When is Coban Lite (self-adhering compression wrap) contraindicated in a patient with a history of venous insufficiency?

Contraindications for Coban Lite Compression Wrap

Coban Lite is absolutely contraindicated when the ankle-brachial pressure index (ABPI) is below 0.5, as this indicates severe arterial insufficiency that would be worsened by compression therapy. 1

Absolute Contraindications

Severe Arterial Disease

• ABPI < 0.5: This is the manufacturer-specified cutoff for Coban Lite, below which the product must not be used 1
• Patients requiring revascularization first should not receive any compression therapy 2, 3
• The most dangerous error in compression therapy is failing to assess arterial circulation before application 2, 4

Active Conditions Precluding Compression

• Acute deep vein thrombosis without anticoagulation coverage 5
• Active bleeding or high bleeding risk that has not been controlled 5
• Severe peripheral arterial disease requiring urgent revascularization 5

Relative Contraindications (Use with Extreme Caution or Avoid)

Skin and Tissue Integrity Issues

• Dermatitis or skin breakdown: Active skin infections or severe dermatitis make compression unsafe 5
• Skin ulceration at the application site (though venous ulcers themselves are an indication for compression, active infection or severe surrounding tissue damage may require delay) 5
• Allergic hypersensitivity to compression materials 5

Vascular Compromise

• Lower-extremity bypass procedures: Recent arterial bypass grafts are at risk of compression-related compromise 5
• Lower-extremity trauma with plaster cast: Compression under or over casts creates compartment syndrome risk 5

Borderline Arterial Perfusion

• ABPI 0.5-0.6: While Coban Lite is technically indicated at ABPI ≥0.5, this represents borderline perfusion requiring careful monitoring 1
• Approximately 16% of venous leg ulcer patients have unrecognized concomitant arterial disease, making pre-compression arterial assessment mandatory 2, 4

Critical Pre-Application Assessment

Mandatory Evaluation Steps

1. Always measure ABPI before any compression application - this is the single most important safety step 2, 3, 4
2. Assess for active bleeding or bleeding risk - compression should be delayed until hemostasis is achieved 5
3. Examine skin integrity - identify dermatitis, breakdown, or infection that would preclude safe application 5
4. Evaluate for recent vascular procedures - arterial interventions require clearance before compression 5

ABPI-Based Decision Algorithm

• ABPI ≥ 0.8: Standard compression (30-40 mmHg) is safe; use standard Coban 2 Layer system 1
• ABPI 0.5-0.8: Reduced compression (25-30 mmHg) is indicated; Coban Lite is specifically designed for this range 1, 6
• ABPI < 0.5: Compression is contraindicated; refer for vascular evaluation and revascularization 2, 3, 1

Special Populations Requiring Caution

Patients with Mixed Disease

• Concomitant venous insufficiency and peripheral arterial disease: This increasingly common scenario (especially in elderly patients) requires reduced compression with careful ABPI monitoring 7
• Even with appropriate ABPI (≥0.5), monitor for signs of arterial compromise during treatment 7

Trauma Patients

• Major trauma with lower-extremity injury: Mechanical compression may be contraindicated by the injury pattern itself 5
• Active hemorrhage: Pharmacologic or mechanical prophylaxis should be delayed until bleeding is controlled 5

Common Pitfalls to Avoid

• Never apply compression without ABPI measurement - this single omission accounts for the most serious complications 2, 4
• Don't assume venous disease is isolated - arterial disease coexists in a substantial minority of patients 2, 4
• Avoid compression over fresh surgical sites or bypass grafts - wait for appropriate healing and surgical clearance 5
• Don't ignore patient reports of increased pain - this may signal arterial compromise requiring immediate bandage removal 6