Are Sequential Compression Devices (SCDs) and Intermittent Pneumatic Compression (IPCs) effective at preventing Deep Vein Thromboses (DVTs)?

From the Guidelines

Yes, Sequential Compression Devices (SCDs) and Intermittent Pneumatic Compression (IPCs) are effective at preventing Deep Vein Thromboses (DVTs). These mechanical prophylaxis methods work by applying sequential pressure to the lower extremities, improving venous return and preventing blood stasis, which is a key factor in DVT formation. They are particularly valuable for patients who have contraindications to pharmacological prophylaxis such as anticoagulants. According to a study published in 2018 1, IPC in addition to routine care is recommended over routine care to reduce the risk of DVT in immobile stroke patients without contraindications. The study found that IPC significantly reduced the odds of proximal DVT (odds ratio, 0.65; 95% CI, 0.51–0.84; P=0.001) compared with no IPC.

Key Points to Consider

• SCDs and IPCs should be applied correctly and worn consistently while the patient is immobile, especially during hospitalization or after surgery.
• The devices should be removed only for short periods (such as during bathing) and reapplied promptly.
• The mechanism of action involves mimicking the natural muscle pump action of the legs, which helps maintain blood flow and reduces the risk of clot formation.
• While these devices are effective, they are often most beneficial when used as part of a comprehensive DVT prevention strategy that may include early mobilization and, when not contraindicated, pharmacological prophylaxis.
• For patients at particularly high risk, such as those undergoing orthopedic surgery or with multiple risk factors, combining mechanical and pharmacological methods may provide the best protection against DVT.

Important Considerations

• Contraindications to IPC include leg conditions such as dermatitis, gangrene, severe edema, venous stasis, severe peripheral vascular disease, postoperative vein ligation, or grafting, as well as existing swelling or other signs of an existing DVT 1.
• Skin breaks were more common in the IPC group (3.1% versus 1.4%; P=0.002) 1.
• A meta-analysis including the trial and 2 smaller trials confirmed the results of the study, highlighting the effectiveness of IPC in preventing DVT 1.

From the Research

Effectiveness of SCDs and IPCs in Preventing DVTs

• Sequential Compression Devices (SCDs) and Intermittent Pneumatic Compression (IPCs) are methods used to prevent Deep Vein Thromboses (DVTs) in high-risk patients.
• Studies have shown that IPCs can reduce the risk of DVT by 60% in postoperative patients 2.
• A meta-analysis of 15 eligible studies found that IPC devices reduced the risk of DVT by 60% (relative risk 0.40,95% CI 0.29 - 0.56; p < 0.001) 2.
• In patients who have had a stroke, IPC has been shown to reduce the risk of DVT by 3.6% (95% CI 1.4-5.8) 3.

Comparison of SCDs and IPCs

• A study comparing SCDs and foot pumps for DVT prophylaxis in high-risk trauma patients found no difference in the incidence of DVT between the two groups 4.
• SCDs were used in 64% of patients, while foot pumps were used in 34% of patients, often due to lower extremity injuries 4.
• Another study found that compliance with SCD prophylaxis was low, with only 19% of patients being fully compliant 5.

Safety and Efficacy

• IPCs have been shown to be an effective and safe modality in preventing both DVT and pulmonary embolism in high-risk ICU patients 6.
• A study found that IPC is an effective method of reducing the risk of DVT and possibly improving survival in a wide variety of patients who are immobile after stroke 3.
• Skin breaks on the legs were reported in 3% of patients allocated IPC, and falls with injury were reported in 2% of patients in the IPC group 3.