• Juliessa M Pavon, Soheir S Adam, Zayd A Razouki, Jennifer R McDuffie, Paul F Lachiewicz, Andrzej S Kosinski, Christopher A Beadles, Thomas L Ortel, Avishek Nagi, and John W Williams.
• Division of Geriatrics, Duke University Medical Center, Durham, North Carolina; Durham Veterans Affairs Medical Center, GRECC, Durham, North Carolina.
• J Arthroplasty. 2016 Feb 1; 31 (2): 524-32.

BackgroundThromboprophylaxis regimens include pharmacologic and mechanical options such as intermittent pneumatic compression devices (IPCDs). There are a wide variety of IPCDs available, but it is uncertain if they vary in effectiveness or ease of use. This is a systematic review of the comparative effectiveness of IPCDs for selected outcomes (mortality, venous thromboembolism [VTE], symptomatic or asymptomatic deep vein thrombosis, major bleeding, ease of use, and adherence) in postoperative surgical patients.MethodsWe searched MEDLINE (via PubMed), Embase, CINAHL, and Cochrane CENTRAL from January 1, 1995, to October 30, 2014, for randomized controlled trials, as well as relevant observational studies on ease of use and adherence.ResultsWe identified 14 eligible randomized controlled trials (2633 subjects) and 3 eligible observational studies (1724 subjects); most were conducted in joint arthroplasty patients. Intermittent pneumatic compression devices were comparable to anticoagulation for major clinical outcomes (VTE: risk ratio, 1.39; 95% confidence interval, 0.73-2.64). Limited data suggest that concurrent use of anticoagulation with IPCD may lower VTE risk compared with anticoagulation alone, and that IPCD compared with anticoagulation may lower major bleeding risk. Subgroup analyses did not show significant differences by device location, mode of inflation, or risk of bias elements. There were no consistent associations between IPCDs and ease of use or adherence.ConclusionsIntermittent pneumatic compression devices are appropriate for VTE thromboprophylaxis when used in accordance with current clinical guidelines. The current evidence base to guide selection of a specific device or type of device is limited.Copyright © 2016 Elsevier Inc. All rights reserved.

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