Effects of intermittent pneumatic compression on venous haemodynamics and fibrinolytic activity

Pneumatic intermittent compression is an effective method to prevent postoperative venous thromboembolism. Its efficacy has been ascribed to both a haemodynamic action (increase of blood flow velocity) and a stimulation of endogenous fibrinolytic activity [via the production of tissue-type plasminogen activator (t-PA) by the vascular endothelium]. The relative contribution of these two effects is still debated. In a randomized, cross-over study in ten healthy volunteers, we compared the haemodynamic and fibrinolytic effects of two different pneumatic intermittent compression devices: a classical, low-pressure, whole-leg boots system, and a novel, high-pressure, plantar compression system. The study was performed at rest, to compare haemodynamics and fibrinolytic activity modifications, and under induced venous leg stasis, in order to compare the two compression systems in experimental conditions mimicking laparoscopic surgery. Our data show that (1) a pneumatic compression device that exerts its compression on the plantar venous plexus only induced an increase of venous blood peak velocity and flow in the common femoral vein that is very similar to that induced by the classical whole-leg boots compression system; (2) the venous stasis induced by an external pressure mimicking the conditions of laparoscopic surgery further increased the absolute velocity and flow increase, with the two intermittent compression systems tested; (3) no changes of t-PA or plasminogen activator-inhibitor 1 antigens were observed with either pneumatic compression device. In conclusion, the present study indicates that the antithrombotic effect of mechanical prophylaxis is probably mainly due to its ability to increase venous peak velocity and flow, especially under venous stasis conditions.