Deep vein thrombosis prophylaxis and hip replacement: pneumatic compression prevented DVT and PE.

Clinical bottom line (level 1b)

  1. Patients who underwent elective total hip replacement and were given pneumatic compression stockings for 14 days or until discharge, were less likely to have a venous thromboembolism than those not given any prophylaxis (NNT = 4 at 3 months) .
Hull et al: Journal of the American Medical Association 1990; 263 (17): 2313-2317
Expires May 2003

The study

Unblinded concealed randomised trial without intention-to-treat
Setting: university hospital, Canada

310 patients (aged range 22 to 88 years; mean 65, 60% female) having elective total hip replacement

Excluded if
  • allergic to contrast media
  • unable to wear compression stockings
  • on aspirin therapy
  • history of venous thromboembolism


    • Control Group: (n = 158, 158 analysed): no prophylaxis
    Experimental Group: (n = 152, 152 analysed): sequential calf and thigh intermittent compression until discharge or 14 days. Stockings removed when patients were walking about.
    All patients had bilateral venous thromboembolism. If pulmonary embolism was suspected, a v/q scan was performed- positive if high probability. Patients had a pulmonary angiogram if scan was indeterminate.
    100% followed for 3 months

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    deep venous thrombosis or pulmonary embolism 3 months 77
    (48.7%)    		 36
    (23.7%)    		 51%
    (33% to 65%)    		 25.1%
    (14.7% to 35.4%)    		 4
    (3 to 7)

  • Only one pulmonary embolism occurred.

    • Comments

    1. Stockings were worn for a long time- some centres only use compression during operation. How does this compare?
    2. There are some small head to head comparisons of IPC and antithrombotic therapy that suggest that IPC may be less effective, particularly at preventing asymptomatic venographic proximal deep vein thrombosis.

    Citation

    1. Hull RD, Raskob GE, Gent M, et al: Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement. Journal of the American Medical Association 1990; 263 (17): 2313-2317
    Contributor: Chris Ball and Clare Wotton, May 2000
    Reviewer: Edward Etchells

    Clinical Question.
    Patient elective hip replacement
    Intervention or Exposure pneumatic compression
    Comparison no prophylaxis
    Outcome veinous thromboembolism