled study on claudicants and grafted arteriopaths. World J Surg. 2002;26: 861-6.26861 2002 [PubMed][CrossRef]

Kumar S, Samraj K, Nirujogi V, Budnik J, Walker MA. Intermittent pneumatic compression as an adjuvant therapy in venous ulcer disease. J Tissue Viability. 2002;12: 42-8.1242 2002 [PubMed]

Mani R, Vowden K, Nelson EA. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database Syst Rev. 2001;(4): CD001899.CD001899 2001

Vowden K. The use of intermittent pneumatic compression in venous ulceration. Br J Nurs. 2001;10: 491-509.10491 2001 [PubMed]

Ringley CD, Johanning JM, Gruenberg JC, Veverka TJ, Barber KR. Evaluation of pulmonary arterial catheter parameters utilizing intermittent pneumatic compression boots in congestive heart failure. Am Surg. 2002;68: 286-90.68286 2002 [PubMed]

Cotton TL. The prevention of deep vein thrombosis, with particular reference to mechanical methods of prevention. Surgery. 1977;81: 228-35.81228 1977 [PubMed]

Dai G, Gertler JP, Kamm RD. The effects of external compression on venous blood flow and tissue deformation in the lower leg. J Biomech Eng. 1999;121: 557-64.121557 1999 [PubMed][CrossRef]

Malone MD, Cisek PL, Comerota AJ Jr, Holland B, Eid IG, Comerota AJ. High-pressure, rapid-inflation pneumatic compression improves hemodynamics in healthy volunteers and patients who are post-thrombotic. J Vasc Surg. 1999;29: 593-9.29593 1999 [PubMed][CrossRef]

Rithalia SV, Heath GH, Gonsalkorale M. Evaluation of intermittent pneumatic compression systems. J Tissue Viability. 2002;12: 52-7.1252 2002

Eisele R, Maier E, Kinzl L, Gude U. [Stationary thromboprophylaxis in casualty surgery. Relevance of postoperative mobility and preexisting risk factors]. Unfallchirurg. 2004;107: 294-9. German.107294 2004 [PubMed][CrossRef]

Eisele R, Weickert E, Eren A, Kinzl L. The effect of partial and full weight-bearing on venous return in the lower limb. J Bone Joint Surg Br. 2001;83: 1037-40.831037 2001 [PubMed][CrossRef]

Gibbs NM. Venous thrombosis of the lower limbs with particular reference to bed-rest. Br J Surg. 1957;45: 209-36.45209 1957 [PubMed][CrossRef]

Agu O, Hamilton G, Baker D. Graduated compression stockings in the prevention of venous thromboembolism. Br J Surg. 1999;86: 992-1004.86992 1999 [CrossRef]

Byrne B. Deep vein thrombosis prophylaxis: the effectiveness and implications of using below-knee or thigh-length graduated compression stockings. Heart Lung. 2001;30: 277-84.30277 2001 [PubMed][CrossRef]

Hui AC, Heras-Palou C, Dunn I, Triffitt PD, Croizier A, Imeson J, Gregg PJ. Graded compression stockings for prevention of deep-vein thrombosis after hip and knee replacement. J Bone Joint Surg Br. 1996;78: 550-4.78550 1996

Westrich GH, Specht LM, Sharrock NE, Windsor RE, Sculco TP, Haas SB, Trombley JF, Peterson M. Venous haemodynamics after total knee arthroplasty: evaluation of active dorsal to plantar flexion and several mechanical compression devices. J Bone Joint Surg Br. 1998;80: 1057-66.801057 1998 [CrossRef]

Whitelaw GP, Oladipo OJ, Shah BP, DeMuth KA, Coffman J, Segal D. Evaluation of intermittent pneumatic compression devices. Orthopedics. 2001;24: 257-61.24257 2001 [PubMed]

Aitken AG, Godden DJ. Real-time ultrasound diagnosis of deep vein thrombosis: a comparison with venography. Clin Radiol. 1987;38: 309-13.38309 1987 [PubMed][CrossRef]

Bauer DC. Ultrasound surveillance to detect postoperative venous thrombosis. JAMA. 1992;268: 2650-51.2682650 1992 [PubMed][CrossRef]

Cronan JJ. Ultrasound evaluation of deep venous thrombosis. Semin Roentgenol. 1992;27: 39-52.2739 1992 [PubMed][CrossRef]

Eisele R, Orend K-H, Mohr M, Schulte M. The age of a venous thrombosis: experimental and clinical experience with duplex color-coded ultrasound. Vasc Surg. 1996;30: 301-9.30301 1996

Lewis BD, James EM, Welch TJ, Joyce JW, Hallett JW, Weaver AL. Diagnosis of acute deep venous thrombosis of the lower extremities: prospective evaluation of color Doppler flow imaging versus venography. Radiology. 1994;192: 651-5.192651 1994 [PubMed]

Elliott CG, Dudney TM, Egger M, Orme JF, Clemmer TP, Horn SD, Weaver L, Handrahan D, Thomas F, Merrell S, Kitterman N, Yeates S. Calf-thigh sequential pneumatic compression compared with plantar venous pneumatic compression to prevent deep-vein thrombosis after non-lower extremity trauma. J Trauma. 1999;47: 25-32.4725 1999 [PubMed][CrossRef]

Blanchard J, Meuwly JY, Leyvraz PF, Miron MJ, Bounameaux H, Hoffmeyer P, Didier D, Schneider PA. Prevention of deep-vein thrombosis after total knee replacement. Randomised comparison between a low-molecular-weight heparin (nadroparin) and mechanical prophylaxis with a foot-pump system. J Bone Joint Surg Br. 1999;81: 654-9.81654 1999 [PubMed][CrossRef]

Delis KT, Slimani G, Hafez HM, Nicolaides AN. Enhancing venous outflow in the lower limb with intermittent pneumatic compression. A comparative haemodynamic analysis on the effect of foot vs. calf vs. foot and calf compression. Eur J Vasc Endovasc Surg. 2000;19: 250-60.19250 2000 [CrossRef]

Spain DA, Bergamini TM, Hoffmann JF, Carrillo EH, Richardson JD. Comparison of sequential compression devices and foot pumps for prophylaxis of deep venous thrombosis in high-risk trauma patients. Am Surg. 1998;64: 522-6.64522 1998 [PubMed]

Spaeth EE, Roberts GW, Yadwadkar SR, Ng PK, Jackson CM. The influence of fluid shear on the kinetics of blood coagulation reactions. Trans Am Soc Artif Intern Organs. 1973;19: 179-87.19179 1973 [PubMed]

Turitto VT, Baumgartner HR. Platelet interaction with subendothelium in flowing rabbit blood: effect of blood shear rate. Microvasc Res. 1979;17: 38-54.1738 1979 [PubMed][CrossRef]

Chen AH, Frangos SG, Kilaru S, Sumpio BE. Intermittent pneumatic compression devices—physiological mechanisms of action. Eur J Vasc Endovasc Surg. 2001;21: 383-92.21383 2001 [PubMed][CrossRef]

Chouhan VD, Comerota AJ, Sun L, Harada R, Gaughan JP, Rao AK. Inhibition of tissue factor pathway during intermittent pneumatic compression: a possible mechanism for antithrombotic effect. Arterioscler Thromb Vasc Biol. 1999;19: 2812-7.192812 1999 [PubMed]

Christen Y, Wutschert R, Weimer D, de Moerloose P, Kruithof EK, Bounameaux H. Effects of intermittent pneumatic compression on venous haemodynamics and fibrinolytic activity. Blood Coagul Fibrinolysis. 1997;8: 185-90.8185 1997 [CrossRef]

Comerota AJ, Chouhan V, Harada RN, Sun L, Hosking J, Veermansunemi R, Comerota AJ Jr, Schlappy D, Rao AK. The fibrinolytic effects of intermittent pneumatic compression: mechanism of enhanced fibrinolysis. Ann Surg. 1997;226: 306-14.226306 1997 [PubMed][CrossRef]

Jacobs DG, Piotrowski JJ, Hoppensteadt DA, Salvator AE, Fareed J. Hemodynamic and fibrinolytic consequences of intermittent pneumatic compression: preliminary results. J Trauma. 1996;40: 710-17.40710 1996 [CrossRef]

Chen LE, Liu K, Qi WN, Joneschild E, Tan X, Seaber AV, Stamler JS, Urbaniak JR. Role of nitric oxide in vasodilation in upstream muscle during intermittent pneumatic compression. J Appl Physiol. 2002;92: 559-66.92559 2002

Westrich GH, Sculco TP. Prophylaxis against deep venous thrombosis after total knee arthroplasty. Pneumatic plantar compression and aspirin compared with aspirin alone. J Bone Joint Surg Am. 1996;78: 826-34.78826 1996

Woolson ST, Robinson RK, Khan NQ, Rogers BS, Maloney WJ. Deep venous thrombosis prophylaxis for knee replacement: warfarin and pneumatic compression. Am J Orthop. 1998;27: 299-304.27299 1998 [PubMed]

Stone MH, Limb D, Campbell P, Stead D, Culleton G. A comparison of intermittent calf compression and enoxaparin for thromboprophylaxis in total hip replacement. A pilot study. Int Orthop. 1996;20: 367-9.20367 1996 [CrossRef]

Larson CM, MacMillan DP, Lachiewicz PF. Thromboembolism after total knee arthroplasty: intermittent pneumatic compression and aspirin prophylaxis. J South Orthop Assoc. 2001;10: 155-63.10155 2001 [PubMed]

Fordyce MJ, Ling RS. A venous foot pump reduces thrombosis after total hip replacement. J Bone Joint Surg Br. 1992;74: 45-9.7445 1992

Hull RD, Pineo GF. Intermittent pneumatic compression for the prevention of venous thromboembolism. Chest. 1996;109: 6-9.1096 1996 [PubMed][CrossRef]

Ward WG, Olin MD. Simple, hybrid deep venous thrombosis/pulmonary embolus prophylaxis after total hip arthroplasty. J South Orthop Assoc. 1999;8: 14-9.814 1999 [PubMed]

Woolson ST. Intermittent pneumatic compression prophylaxis for proximal deep venous thrombosis after total hip replacement. J Bone Joint Surg Am. 1996;78: 1735-40.781735 1996 [PubMed]

Hooker JA, Lachiewicz PF, Kelley SS. Efficacy of prophylaxis against thromboembolism with intermittent pneumatic compression after primary and revision total hip arthroplasty. J Bone Joint Surg Am. 1999;81: 690-6.81690 1999

de Lissovoy G, Yusen RD, Spiro TE, Krupski WC, Champion AH, Sorensen SV. Cost for inpatient care of venous thrombosis: a trial of enoxaparin vs standard heparin. Arch Intern Med. 2000;160: 3160-5.1603160 2000 [CrossRef]

Edelsberg J, Ollendorf D, Oster G. Venous thromboembolism following major orthopedic surgery: review of epidemiology and economics. Am J Health Syst Pharm. 2001;58Suppl 2: S4-13.58S4 2001 [PubMed]

Ollendorf DA, Vera-Llonch M, Oster G. Cost of venous thromboembolism following major orthopedic surgery in hospitalized patients. Am J Health Syst Pharm. 2002;59: 1750-4.591750 2002 [PubMed]

Topics

deep vein thrombosis ; antimicrobial chemoprophylaxis ; chemoprevention ; economic inflation ; pneumatic compression therapy

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R. Eisele, L. Kinzl, T. Koelsch; Rapid-Inflation Intermittent Pneumatic Compression for Prevention of Deep Venous Thrombosis. The Journal of Bone & Joint Surgery. 2007 May;89(5):1050-1056.

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