Deep vein thrombosis:prophylaxis: calf pneumatic compression was not clearly better than thigh.

Clinical bottom line (level 1b-)

In patients having major urological surgery, calf pneumatic compression was not clearly as effective as thigh pneumatic compression.

Soderdahl et al: Journal of Urology 1997; 157: 1774-1776

Expires April 2003

The study

Unblinded concealed randomised trial without intention-to-treat
Setting: military medical centre, USA

90 patients (aged range 24 to 80 years;mean 65, ?% male) having major urological surgery (prostatectomy, renal surgery, lymph node dissection)

Excluded if

incomplete data

Control Group: (n = 47, 47 analysed): thigh-length sequential pneumatic compression during surgery
Experimental Group: (n = 43, 43 analysed): calf-length uniform pneumatic compression during surgery
All patients had blinded bilateral lower extremity ultrasound on days 3 or 4 and 6 or 7.
100% followed for 10 months
Outcome notes:

venous thromboembolism : DVT diagnosed by ultrasound; PE diagnosed by v/q scan or pulmonary angiography.

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNH (95% CI)
venous thromboembolism	10 months	1 (2.13%)	2 (4.65%)	-119% (-2200% to 79%)	-2.52% (-10.1% to 5.00%)	40 (NNT = 20 to infinity; NNH = 10 to infinity)

Events were one asymptomatic DVT and two PE (one 17 months later in a patient with metastatic cancer).

Comments

Ultrasound scan is not a sensitive method of excluding DVT in post-op patients (Wells et al).
The study is too small to detect any differences.

Citation

Soderdahl DW, Henderson SR, Hansberry KL: A comparison of intermittent pneumatic compression of the calf and whole leg in preventing deep venous thrombosis in urological surgery. Journal of Urology 1997; 157: 1774-1776

Contributor: Chris Ball and Clare Wotton, May 2000
Reviewer:

_{Clinical Question.}

_Patient	_{major urological surgery}
_{Intervention or Exposure}	_{thigh length compression}
_Comparison	_{calf-length compression}
_Outcome	_VTE