Efficacy Of Intermittent Pneumatic Compression Research Articles

Efficacy of intermittent pneumatic compression on breast cancer-related upper limb lymphedema: a systematic review and meta-analysis in clinical studies.

Complete decongestive therapy (CDT) and intermittent pneumatic compression (IPC) are the most common combination of treatments in breast cancer-related upper limb lymphedema. The effects of IPC as an addition to CDT are inconsistent in different studies. This meta-analysis aimed to explore whether IPC could bring additional benefits to CDT. Literatures were retrieved from databases with full-text publications ranging from January 1995 to March 2024. Fixed-effect models were applied to subsequent analysis if no heterogeneity was detected by using the Inverse formula. Publication bias was assessed using the Begg's test and Eagger's test. Twelve studies were finally included for further analysis. Results showed that additional application of IPC to CDT could further improve lymphedema within 4 weeks after the treatment period [standard mean difference (SMD) =-0.2 mL, 95% confidence interval (CI): -0.33 to -0.07 mL]. However, this additional benefit was weakened within about 9.4±2.6 weeks' follow-up duration after ceasing physical therapy (SMD =-0.15 mL, 95% CI: -0.33 to 0.04 mL). Periodically continuous treatment should be suggested to maintain the effect of CDT + IPC to promote lymph drainage and lymphedema improvement. Nonetheless, the treatment involved in the studies ranged from 4 to 12 weeks, therefore potential bias might exist.

Effects of intermittent pneumatic compression on serum HMGB1 levels of deep venous thrombosis of lower extremity in severe traumatic brain injury patients

Objective: To investigate the efficacy of intermittent pneumatic compression (IPC) in prevention of deep venous thrombosis (DVT) in severe traumatic brain injury (TBI) patients and to observe the effects of IPC on hemorheological and coagulation indices, as well as high-mobility group box 1 (HMGB1) in severe TBI patients. Methods: The present prospective open randomized controlled research recruited 332 severe TBI cases seen during May 2017~November 2019. All patients were randomly divided into two groups, with 166 cases in the control group and 166 cases in the IPC group. The serum levels of HMGB1 were determined using an enzyme linked immunosorbent assay (ELISA). The flow velocity of common femoral vein was also evaluated using Doppler ultrasound before treatment, as well as at 1 d, 3 d, 7 d and 14 d after admission. Levels of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-Dimer (D-D) were also evaluated before treatment, as well as at 7 d and 14 d after admission. Results: DVT occurred in a total of 35 (10.54%) cases of all patients, with 6 (3.61%) cases in IPC group, which was significantly lower than 29 (17.47%) cases in the control group. Serum FIB levels were significantly lower in the IPC group at 7 d and 14 d after treatment compared with the control. At 3 d, 7 d and 14 d after treatment, the levels of flow velocity of common femoral vein were markedly higher in IPC group compared with the control and after 3 d treatment, the levels of HMGB1 at 1 d, 3 d, 7 d and 14 d were all markedly lower in IPC group than the control. After admission, the serum levels of HMGB1 were markedly higher in DVT patients compared with the non-DVT patients at 1 d, 3 d, 7 d and 14 d and were negatively correlated with the flow velocity of common femoral vein at 3 d, 7 d and 14 d. Conclusion: IPC treatment could prevent DVT in severe TBI patients, which was associated with increased velocity of common femoral vein and decreased FIB and HMGB1 levels. HMGB1 may be useful as a potential biomarker for DVT in severe TBI patients.

The efficacy of intermittent pneumatic compression and negative pressure therapy on muscle function, soreness and serum indices of muscle damage: a randomized controlled trial

BackgroundThe study aimed to assess whether intermittent pneumatic compression (IPC) and intermittent negative pressure (INP) would attenuate the muscle damaging effects of eccentric exercise.MethodsForty-five healthy males were recruited. Immediately post, 24 and 48 h post eccentric exercise consisting of 100 drop jumps, volunteers randomly received 30-min sessions of intermittent pneumatic compression (IPC, n = 15) or intermittent negative pressure (INP, n = 15), or sham microcurrent (PT, n = 15). Creatine kinase (CK), lactate dehydrogenase (LDH), isokinetic muscle strength, soreness and active flexion of the knee joint were measured after every therapy session.ResultsNo significant intergroup differences were observed in biochemical or functional measurements. However, there was an increase in muscle soreness (P < 0.05), CK and LDH activity (P < 0.05), and a reduction in muscle strength (P < 0.05) and range of active knee flexion (P < 0.05).ConclusionsThe prescription of IPC and INP did not attenuate the reduction of markers to muscle function or pain perception up to 48 h after muscle damaging exercise. Future research should focus on the potential impact of treatment frequency and duration on muscle recovery.Trial registration The study was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR); The trial registration number: ACTRN12621001294842; date of registration: 24/09/2021.

Influence of intermittent pneumatic compression on foot sensation and balance control in chemotherapy-induced peripheral neuropathy patients

BackgroundChemotherapy-induced peripheral neuropathy, a side effect of cancer treatment, presents several issues to patients, including reduced sensation and increased fall risk. Previously, massage therapy has been shown to improve chemotherapy-induced peripheral neuropathy symptoms, possibly through increased blood flow. A custom built intermittent pneumatic compression device, previously shown to increase lower leg blood flow, was tested as a plausible treatment modality. MethodsSeven cancer survivors suffering from chemotherapy-induced peripheral neuropathy were recruited. Foot sensation (Semmes-Weinstein test) as well as static (dual and tandem stance) and dynamic (timed-up-and-go) balance control tests were performed both pre and post a 5-min intermittent pneumatic compression intervention. Self-reported feedback was provided by participants following testing and 24-h later. FindingsFive participants reported positive changes in their feet immediately following intermittent pneumatic compression treatment while four of those participants reported positive changes up to 24 h after intervention. Foot sensation was unchanged regardless of location tested (P ≥ 0.23). Postural sway path length and sway area were unchanged following intervention during dual stance (P ≥ 0.14), but path length was significantly reduced (~19.9%) following intervention during tandem stance (P = 0.033). Timed-up-and-go duration was also significantly reduced (~7.0%, P = 0.012). InterpretationOverall, these findings demonstrate that intermittent pneumatic compression may be a plausible treatment modality for improving self-reported foot sensation as well as static and dynamic balance control. As a pilot study, this study provides sufficient context for further research exploring the efficacy of intermittent pneumatic compression as a treatment using a randomized control trial design.

The Effects of Body Mass Index on Efficacy of Intermittent Pneumatic Compression

The Effects of Body Mass Index on Efficacy of Intermittent Pneumatic Compression

Meta-Analysis of the Role of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Critically Ill Patients.

Critically ill patients (patients treated in a medical or surgical intensive care unit) are at high risk of venous thromboembolism (VTE) development (deep vein thrombosis [DVT] and/or pulmonary embolism). Multiple thromboprophylaxis strategies have been used for the prevention of VTE in this population with various outcomes. Therefore, we aimed to evaluate the efficacy of intermittent pneumatic compression (IPC) prophylaxis in the lower limb compared with no treatment, anticoagulant use, or their combinations in reducing risk. A comprehensive electronic database search was conducted for all randomized clinical trials (RCTs) comparing the clinical outcomes of IPC versus anticoagulants or no treatment or their combinations for the prevention of VTE for critically ill patients. The primary outcome was VTE. The secondary outcome was DVT. We performed a Bayesian network meta-analysis to calculate odds ratios (ORs) and 95% credible intervals (CrIs). We included 5 RCTs with 3133 total patients, represented by a mean age of 49.61 ± 18 years, while 60.28% were male. There was a significant reduction of the primary outcome (incidence of VTE events) when no treatment was compared with IPC (OR = 0.36; 95% CrI = 0.18-0.71), anticoagulation alone (OR = 0.30; 95% CrI = 0.12-0.68), or anticoagulation with IPC (OR = 0.34; 95% CrI = 0.13-0.81). In addition, there was a significant reduction in DVT when no treatment was compared with IPC (OR = 0.45; 95% CrI = 0.21-0.9), anticoagulation alone (OR = 0.16; 95% CrI = 0.03-0.66), or anticoagulation with IPC (OR = 0.18; 95% CrI = 0.03-0.84). However, there were no significant differences between other comparisons (IPC vs anticoagulation alone, anticoagulation alone vs anticoagulation with IPC, or anticoagulation with IPC vs IPC alone) regarding VTE or DVT incidence. Among critically ill patients, IPC alone, anticoagulation alone, and IPC with anticoagulation were associated with a significant reduction of VTE and DVT incidence compared with no treatment. However, there was no significant difference between these modalities when compared together. Therefore, further larger studies comparing those different thromboprophylaxis modalities and their combinations are needed to provide more robust results for future clinical recommendations.

THE EFFICACY OF INTERMITTENT PNEUMATIC COMPRESSION AS A SUBSTITUTE FOR MANUAL LYMPHATIC DRAINAGE IN COMPLETE DECONGESTIVE THERAPY IN THE TREATMENT OF BREAST CANCER RELATED LYMPHEDEMA

The aim of this study is to evaluate the efficacy of intermittent pneumatic compression (IPC) as a substitute for manual lymphatic drainage (MLD) in complete decongestive therapy (CDT) for treatment of advanced stages of breast cancer-related lymphedema. In this randomized, single-blind, controlled study, 46 patients with breast cancer-related lymphedema were divided into 2 groups. Both MLD with compression bandage (CB) group (n=24) and IPC with CB group (n=22) received treatment 3 days a week for 5 weeks. Home exercise program was also given to all patients. At the end of the 5th week, patients were treated with a daily 23-hour compression garment and home exercise routines. Assessments were taken at baseline, the fifth week, and the third month. Arm circumference was measured at 5 different areas, shoulder range of motion (ROM) was evaluated with a goniometer, pain, and tightness, and heaviness sensations were assessed with visual analog scale. Both groups had similar demographic and clinical characteristics (p<0.05). There were no significant differences between groups and both groups showed significant improvement (p<0.05) in the five measurement levels of the arm circumference at the fifth week and third month. Similarly, shoulder ROM, pain, tightness, and heaviness sensations improved in both groups (p<0.05). Both MLD and IPC as a component of CDT were found successful at 5 weeks and 3 months without superiority to each other.

Prevention of venous thrombosis of the lower extremities and pulmonary embolism in neurological patients in the intensive care unit using intermittent pneumatic compression

To assess the efficacy of intermittent pneumatic compression (IPC) in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurological patients. The study included 101 patients with acute disorders of cerebral circulation: 52 patients underwent IPC for prevention of DVT of the lower extremities, 49 patients received only basic treatment. Clinical examination, venous duplex scan of the lower extremities and telethermography were performed. IPC significantly reduces the risk of DVT of the lower extremities and PE mortality in the first 20 days in patients with stroke and motor deficit. Ultrasound and thermography can effectively assess the dynamics of treatment.

Efficacy of intermittent pneumatic compression for venous thromboembolism prophylaxis in patients undergoing gynecologic surgery: A systematic review and meta-analysis.

We sought to comprehensively assess the efficacy of Intermittent Pneumatic Compression (IPC) in patients undergoing gynecologic surgery. A computerized literature search was conducted in Pubmed, Embase and Cochrane Library databases. Seven randomized controlled trials involving 1001 participants were included. Compared with control, IPC significantly lowered the deep vein thrombosis (DVT) risk [risk ratio (RR) = 0.33, 95% confidence interval (CI): 0.16 – 0.66]. The incidence of DVT in IPC and drugs group was similar (4.5% versus. 3.99%, RR = 1.19, 95% CI: 0.42 – 3.44). With regards to pulmonary embolism risk, no significant difference was observed in IPC versus control or IPC versus drugs. IPC had a lower postoperative transfusion rate than heparin (RR = 0.53, 95% CI: 0.32 – 0.89), but had a similar transfusion rate in operating room to low molecular weight heparin (RR = 1.06, 95% CI: 0.69 – 1.63). Combined use of IPC and graduated compression stockings (GCS) had a marginally lower risk of DVT than GCS alone (RR = 0.38, 95% CI: 0.14 – 1.03). In summary, IPC is effective in reducing DVT complications in gynecologic surgery. IPC is neither superior nor inferior to pharmacological thromboprophylaxis. However, whether combination of IPC and chemoprophylaxis is more effective than IPC or chemoprophylaxis alone remains unknown in this patient population.

Intermittent pneumatic compression versus multilayer bandages for reducing post mastectomy lymphedema: A randomized controlled trial.

Background: Lymphoedema is a serious health, psychosocial and economic problem among patients treated for malignant tumors which requested specified physical therapy aiming to reverse further increase of limb size. Purpose: The aim of this study was to compare the efficacy of intermittent pneumatic-compression and multilayer bandages (Mobiderm bandage) in reduction of post mastectomy lymphedema. Methods: Thirty female patients with unilateral post mastectomy secondary lymphedema participated in this study. Patients were randomly assigned into two equal groups of 15, group (A) received intermittent pneumatic compression therapy for 20 min per day, daily for 3 weeks in addition to traditional medical treatment with manual lymphatic drainage and group (B) received multilayer bandages for 20 hours per day, daily for 3 weeks. Results: After one week of treatment (Post 1), between group statistical analysis showed significant increase (p< 0.05) in functional scale measures, slight improvements (p< 0.05) in goniometric measurement at several points despite no improvements (p≥ 0.05) in the other points. Nevertheless, the tape measurement showed no significant changes in most points (p≥ 0.05). This study showed a significant increase (p< 0.05) in goniometric measurement, tape measurement at most points of measures and functional scale measures in both groups after three weeks of treatment (Post 3) in comparing between pre and post 3 treatment within each group but with higher improvement in group B than group A. Conclusions: Mobiderm bandage produced objective improvement in lymphedema more than the usage of intermittent pneumatic compression, however both considered as a gold therapeutic tool in the management of lymphedema post mastectomy.

Comparison of efficacy of the intermittent pneumatic compression with a high- and low-pressure application in reducing the lower limbs phlebolymphedema.

IntroductionThe primary lymphedema and chronic venous insufficiency present an important medical problem, and effective physical therapeutic methods to treat this problem are still at the search phase. The aim of this study was to compare the efficacy of intermittent pneumatic compression (IPC) of a high- or low-pressure level in the treatment of primary phlebolymphedema of the lower limbs.MethodsThe study included 81 patients with chronic venous insufficiency and primary lymphedema of the lower limbs. Group A consisted of 28 patients who underwent a monthly antiedematous therapy including a manual lymphatic drainage, multilayer bandaging, and IPC with the output pressure of 120 mmHg. Group B consisted of 27 patients who underwent the same basic treatment as group A and IPC with the output pressure of 60 mmHg. Group C (control) consisted of 26 patients who underwent only a basic treatment – without IPC.ResultsAfter completion of the study, it was found that the greatest reduction of edema occurred in patients who underwent treatment with a pressure of 120 mmHg. The comparison of percentage reduction of edema showed a statistically significant advantage of the group A over groups B and C, both for the changes in the right (P=0.01) and the left limb (P=0.01). Results in patients undergoing intermittent compression of the lower pressure (60 mmHg) were similar to those obtained in the control group.ConclusionThe IPC with the pressure of 120 mmHg inside the chambers effectively helps to reduce a phlebolymphedema. Furthermore, it appears that the treatments with a pressure of 60 mmHg are ineffective and their application becomes useless only in the antiedematous therapy.

The efficacy of intermittent pneumatic compression in the prevention of lower extremity deep venous thrombosis.

Intermittent pneumatic compression (IPC) has been used to prevent lower extremity deep venous thrombosis for more than 30 years and is a popular choice for prophylaxis among both physicians and patients because of its efficacy and reduced risk of bleeding compared with pharmacologic prophylaxis. However, the efficacy of IPC may depend on the clinical situation as well as on several variables associated with the devices. To determine the efficacy of IPC, recent guidelines and literature were reviewed. IPC is efficacious as a sole prophylactic agent in low- or moderate-risk surgical patients and in patients with high risk of bleeding with pharmacologic prophylaxis. In high-risk surgical and medical patients, IPC is recommended as a synergistic tool in combination with pharmacologic agents, if pharmacologic agents are not contraindicated. No specific compression modality proved its superiority, although newer portable battery-powered devices seem to allow better patient compliance and satisfaction.

The Effects of Intermittent Pneumatic Compression during Cesarean Delivery on Fibrinolysis

Pregnancy is associated with increased risk for thromboembolic events. Intermittent pneumatic compression (IPC) devices are the method of thromboprophylaxis in a nonpregnant population. The aim of this study was to examine the effects of IPC on markers of fibrinolysis during cesarean delivery. We conducted a randomized controlled trial from April 2009 to March 2010 of women undergoing scheduled elective cesarean delivery. Forty-nine women were randomized to IPCs or usual care. All participants had three blood samples obtained: (1) baseline, (2) 1 hour after randomization, and (3) 30 minutes after cesarean delivery. Tissue-type plasminogen activator (tPA), urokinase-type plasminogen activator (uPA), thrombin-antithrombin complex (TAT), plasminogen activator inhibitor-1 (PAI-1), and plasminogen activator inhibitor-2 (PAI-2) levels were analyzed in each sample using an enzyme-linked immunosorbent assay. Statistical analysis was performed using repeated measures two-way analysis of variance with α = 0.05. There was a time-dependent change in tPA, uPA, and PAI-1 levels following delivery but no difference in TAT and PAI-2 levels with time. There were no differences between women randomized to IPCs or usual care. Markers of fibrinolysis were not significantly altered by IPCs in this study of low-risk pregnant women. Further research regarding the mechanism and efficacy of IPCs in pregnant women is warranted.

Effect of intermittent pneumatic compression on venous thrombosis prevention in elder patients with hip fracture deep after operation

Objective To evaluate the safety and efficacy of intermittent pneumatic compression (IPC) in prevention of deep venous thrombosis (DVT) after orthopedic operation of hip fracture in elder patients.Methods From Aug 2007 to Dec 2010,87 patients were assigned randomly into IPC group (n =44) and control group (n =43).Patients received regular DVT prevention in the control group.In the IPC group,IPC was added to the prevention strategy same to control group.The differences of lower limb circumferences and D -dimer in blood plasma of all the patients were tested in the 3th day,7th day and 14th day after surgery.The DVT rates of both groups were accessed by color Doppler ultrasound.Results No significant difference of lower limb circumferences was found between IPC group and control group in the 3th day after the operation (P ＞0.05).The circumference differences of lower limbs in IPC group were significantly smaller than the control group in 7th day and 14th day after the surgery [(2.8698 ±0.8887) vs (3.3558 ±0.9064) cm; t =-2.871,-2.702 ;P ＜0.01].The D-dimer of patients in IPC group was significantly lower than control group in 3th day [(0.6498 ±0.2175) vs (0.7541 ±0.2380) ng/L;t =-2.133,P ＜0.05].There were 20 patients developed DVT,with 14 cases in control group and 6 cases in IPC group.The DVT rate of IPC group was significantly lower than that of control group (13.95％ vs 31.82％;x2 =3.920,P＜0.05).Conclusions This study confirmed the efficacy and safety of the addition of IPC to regular prevention in DVT prophylaxis for elder patients after surgery of hip fracture. Key words: Elder; Hip fracture; Intermittent pneumatic compression; Deep venous thrombosis

The efficacy of intermittent pneumatic compression in the prevention of venous thromboembolism in medical critically ill patients

To evaluate the efficacy of intermittent pneumatic compression (IPC) in the prevention of venous thromboembolism (VTE) in medical critically ill patients. A prospective, randomized, controlled study was conducted. One hundred and sixty-two medical critically ill patients were randomly assigned to IPC group and control group by random number table after admitted to intensive care unit (ICU) from June 2008 to June 2010. Patients under anticoagulation medicine therapy were excluded. Patients in the IPC group were treated with IPC to prevent VTE after ICU admission. No measures were taken to prevent VTE in the control group. The rate of VTE [deep vein thrombosis (DVT) and pulmonary embolism (PE)], duration of mechanical ventilation(MV), the length of stay in ICU, rate of non-sudden cardiac death and ICU mortality rate and related side-effects of IPC were compared during the subsequent 28 days between two groups. Compared with control group, IPC group was shown to have a significantly lower rate of DVT [3.80%(3/79) vs. 19.28%(16/83), P<0.01], lower rate of PE [0 (0/79) vs. 9.64%(8/83), P<0.01] and lower rate of non-sudden cardiac death [1.26%(1/79) vs. 7.23%(6/83), P<0.01]. Compared with control group, duration of MV (days: 8±6 vs. 9±8) and length of stay in ICU (days: 9±7 vs. 10±7) were shorter, and the ICU mortality rate of 28 days (24.05% vs. 31.32%) was lower in the IPC group, but they were not statistically significant (all P>0.05). No related side-effects were found in the IPC group. IPC can prevent VTE, and lower the rate of non-sudden cardiac death, and it is safe in medical critically ill patients.

Intermittent Pneumatic Compression or Graduated Compression Stockings for Deep Vein Thrombosis Prophylaxis?

To review the relative efficacy of intermittent pneumatic compression (IPC) and graduated compression stockings (GCS) stated in direct clinical comparisons. Both IPC and GCS are recommended for deep vein thrombosis (DVT) prophylaxis in surgical patients. Although both are known to be effective, guidance is less clear on the clinical grounds for choosing between the 2 devices. Major medical databases were searched for trial reports published between January 1970 and August 2008. All trials comprising a direct clinical comparison between IPC and GCS were reviewed. Ten direct comparisons were found, 9 of which were with surgical patients. The difference in DVT outcome only reached statistic significance in 3, all of which showed IPC to have the lower DVT rate. Five of the trials that did not produce statistic significance included fewer than 40 patients in each study group. The crude cumulated DVT rate for all the trials was 5.9% for GCS and 2.8% for IPC. There is only weak evidence to show a difference in performance between the devices, however, given the many influential factors, caution should be taken in assuming equivalence.

On the mechanism of action of pneumatic compression devices: Combined magnetic resonance imaging and duplex ultrasound investigation

This study investigated the relationships between the interface pressure produced by intermittent pneumatic compression (IPC) devices, the deformation of extremity tissues produced by this pressure, and changes in venous blood flow associated with this deformation by use of magnetic resonance imaging (MRI) and duplex ultrasound (DUS) imaging in addition to the pressure measurement. The calf garments of two IPC devices (WizAir, Medical Compression Systems, Inc, Ltd, Or-Akiva, Israel; VenaFlow, AirCast Inc, Summit, NJ) were tested in five healthy volunteers. The interface pressure was measured with Tactilus Human Body Interface sensor system (Sensor Products Inc, Madison, NJ). Changes in tissue volumes were assessed with MRI. Velocity and flow changes in the great saphenous vein (GSV) and femoral veins (FV) were evaluated by DUS scans. The spatial distribution of interface pressure differed substantially between the two devices. These differences were in the location and percentage of calf surface area to which different pressure was applied. Both devices produced the tissue compression consistent with each device's unique pattern of the interface pressure distribution. Compression by the IPC devices was associated with a measurable decrease in the volume of subcutaneous tissue under the garment, the total volume of superficial veins, and the volume of the GSV. No measurable changes occurred in subfascial volume of the calf. Compression was associated with significant increase in flow velocities in the GSV and FV. The increase of volume flow was significant in FV, but not in GSV. Comparing hemodynamic data with MRI data showed that the flow velocity increase in FV and GSV caused by IPC highly correlated with decrease in volume of superficial veins and subcutaneous tissue measured by MRI, but not with changes in subfascial volume. A single strongest predictor of venous flow increase was the change in subcutaneous veins volume. This methodology provides means for the investigation of relationships between the pressure in the garment, interface pressure, tissue deformation, and hemodynamic respond to IPC. The clinical efficacy of IPC should not be explicitly attributed to the magnitude of the pressure in the garment. Similar hemodynamic responses to IPC can be produced by different spatial distributions of pressure resulting in different patterns of tissue compression. Further investigation of biomechanical mechanisms of IPC is needed to guide the development of better engineering solutions for mechanical devices aimed at prevention of venous thrombosis.

Improving limb salvage in critical ischemia with intermittent pneumatic compression: A controlled study with 18-month follow-up

Intermittent pneumatic compression (IPC) is an effective method of leg inflow enhancement and amelioration of claudication in patients with peripheral arterial disease. This study evaluated the clinical efficacy of IPC in patients with chronic critical limb ischemia, tissue loss, and nonhealing wounds of the foot after limited foot surgery (toe or transmetatarsal amputation) on whom additional arterial revascularization had been exhausted. Performed in a community and multidisciplinary health care clinic (1998 through 2004), this retrospective study comprises 2 groups. Group 1 (IPC group) consisted of 24 consecutive patients, median age 70 years (interquartile range [IQR], 68.7-71.3) years, who received IPC for tissue loss and nonhealing amputation wounds of the foot attributable to critical limb ischemia in addition to wound care. Group 2 (control group) consisted of 24 consecutive patients, median age 69 years (IQR, 65.7-70.3 years), who received wound care for tissue loss and nonhealing amputation wounds of the foot due to critical limb ischemia, without use of IPC. Stringent exclusion criteria applied. Group allocation of patients depended solely on their willingness to undergo IPC therapy. Vascular assessment included determination of the resting ankle-brachial pressure index, transcutaneous oximetry (TcPO(2)), duplex graft surveillance, and foot radiography. Outcome was considered favorable if complete healing and limb salvage occurred, and adverse if the patient had to undergo a below knee amputation subsequent to failure of wound healing. Follow-up was 18 months. Wound care consisted of weekly débridement and biologic dressings. IPC was delivered at an inflation pressure of 85 to 95 mm Hg, applied for 2 seconds with rapid rise (0.2 seconds), 3 cycles per minute; three 2-hourly sessions per day were requested. Compliance was closely monitored. Baseline differences in demography, cardiovascular risk factors (diabetes mellitus, smoking, hypertension, dyslipidemia, renal impairment), and severity of peripheral arterial disease (ankle-brachial indices, TcPO(2), prior arterial reconstruction) were not significant. The types of local foot amputation that occurred in the two groups were not significantly different. In the control group, foot wounds failed to heal in 20 patients (83%) and they underwent a below knee amputation; the remaining four (17%, 95% confidence interval [CI], 0.59%-32.7%) had complete healing and limb salvage. In the IPC group, 14 patients (58%, 95% CI, 37.1%-79.6%) had complete foot wound healing and limb salvage, and 10 (42%) underwent below knee amputation for nonhealing foot wounds. Wound healing and limb salvage were significantly better in the IPC group (P < .01, chi(2)). Compared with the IPC group, the odds ratio of limb loss in the control group was 7.0. On study completion, TcPO(2) on sitting was higher in the IPC group than in the control group (P = .0038). IPC used as an adjunct to wound care in patients with chronic critical limb ischemia and nonhealing amputation wounds/tissue loss improves the likelihood of wound healing and limb salvage when established treatment alternatives in current practice are lacking. This controlled study adds to the momentum of IPC clinical efficacy in critical limb ischemia set by previously published case series, compelling the pursuit of large scale multicentric level 1 studies to substantiate its actual clinical role, relative indications, and to enhance our insight into the pertinent physiologic mechanisms.

Antiplatelet drug use preceding the onset of intracerebral hemorrhage is associated with increased mortality

Recent studies highlight the contribution of antiplatelet therapy to clinical severity and increased mortality of intracerebral hemorrhage (ICH) but results are discrepant. The aim of this report was to evaluate the association between antiplatelet drug use preceding the onset of ICH and the mortality, assessed at regular intervals, among patients with acute ICH. We analyzed data from a randomized study which enrolled consecutive patients with a documented acute ICH to evaluate the efficacy of intermittent pneumatic compression of the legs in venous thrombosis prevention. Clinical characteristics and treatment used before the onset of ICH were checked at the time of inclusion. Mortality was assessed at regular intervals until 3 months after ICH diagnosis. Among 138 patients included in this report, 30 were current users of antiplatelet therapy at the time of ICH; they were significantly older and less frequently heavy drinkers than non-users of antiplatelet drugs. Mortality rates were 20% at 8 days, 40% at 1 month, and 47% at 3 months among antiplatelet drug users compared with 6.5%, 13% and 19% among non-users. The corresponding estimated risks for mortality related to antiplatelet drug use were 3.6 (95% CI 1.1-12), 4.5 (95% CI 1.8-11), and 3.6 (95% CI 1.5-8.6). Adjusted for age, hypertension and alcohol over use, antiplatelet therapy remained significantly associated with an increased mortality rate of acute ICH. Current antiplatelet drug use preceding the onset of ICH is associated with increased short-term ICH mortality, independently of age.

Intermittent pneumatic compression for prevention of pulmonary thromboembolism after gynecologic surgery

BackgroundTo investigate the incidence of pulmonary embolism and risk factors for this condition after obstetric and gynecologic surgery, as well as the efficacy of intermittent pneumatic compression.MethodsA total of 6,218 patients operated at Keio University Hospital excluding obstetric or infertility-related surgery and uterine cervical conization were evaluated retrospectively to determine the preventive effect of intermittent pneumatic compression on postoperative pulmonary embolism.ResultsPulmonary embolism occurred in 42 patients (0.68%). Multivariate analysis showed that malignancy, blood transfusion, and a body mass index ≥25 kg/m2 or ≥28 kg/m2 were independent risk factors for postoperative pulmonary embolism. A significantly lower incidence of pulmonary embolism occurred in patients receiving pneumatic compression postoperatively versus those without it. Among gynecologic malignancies, endometrial cancer was a significant risk factor for pulmonary embolism.ConclusionPreventive measures, including intermittent pneumatic compression, should be taken to avoid postoperative pulmonary thromboembolism in the gynecology field.