Venous Thromboembolism Table 11 Evaluating Physical Methods for the Prevention of DVT

Author Year
Country
PEDro Score
Research Design
Sample Size

 

Methods

 

Outcomes

Nash et al. 2000
USA
PEDro=8
RCT
N=20

Population: Mean age=27.9yr; Gender: males=20; Level of injury: tetraplegic=20; Time since injury=2mo-17yr.
Intervention: Patients were randomized into one of two groups: 1) Slow sequential pneumatic compression devices (SCD)-15sec compression, 45sec relaxation at 35 mmHg (ankle), 30 mmHg (calf) or 20 mmHh (thigh); or 2) intermittent pulsatile compression (IPC-2sec compression, 18sec relaxation at 160mmHg.
Outcome Measures: Venous flow/min (VFM); average venous velocity (AVV); maximum venous velocity (MVV); for bilateral popliteal and femoral veins at rest (baseline) and during compression.
  1. Popliteal vein: no differences between devices.
  2. Femoral vein: increase in VFM and MVV during IPC versus SCD (p<0.05).
  3. Rest versus compression: VFM, AVV and MVV, all increased during compression (p<0.001).
Becker et al. 1987
USA
PEDro=6
RCT
N=15
Population: Age range=17-75yr; Gender: males=11, females=3; Severity of injury: complete/incomplete; Chronicity=acute.
Intervention: Rotating treatment tables.
Outcome Measures: Impedance blood plethysmography.
  1. 4/5 control patients and only 1/10 treated patients developed positive fibrinogen leg scans.
 

 

 

 

 

 

Matsumoto et al. 2015
Japan
Observational
N=29

Population: Mean Age: 63.2yr; Gender: males=25, females=4; Injury etiology: High fall (n=11, 38%), Fall at ground level (n=8, 28%), Motor Vehicle Accident (n=4, 14%), Sports (n=3, 10%), Low fall (n=2, 7%), Stairs (n=1, 3%); Severity of Injury: AIS A=9, AIS B=2, AIS C=8, AIS D=10; Level of Injury: C3-4=11, C5-8=8, T1-12=6, L1-4=4.
Intervention: All patients were monitored for the development of deep venous thrombosis (DVT) after surgery and after they had received Intermittent pneumatic compression (IPC) with a calf pump and elastic stockings. The pump was attached throughout the day for at least 2wk after surgery and the elastic stockings were utilised after a median of 3 days post-surgery. Assessments were conducted 1, 3, 7, 14, and 28 days post-surgery.
Outcome Measures: Development of deep venous thrombosis (DVT), D-Dimer levels.
  1. DVT developed in 12 patients (41.4%), all of which were located distal to the popliteal vein.
  2. The median length of time from surgery to detection of DVT was 7.5 days.
  3. Seven of the 12 patients (58.3%) with DVT were classified as AIS A, one classified as AIS B (8.3%), three classified as AIS C (25.0%), and one classified as AIS D (8.3%).
  4. Mean D-Dimer level in patients who developed DVT was 14.6+13.5ug-ml but this was not significantly different compared to patients who did not developed DVT (p>0.05) at all assessment time-points except for 7 days after surgery (p=0.028).
  5. Cutoff D-Dimer levels according to the receiver operator characteristic curve did not differ significantly between patients who developed DVT and those who did not except for 3 days after surgery (p=0.0287).
 

 

Do et al. 2013
Korea
Observational
N=185

Population: Mean age: 49.1yr; Gender: male=133, female=52; Injury etiology: traumatic=80, non-traumatic=105; Injury severity: AIS A=48, B=32, C=69, D=36; Level of Injury: cervical=86, thoracic=84, lumbar=15.
Intervention: No intervention. Evaluated the incidence of DVT for patients without pharmacologic thromboprophy­laxis after SCI in the acute rehabilitation setting and to deter­mine the risk factors for DVT. Outcome Measures: Color Doppler ultrasonography to determine incidence of deep venous thrombosis (DVT).
  1. The incidence of DVT after SCI was 27.6% (n=51) (CI: 21.1-34.0) at the time of initial presentation to the acute re­habilitation unit.
  2. Age, sex, completeness of motor paralysis, AIS, level of injury, cause of injury, surgery, and active cancer were not significantly associated with occurrence of DVT (p>0.05 for all).
  3. Ab­sence of surgery (p=0.025) and absence of spasticity (p=0.049) were significantly as­sociated with occurrence of DVT.
  4. Absence of spasticity was a signifi­cant independent risk factor (p=0.027) for occurrence of DVT (OR: 3.28; 95% CI 1.15-9.37).
 

Chung et al.
2011
Korea
Pre-Post
N= 37

Population: Mean age: 53yr; AIS: A=10, B=7, C=12, D=8. Cause: traumatic (n=19), non-traumatic injury (n=18).
Intervention: Mechanical prophylaxis was provided to individuals admitted to SCI rehabilitation.
Outcome Measures: Incidence of deep venous thrombosis (DVT).
  1.  43% developed a DVT (mean=17.2 days post SCI).
  2. 81.2% of DVTs occurred in the distal leg vein.
  3. Age, sex, type of impairment and cause of SCI were not found to be a factor in relation to incidence of DVT.

Winemiller et al. 1999
USA
Case Series
N=285

Population: Mean age=25yr; Severity of injury: Frankel scores: A-B; Chronicity=acute.
Intervention: Chart review of patients who presented with DVT or PE and were subsequently administered sequential pneumatic compression devices (SCD) or gradient elastic stockings (GES).
Outcome Measures: Risk of further deep venous thrombosis (DVT).
  1. Multivariate analysis showed that SCD and GES were associated with a reduced risk of venous thromboembolism.
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