Non-pharmacological interventions for the prevention of venous thromboembolism: a literature review.

Abstract

To assess the relative clinical efficacy of different forms of non-pharmacological prophylaxis, intermittent pneumatic compression and graduated compression stockings in reducing the incidence of venous thromboembolism (VTE) in patients hospitalised following acute stroke. This was a thematic synthesis of literature retrieved from a structured bibliographic search of: Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Summon, British Nursing Index, NHS Evidence, Internurse.com, PubMed, Ovid and the websites of other health information resources, such as the Nursing and Midwifery Council, National Institute for Health and Care Excellence and the World Health Organization. Citations were also searched for using: Web of Science, Google Scholar, the Cochrane Central Register of Controlled Trials, Current Controlled Trials, Stroke Trials Registry and Clinical Trials. Intermittent pneumatic compression (IPC) showed a small but statistically significant (P = 0.001) reduction in rates of deep vein thrombosis (DVT), in both symptomatic and asymptomatic DVT, involving proximal or calf veins, with fewer adverse effects such as skin breakdown and ulcers attributed to IPC, as compared to graduated compression stockings. No single intervention was the most effective for VTE prevention. More reliable evidence is required. Clear and extensive guidelines are necessary to ensure high-quality care for patients with acute stroke to improve their quality of life, and reduce morbidity and mortality rates.