Although pharmacological measures have been generally the preferred treatment for venous thromboembolism prophylaxis post SCI, mechanical means of limiting venous stasis can also serve to reduce the incidence of DVT post SCI. Mechanical treatments are designed to limit stasis and increase fibrinolytic activity in the paralyzed lower extremities. However, it should be noted that use of these devices should be accompanied by twice daily inspection for skin discolouration or breakdown, and broken blood vessels. Pneumatic compression devices are not suitable for patients with severe arterial insufficiency.
A variety of mechanical measures to reduce the incidence of DVT post SCI have been studied. Becker et al. (1987) studied whether rotating treatment tables would prevent the development and progression of DVT in acute SCI patients. The authors noted that rotating treatment tables had been used up to that time in acute SCI patients to maintain spinal cord alignment while facilitating nursing care, allowing even distribution of ventilation and preventing pressure sores. It was hypothesized that because these appliances rotated continuously, they might serve to inhibit thrombosis formation by reducing venous stasis. This randomized trial involved 15 patients with acute SCIs. Four of the five control (nonrotated) patients developed distal and proximal thrombi, assessed by I125 fibrinogen scanning and impedance plethysmography while only one of the ten treated (rotated) SCI patients developed both distal and proximal venous thrombi (p=0.007).
Winemiller et al. (1999) examined the medical charts of 285 SCI patients and found that sequential pneumatic compression devices (SCD) or gradient elastic stockings (GES) were associated with a reduced risk of venous thromboembolism. Multivariate analysis also suggested a decreased risk of venous thromboembolism in SCI patients treated with heparin in the first 14 days or anytime within 42 days. Although this risk reduction was approximately twice that of SCD/GES it was not statistically significant. A pre-post study by Chung et al. (2011) also examined the use of GES, external SCD and early ambulation. To better examine the effectiveness of mechanical compression, individuals were not offered pharmacological prophylaxis which may have contributed to the high DVT incidence (43%) across the study.
More recent studies studying the prophylaxis using isolated compression devices is a study by (Do et al. 2013). The authors used only compression for VTE prophylaxis on 185 SCI patients. DVT was detected in 51 of the 185 patients and non-fatal PE was conformed in 13 patients in the first three months. No patients displayed thrombosis more than three months after SCI. Another similar study utilized only pneumatic compression and elastic stockings, but no anticoagulation. Patients were on compression devices all day except when they were out of bed. Elastic stockings were on most of the time except when bathing. DVT was diagnosed in 12 patients out of the 29 enrolled (Matsumoto et al. 2015). The Consortium for Spinal Cord Injury (2008) clinical practise guidelines, supports the application of mechanical compression devices early after injury since it is the period of highest VTE incidence (p. 38).
There is level 4 evidence (from one pre-post study and one case series; Chung et al. 2011; Winemiller et al. 1999) that sequential pneumatic compression devices or gradient elastic stockings were associated with a reduced risk of venous thromboembolism post SCI.
There is level 1b evidence (from one RCT; Becker et al. 1987) that rotating treatment tables reduce the incidence of venous thrombi in acute SCI patients.
- Sequential pneumatic compression devices and gradient elastic stockings may reduce the incidence of venous thromboembolism post SCI.
- Rotating treatment tables may reduce the incidence of venous thromboembolism post SCI.