Mechanical Compression Versus Subcutaneous Heparin Therapy in Postoperative and Posttrauma Patients: A Systematic Review and Meta-Analysis

World Journal of Surgery - Tập 34 - Trang 10-19 - 2009
Robert W. Eppsteiner1, Jennifer J. Shin2, Jonas Johnson3, Rob M. van Dam4
1Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa, USA
2Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, USA
3Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA
4Harvard School of Public Health, Boston, USA

Tóm tắt

The risk of postoperative venous thromboembolic disease is as high as 30%, with an associated fatality risk of 1%. Therefore, prophylaxis is essential, but the optimal regimen remains controversial. This study was designed to systematically review and quantitatively summarize the impact of mechanical compression versus subcutaneous heparin on venous thromboembolic disease and posttreatment bleeding in postsurgical and posttrauma patients. Computerized searches of the MEDLINE and EMBASE databases through November 2008 were performed and supplemented with manual searches. We included studies that had: (1) a patient population undergoing surgery or admitted immediately posttrauma, (2) a randomized comparison of prophylaxis with mechanical compression versus subcutaneous heparin, (3) outcome measured in terms of deep vein thrombosis (DVT), pulmonary embolism (PE), or bleeding. Two reviewers independently extracted data from the original articles, which represented 16 studies, including a total of 3,887 subjects. Meta-analysis was performed using a random effects model. The pooled relative risk for mechanical compression compared with subcutaneous heparin was 1.07 (95% confidence interval [CI] 0.72, 1.61) for DVT and 1.03 (95% CI 0.48, 2.22) for PE. Mechanical compression was associated with a significantly reduced risk of postoperative bleeding compared with subcutaneous heparin (risk ratio 0.47; 95% CI 0.31, 0.70). Subgroup analyses by heparin type suggested that low molecular weight heparin may reduce risk of DVT compared with compression (relative risk 1.80; 95% CI 1.16, 2.79) but remains similarly associated with an increased risk of bleeding. These results suggest that the overall bleeding risk profile favors the use of compression over heparin, with the benefits in term of venous thromboembolic disease prophylaxis being similar between groups. Subgroup analyses suggest that low molecular weight heparin may have a differential effect; this observation should be further evaluated in future studies.

Tài liệu tham khảo

Qadan M, Tyson M, McCafferty MH, Hohmann SF, Polk HC Jr (2008) Venous thromboembolism in elective operations: balancing the choices. Surgery 144:654–661

Hitos K, Cannon M, Cannon S, Garth S, Fletcher JP (2007) Effect of leg exercises on popliteal venous blood flow during prolonged immobility of seated subjects: implications for prevention of travel-related deep vein thrombosis. J Thromb Haemost 5:1890–1895

Bajzar L, Chan AK, Massicotte MP, Mitchell LG (2006) Thrombosis in children with malignancy. Curr Opin Pediatr 18:1–9

Barrett J, Hamilton W (2006) Malignancy and deep vein thrombosis. Br J Gen Pract 56:886

Spain DA, Bergamini TM, Hoffmann JF, Carrillo EH, Richardson JD (1998) Comparison of sequential compression devices and foot pumps for prophylaxis of deep venous thrombosis in high-risk trauma patients. Am Surg 64:522–526

Freedman KB, Brookenthal KR, Fitzgerald RH Jr, Williams S, Lonner JH (2000) A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg Am 82-A:929–938

Cook D, McMullin J, Hodder R, Heule M, Pinilla J, Dodek P, Stewart T (2001) Prevention and diagnosis of venous thromboembolism in critically ill patients: a Canadian survey. Crit Care 5:336–342

Wu EC, Barba CA (2000) Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg 10:7–14

Kurtoglu M, Yanar H, Bilsel Y, Guloglu R, Kizilirmak S, Buyukkurt D, Granit V (2004) Venous thromboembolism prophylaxis after head and spinal trauma: intermittent pneumatic compression devices versus low molecular weight heparin. World J Surg 28:807–811

Ginzburg E, Cohn SM, Lopez J, Jackowski J, Brown M, Hameed SM (2003) Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma. Br J Surg 90:1338–1344

Warwick D, Harrison J, Glew D, Mitchelmore A, Peters TJ, Donovan J (1998) Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement. A prospective, randomized trial. J Bone Joint Surg Am 80:1158–1166

Nicolaides AN, Fernandes e Fernandes J, Pollock AV (1980) Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis. Surgery 87:69–76

Nicolaides AN, Miles C, Hoare M, Jury P, Helmis E, Venniker R (1983) Intermittent sequential pneumatic compression of the legs and thromboembolism-deterrent stockings in the prevention of postoperative deep venous thrombosis. Surgery 94:21–25

Maxwell GL, Synan I, Dodge R, Carroll B, Clarke-Pearson DL (2001) Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial. Obstet Gynecol 98:989–995

Clarke-Pearson DL, Synan IS, Dodge R, Soper JT, Berchuck A, Coleman RE (1993) A randomized trial of low-dose heparin and intermittent pneumatic calf compression for the prevention of deep venous thrombosis after gynecologic oncology surgery. Am J Obstet Gynecol 168:1146–1154

Pitto RP, Hamer H, Heiss-Dunlop W, Kuehle J (2004) Mechanical prophylaxis of deep-vein thrombosis after total hip replacement a randomised clinical trial. J Bone Joint Surg Br 86:639–642

Kosir MA, Schmittinger L, Barno-Winarski L, Duddella P, Pone M, Perales A, Lange P, Brish LK, McGee K, Beleski K, Pawlak J, Mammen E, Sajahan NP, Kozol RA (1998) Prospective double-arm study of fibrinolysis in surgical patients. J Surg Res 74:96–101

Rasmussen A, Hansen PT, Lindholt J, Poulsen TD, Toftdahl DB, Gram J, Toftgaard C, Jespersen J (1988) Venous thrombosis after abdominal surgery A comparison between subcutaneous heparin and antithrombotic stockings, or both. J Med 19(3–4):193–201

Blanchard J, Meuwly JY, Leyvraz PF, Miron MJ, Bounameaux H, Hoffmeyer P, Didier D, Schneider PA (1999) Prevention of deep-vein thrombosis after total knee replacement. Randomised comparison between a low-molecular-weight heparin (nadroparin) and mechanical prophylaxis with a foot-pump system. J Bone Joint Surg Br 81:654–659

Coe NP, Collins RE, Klein LA, Bettmann MA, Skillman JJ, Shapiro RM, Salzman EW (1978) Prevention of deep vein thrombosis in urological patients: a controlled, randomized trial of low-dose heparin and external pneumatic compression boots. Surgery 83:230–234

Santori FS, Vitullo A, Stopponi M, Santori N, Ghera S (1994) Prophylaxis against deep-vein thrombosis in total hip replacement. Comparison of heparin and foot impulse pump. J Bone Joint Surg Br 76:579–583

Camporese G, Bernardi E, Prandoni P, Noventa F, Verlato F, Simioni P, Ntita K, Salmistraro G, Frangos C, Rossi F, Cordova R, Franz F, Zucchetta P, Kontothanassis D, Andreozzi GM (2008) Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med 149:73–82

Knudson MM, Collins JA, Goodman SB, McCrory DW (1992) Thromboembolism following multiple trauma. J Trauma 32:2–11

Norgren L, Toksvig-Larsen S, Magyar G, Lindstrand A, Albrechtsson U (1998) Prevention of deep vein thrombosis in knee arthroplasty. Preliminary results from a randomized controlled study of low molecular weight heparin vs. foot pump compression. Int Angiol 17:93–96

DerSimonian R, Kacker R (2007) Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials 28:105–114

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

Sterne JA, Gavaghan D, Egger M (2000) Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol 53:1119–1129

Koch A, Bouges S, Ziegler S, Dinkel H, Daures JP, Victor N (1997) Low molecular weight heparin and unfractionated heparin in thrombosis prophylaxis after major surgical intervention: update of previous meta-analyses. Br J Surg 84:750–759

Howard AW, Aaron SD (1998) Low molecular weight heparin decreases proximal and distal deep venous thrombosis following total knee arthroplasty. A meta-analysis of randomized trials. Thromb Haemost 79:902–906

Nurmohamed MT, Rosendaal FR, Buller HR, Dekker E, Hommes DW, Vandenbroucke JP, Briet E (1992) Low-molecular-weight heparin versus standard heparin in general and orthopaedic surgery: a meta-analysis. Lancet 340(8812):152–156

Handoll HH, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ (2002) Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev 4:CD000305

Cornwell EE III, Chang D, Velmahos G, Jindal A, Baker D, Phillips J, Bonar J, Campbell K (2002) Compliance with sequential compression device prophylaxis in at-risk trauma patients: a prospective analysis. Am Surg 68:470–473

Velmahos GC, Kern J, Chan LS, Oder D, Murray JA, Shekelle P (2000) Prevention of venous thromboembolism after injury: an evidence-based report–part I: analysis of risk factors and evaluation of the role of vena caval filters. J Trauma 49:132–139

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World Journal of Surgery

Tập 34

10-19

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