Winemiller et al. (1999) examined the medical charts of 285 individuals with SCI and found that sequential pneumatic compression devices (SCD) or gradient elastic stockings were associated with a reduced risk of VTE. Multivariate analysis also suggested a decreased risk of VTE in individuals with SCI treated with heparin in the first 14 days or anytime within 42 days. Although this risk reduction was approximately twice that of SCD/gradient elastic stockings it was not statistically significant. A pre-post study by Chung et al. (2011) also examined the use of gradient elastic stockings, 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.
Maxwell et al. (2002) retrospectively reviewed individuals with acute SCI for an average of 23 days following injury, who used SCD as thromboprophylaxis. The authors found the incidence of DVT and PE to be 7.1% and 2.4%, respectively.
In a small randomized controlled trial, Nash et al. (2000) compared the effects of slow SCD and rapid intermittent pulsatile pneumatic compression devices (IPC) on venous hemodynamics in subjects with complete tetraplegia. Doppler examination of the popliteal and femoral veins in each compression condition revealed significant improvements in hemodynamic parameters in both treatment groups from rest. However, resting volume flow per minute and maximal venous velocity was significantly enhanced in the IPC group. As maximal venous velocity is considered a key measure to evaluate the effectiveness of compression devices used for DVT prevention, the authors suggest that IPC is more effective than SCD. It is important to note that incidence of DVT was not recorded in this study. Therefore, further research regarding the incidence of DVT is necessary to truly determine the superiority of one method over the other.
There is level 1b evidence (from one RCT: Becker et al. 1987) that rotating treatment tables reduce the incidence of venous thromboembolism in individuals with acute SCI.
There is level 4 evidence (from one pre-post and two case series: Chung et al. 2011; Maxwell et al. 2002; Winemiller et al. 1999) that sequential compression or gradient elastic stockings are associated with a reduced the risk of venous thromboembolism in acute SCI individuals.
There is level 1b evidence (from one RCT: Nash et al. 2000) that rapid intermittent pulsatile compression devices are more effective than slow sequential compression devices for stimulating venous blood flow in chronic SCI individuals.