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Intermittent pneumatic compression thromboprophylaxis among critically ill children: a single-center retrospective

Nikhil Vallabhaneni1, Marisol Betensky2,3, A J Caberto4

  • 1Department of Pediatrics, Division of Pediatric Critical Care Medicine, Medical College of Georgia, Augusta, GA, USA.

Research and Practice in Thrombosis and Haemostasis
|November 24, 2025
PubMed

Insights

Intermittent pneumatic compression (IPC) is widely used for preventing hospital-acquired venous thromboembolism (HAVTE) in critically ill children. However, this study found IPC did not reduce HAVTE risk in high or moderate-risk patients, suggesting a need for risk-stratified trials.

Area of Science:

  • Pediatric Critical Care Medicine
  • Vascular Medicine
  • Thrombosis Research

Background:

  • Mechanical thromboprophylaxis, including intermittent pneumatic compression (IPC), is a common strategy for preventing hospital-acquired venous thromboembolism (HAVTE) in critically ill children.
  • The efficacy of IPC in reducing VTE risk in this pediatric population lacks robust supportive evidence.

Purpose of the Study:

  • To evaluate the association between IPC thromboprophylaxis and the incidence of HAVTE in critically ill children.
  • To determine if IPC effectiveness varies across different risk stratification tiers for HAVTE.

Main Methods:

  • A single-center, retrospective cohort study included children under 18 hospitalized in a pediatric intensive care unit (2020-2023).
  • Patients with pre-existing VTE or on therapeutic anticoagulation were excluded. HAVTE risk was stratified into low, moderate, and high tiers.
  • Logistic regression analyzed the association between IPC and radiographically confirmed HAVTE within each risk tier.

Main Results:

  • Of 4440 children, 30 (0.7%) developed HAVTE. IPC was used in 18.7% of patients.
  • No significant association between IPC and reduced HAVTE risk was found in high-risk (OR: 0.27) or moderate-risk (OR: 0.81) patients.
  • Conversely, IPC was associated with an increased risk of HAVTE in low-risk patients (OR: 6.3).

Conclusions:

  • IPC thromboprophylaxis is frequently prescribed for critically ill children but does not appear to reduce HAVTE risk in moderate to high-risk individuals.
  • Findings align with recent administrative data and highlight the necessity for risk-stratified clinical trials to ascertain IPC's true efficacy.
  • Current practices may warrant re-evaluation, particularly in lower-risk pediatric populations.
Abstract

Keywords:
hospital-acquired venous thromboembolismmechanical thromboprophylaxispediatrics

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