Arabi YM, et al. - Researchers sought to ascertain the incidence of deep-vein thrombosis among critically ill patients receiving pharmacologic thromboprophylaxis alone vs combined with adjunctive intermittent pneumatic compression. Findings revealed no significant difference in the incidence of proximal lower-limb deep-vein thrombosis between the two methods.

Methods

• Patients who were considered adults according to local standards at the participating sites (≥14, ≥16, or ≥18 years of age) were assigned within 48 hours after admission to an intensive care unit (ICU) to receive either intermittent pneumatic compression for at least 18 hours each day in addition to pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin (pneumatic compression group) or pharmacologic thromboprophylaxis alone (control group).
• Incident (ie, new) proximal lower-limb deep-vein thrombosis, as detected on twice-weekly lower-limb ultrasonography after the third calendar day since randomization until ICU discharge, death, attainment of full mobility, or trial day 28, whichever occurred first, was assessed as the primary outcome.

Results

• Researchers randomized a total of 2,003 patients—991 to the pneumatic compression group and 1,012 to the control group.
• For a median of 7 days (interquartile range, 4 to 13), they applied intermittent pneumatic compression for a median of 22 hours (interquartile range, 21 to 23) daily.
• In 37 of 957 patients (3.9%) in the pneumatic compression group and in 41 of 985 patients (4.2%) in the control group, occurrence of the primary outcome was observed (relative risk, 0.93; 95% confidence interval [CI], 0.60 to 1.44; P=0.74).
• One hundred three of 991 patients (10.4%) in the pneumatic compression group and 95 of 1,012 patients (9.4%) in the control group experienced venous thromboembolism (pulmonary embolism or any lower-limb deep-vein thrombosis; relative risk, 1.11; 95% CI, 0.85 to 1.44); death from any cause at 90 days was reported for 258 of 990 patients (26.1%) and 270 of 1,011 patients (26.7%), respectively (relative risk, 0.98; 95% CI, 0.84 to 1.13).