Invited commentary

Abstract

We thoroughly enjoyed reading this study by Dr Labropolous and colleagues, in which they clearly demonstrate that the use of intermittent pneumatic compression (IPC) devices is fraught with difficulties, even after implementation of strategies to improve compliance. The physiologic effects of IPC can be grouped into hemodynamic, hematologic, flow-induced alterations of the endothelium of the veins and an increase in lymphatic drainage. IPC devices prevent venous thromboembolism (VTE) by reducing venous stasis and increasing endogenous fibrinolytic potential. It remains unknown which of these effects is most important for the prevention of VTE. Nonetheless, for the hemodynamic effects, correct calf application of IPC and continuous use are required to be effective. Several large meta-analyses have demonstrated that IPC use alone can reduce the incidence of deep venous thrombosis (DVT) by >60%, with even greater reduction by the combination of pharmacologic and mechanical prophylaxis. 1 Delos Reyes A.P. Partsch H. Mosti G. Obi A. Lurie F. Report from the 2013 meeting of the International Compression Club on advances and challenges of compression therapy. J Vasc Surg Venous Lymphat Disord. 2014; 2: 469-476 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar A recent Cochrane review concluded that on the basis of moderate-quality evidence, combining IPC with pharmacologic prophylaxis, compared with IPC or pharmacologic prophylaxis alone, decreased DVT compared with compression and decreased pulmonary embolism compared with anticoagulation. The addition of pharmacologic prophylaxis to IPC increased the risk of bleeding compared with IPC alone, but not the other way around. 2 Kakkos S.K. Caprini J.A. Geroulakos G. Nicolaides A.N. Stansby G.P. Reddy D.J. et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev. 2016; 9: CD005258 PubMed Google Scholar The proper use of IPC is unequivocally an important preventive strategy. The staff and patient perspectives on compliance with mechanical prophylaxis for venous thromboembolismJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 6Issue 4PreviewThis study evaluated the accuracy of assessment and compliance with proper use of intermittent pneumatic compression (IPC) devices before and after implementation of education, accountability, and oversight measures for health care providers. Full-Text PDF