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Peripheral Artery Disease: causes and consequences

Coronary Artery Disease: causes and consequences

Other Options for Preventing Venous Thromboembolism

This section details the other options for thromboprophylaxis, including antiplatelet agents and mechanical prophylaxis

 

Other options for VTE prevention

Antiplatelet agents

 

Although ASA (aspirin) is more effective than placebo in preventing VTE in high-risk patients, it is less effective than LMWH.1 There are insufficient data comparing ASA with warfarin or UFH for VTE prophylaxis, and there are currently no comparative studies with the NOACs.1 The 2012 American College of Chest Physicians (ACCP) guidelines recommend ASA, among other antithrombotics, over no prophylaxis at all, but LMWH or oral anticoagulants are preferred.2

 

Mechanical prophylaxis

 

Mechanical prophylaxis methods do reduce the risk of DVT, although they have not been studied as intensively as pharmacological options:2,3

  • Mechanical methods of prophylaxis include elastic compression stockings and various intermittent compression devices, all of which increase venous outflow or reduce blood stasis within the leg veins
  • Elastic compression stockings have been shown to effectively reduce symptomatic DVT; however, their use is also associated with an increase in skin complications
  • Mechanical prophylaxis should be used primarily in patients who are at high risk of bleeding or as an adjunct to anticoagulant therapy

 

Summary of mechanical prophylaxis methods
MethodFunctionSupporting data
Elastic (graduated) compression stockingsProvide circumferential pressure that gradually decreases from the ankle to the thigh to promote venous blood flowStudies in hip surgery,4 general surgery5 and stroke6
Intermittent pneumatic compressionLeggings repeatedly inflated and deflated by a pneumatic pump with the goal of mimicking natural calf muscle contractions that promote venous returnMeta-analysis of published studies5
Venous foot pumpImitates the physiological pumping action of weight bearing on the venous plexus of the sole of the foot to simulate the effect of normal walking and increase venous flowLimited
References
  • Karthikeyan G, Eikelboom JW, Turpie AGG, Hirsh J. Does acetyl salicylic acid (ASA) have a role in the prevention of venous thromboembolism? Br J Haematol 2009;146:142–149. Return to content
  • Falck-Ytter Y, Francis CW, Johanson NA et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:e278S–e325S. Return to content
  • Geerts WH, Bergqvist D, Pineo GF et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 2008;133:381S–453S. Geerts WH, Bergqvist D, Pineo GF et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 2008;133:381S–453S. Return to content
  • Cohen AT, Skinner JA, Warwick D, Brenkel I. The use of graduated compression stockings in association with fondaparinux in surgery of the hip. A multicentre, multinational, randomised, open-label, parallel-group comparative study. J Bone Joint Surg Br 2007;89:887–892. Return to content
  • Gould MK, Garcia DA, Wren SM et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:e227S–e277S. Return to content
  • Dennis M, Sandercock PA, Reid J et al. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet 2009;373:1958–1965. Return to content

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