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Intermittent compression devices as antithrombotic strategy in neurosurgical interventions: a prospective randomized
Zhaoyuan Zhang1, Asdrubal Marcano1, Menno V Huisman2
1Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands.
Background:
Postoperative venous thrombosis is linked to high morbidity and mortality and the risk is heightened in neurosurgical patients due to prolonged immobilization, hypercoagulability, and long surgeries. Optimal prophylaxis under debate and variations in practices are prevalent.
Objective:
To assess the effectiveness of limb intermittent compression devices (ICD) combined with subcutaneous low-molecular-weight heparin (LMWH) compared with LMWH alone as a prophylactic strategy for venous thromboembolism (VTE).
Methods:
Patients undergoing elective lengthy neurosurgical procedures were randomized to perioperative 48-hour ICD + LMWH or to LMWH alone. Duplex ultrasonography was performed postoperatively to evaluate the presence of VTE (VTE systematic screening). Two months after surgery, clinical signs of VTE during the postoperative period were appraised (VTE clinical symptoms), and quality of life was evaluated. Possible risk factors for VTE were evaluated.
Results:
A total of 283 patients were included in the study. The VTE incidence in the treatment arm ICD + LMWH was 2.5% based on clinical symptoms and 0% based on systematic screening, while the VTE incidence in the control arm LMWH was 3.1% (risk difference: -0.6% [95% CI, -4.5 to 3.4]) based on clinical symptoms, and 1.0% (risk difference: -1.0% [95% CI, -3.0 to 1.0]) based on systematic screening. In total, the relative risk for VTE in the ICD + LMWH treatment versus LMWH was 0.7 (95% CI, 0.2-3.3), corrected for age and sex.
Conclusion:
Limb intermittent compression therapy in addition to LMWH as antithrombotic therapy in the perioperative setting is not likely to lead to less venous thromboembolic events in lengthy neurosurgical interventions. The start of administration of LMWH preoperatively rather than postoperatively seems beneficial.
Trial Registration:
Clinical trials.gov registration number NL56552.058.16.
