From the Guidelines
Sequential Compression Devices (SCDs) are recommended for use during surgical procedures to decrease the risk of venous thromboembolism (VTE), especially in patients with additional risk factors. SCDs should be applied before anesthesia induction and continued throughout the procedure and into the postoperative period until the patient is fully mobile. The most recent and highest quality study, published in 2022 1, supports the use of SCDs in combination with other VTE prophylaxis methods, such as compression stockings and pharmacological prophylaxis with low molecular weight heparin (LMWH) or unfractionated heparin. Key benefits of SCDs include:
- Increasing venous blood flow
- Reducing venous stasis
- Stimulating the release of natural anticoagulants The mechanism of action of SCDs mimics the natural muscle pump action of the legs, which is impaired during surgery due to immobility and anesthesia. By promoting blood flow and reducing stasis, SCDs help prevent the formation of blood clots in the deep veins of the legs. For optimal effectiveness, SCDs should be used in conjunction with other VTE prophylaxis methods as appropriate, based on the patient's risk profile and type of surgery. It's essential to ensure proper fit and consistent use of SCDs throughout the perioperative period for maximum benefit in reducing the risk of venous thrombosis. The use of SCDs is supported by strong evidence and recommendations from recent guidelines, including those from the Enhanced Recovery After Surgery (ERAS) Society 1. In patients at high risk for VTE, such as those with malignancy, obesity, or undergoing pelvic surgery, the use of SCDs is particularly important to reduce the risk of this potentially fatal complication. Overall, the use of SCDs is a crucial component of a comprehensive VTE prophylaxis strategy in surgical patients.
From the Research
Effectiveness of Sequential Compression Devices in Reducing VTE Risk
- Sequential compression devices (SCDs) have been shown to be effective in reducing the risk of venous thromboembolism (VTE) in surgical patients, with a study finding an incidence of clinically detectable postoperative VTE of 0.78% in high-risk patients who received SCDs perioperatively 2.
- Another study found that intermittent pneumatic compression devices (IPCDs), which are similar to SCDs, were comparable to anticoagulation for major clinical outcomes, including VTE, and may lower the risk of major bleeding 3.
- However, compliance with SCDs can be a issue, with one study finding that overall compliance was 73% and was higher in ICU patients compared to non-ICU patients 4.
Comparison with Other Methods
- A study compared the effectiveness of SCDs with ankle-calf movement (AFE) in increasing femoral venous velocity and found that AFE resulted in 43% higher venous velocity on average than did SCDs 5.
- Another study found that adding chemoprophylaxis to SCDs may not reduce the risk of VTE in bariatric surgery patients, with the incidence of VTE within 30 days of surgery being low in both groups 6.
Clinical Implications
- SCDs are a viable option for VTE prophylaxis in high-risk surgical patients, particularly when used in accordance with current clinical guidelines 2, 3.
- However, further research is needed to determine the optimal use of SCDs and other methods for VTE prevention, including the role of chemoprophylaxis and alternative methods such as AFE 6, 5.