Common Side Effects of Intermittent Pneumatic Compression (IPC)
The most common side effect of IPC is skin complications, including skin breaks, ulcers, blisters, and skin necrosis, occurring in approximately 3% of patients. 1
Primary Side Effect: Skin Complications
The CLOTS 3 trial, the largest and most recent high-quality study of IPC in immobile stroke patients (n=2,876), demonstrated that skin breaks on the legs occurred in 44 (3%) of patients allocated to IPC compared to 20 (1%) in the control group (p=0.002), representing a statistically significant increase. 1 This represents an absolute risk increase of approximately 2% attributable to IPC use.
While direct data on skin complications from IPC are limited, guideline panels suggest that rates are likely similar to those seen with graduated compression stockings (GCS), which show skin breaks/ulcers/blisters/skin necrosis in approximately 38 more per 1,000 patients compared to controls (RR 4.02,95% CI 2.34-6.91). 2
Less Common but Serious Complications
Neurovascular Complications
Rare but serious complications include peroneal neuropathy and compartment syndrome, particularly in specific high-risk scenarios. 3 These complications are more likely in:
- Patients with significant weight loss or cachexia (increased peroneal nerve vulnerability) 3
- Prolonged surgical procedures, especially in lithotomy position 3
- Patients with pre-existing neurovascular compromise 3
Falls and Injury
The CLOTS 3 trial found falls with injury occurred in 33 (2%) of IPC patients versus 24 (2%) in controls (p=0.221), showing no statistically significant difference. 1 This suggests IPC does not substantially increase fall risk beyond baseline.
Mortality Signal
Interestingly, deaths within the 30-day treatment period occurred in 156 (11%) of IPC patients versus 189 (13%) of control patients (p=0.057), suggesting a trend toward improved survival rather than harm, though this did not reach statistical significance. 1
Clinical Context and Risk Mitigation
The American College of Chest Physicians guidelines acknowledge that "no data are available on skin complications of IPC use" from direct studies in medical patients, but extrapolate from surgical populations and compression stocking data. 2
Key Risk Factors for Complications:
- Severe arterial insufficiency (contraindication to IPC) 4
- Acute DVT in lower extremities (contraindication) 4
- Large hematomas in the legs 4
- Severe thrombocytopenia (platelet count <20,000/mcL) 4
- Pre-existing skin ulceration or wounds 4
Common Pitfalls to Avoid:
Improper application is extremely common—one observational study found errors in IPC device application in 477 (49%) of 966 observations, with half relating to improper sleeve placement. 5 This misapplication likely increases complication risk while reducing efficacy.
Patients received no IPC prophylaxis in 142 (15%) of observations despite orders, highlighting the importance of ensuring continuous proper use for both safety and efficacy. 5