Related Experiment Video
Updated: Apr 5, 2026
Vascular Occlusion Training for Inclusion Body Myositis: A Novel Therapeutic Approach
Published on: June 5, 2010
Which stroke patients gain most from intermittent pneumatic compression: further analyses of the CLOTS 3 trial
Martin Dennis1, Catriona Graham2, Joel Smith3
1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Insights
Intermittent pneumatic compression (IPC) benefits immobile stroke patients by reducing deep vein thrombosis (DVT) and improving survival, particularly for those with poorer prognoses. Clinicians should consider individual patient outlook when deciding on IPC use.
Area of Science:
- Medical Research
- Clinical Trials
- Vascular Medicine
Background:
- The CLOTS 3 trial previously demonstrated that intermittent pneumatic compression (IPC) reduces deep vein thrombosis (DVT) and enhances survival in stroke patients.
- Subsequent research aimed to refine IPC application by analyzing its efficacy across patient subgroups with varying prognoses.
Purpose of the Study:
- To investigate the differential effects of IPC on immobile acute stroke patients based on their predicted prognosis.
- To provide data that aids clinicians in personalizing IPC treatment decisions.
Main Methods:
- A multicenter, randomized controlled trial involving 2876 immobile acute stroke patients.
- Patients were assigned to either IPC or no IPC and stratified into quintiles based on predicted prognosis using the Six Simple Variable model.
- Primary outcome was proximal DVT at 30 days; secondary outcomes included survival, disability, quality of life, and costs at six months.
Main Results:
- IPC showed minimal impact on DVT and survival in patients with the best prognosis (lowest DVT risk: 6.7%, lowest 6-month mortality: 9.3%).
- In patients with the worst prognosis, IPC significantly reduced DVT risk by 34% and improved survival by 17%, despite increasing length of stay and costs.
- IPC demonstrated consistent benefits in reducing DVT (35-43% odds reduction) and improving survival (11-13%) across intermediate prognosis groups.
Conclusions:
- Intermittent pneumatic compression (IPC) is likely beneficial for reducing DVT and improving survival in most immobile stroke patients, excluding those with the very best prognosis.
- The decision to use IPC should be individualized, weighing potential benefits against the prognosis and considering the futility in patients with extremely poor survival outlook.
- While IPC offers modest benefits for low-risk patients, the cost and inconvenience may outweigh the advantages, suggesting a tailored approach is warranted.
Background:
The CLOTS 3 trial showed that intermittent pneumatic compression (IPC) reduced the risk of DVT and improved survival after stroke.
Aims:
To provide additional information which may help clinicians target IPC on the most appropriate patients by exploring the variation in its effects on subgroups defined by predicted prognosis.
Methods:
A multicentre, parallel group, randomized trial enrolled immobile acute stroke patients and allocated them to IPC or no IPC. The primary outcome was proximal DVT at 30 days. Secondary outcomes at six-months included survival, disability, quality of life, and hospital costs. We stratified patients into quintiles according to their predicted prognosis at randomization, based on the Six Simple Variable model.
Results:
Between December 2008 and September 2012, we enrolled 2876 patients in 94 UK hospitals. Patients with the best predicted outcome had the lowest absolute risk of proximal DVT (6·7%) and death by six-months (9·3%). Allocation to IPC had little effect on DVT, survival, disability, quality of life, hospital length of stay, or costs. In patients with the worst predicted outcomes, the overall risk of DVT and death was 16·0% and 51·3%, respectively. IPC reduced DVT (odds reduction 34%) and improved survival 17% and significantly increased length of stay and hospital costs. In the three intermediate quintiles, IPC reduced the odds of DVT (35-43%) and improved survival (11-13%). Disability and quality of life at six-months depended on baseline severity but was not influenced significantly by IPC.
Conclusions:
IPC appears to reduce the risk of DVT and probably improves survival in all immobile stroke patients, other than the fifth with the best prognosis. It therefore seems reasonable to recommend that IPC should be considered in all immobile stroke patients, but that the final decision should be based on a judgment about the individual's prognosis. In some, their prognosis for survival with an acceptable quality of life will be so poor that use of IPC might be considered futile, while at the other end of the spectrum, patients' risk of DVT, and of dying from VTE, may not be high enough to justify the modest cost and inconvenience of IPC use.
More Related Videos
08:05Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:27Pulmonary Embolism III: Nursing Management
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
01:29Pulmonary Embolism I: Introduction