![]() ![]() ![]() No differences were found between the two types of heparin in the rates of DVT, clinical pulmonary embolism, or death, but use of LMWH carried a lower risk of major bleeding. 1 UFH and LMWH have been studied for DVT prophylaxis in the general medical population, and a meta-analysis published in 2000 found that both heparin types reduced the rates of DVT and clinical pulmonary embolism by 56%-58%. Medical patients account for up to a quarter of venous thromboembolic events in the general population. How can we reduce risk of DVT in general medical patients? ![]() Mechanical prophylaxis must be used with caution, however, if a patient has peripheral arterial insufficiency. 10 The review also found that mechanical prophylaxis in surgical patients may reduce the risk of pulmonary embolism by about two fifths. 9 A recent systematic review found that graduated compression stockings, intermittent pneumatic compression devices, and foot pumps reduce the risk of DVT in surgical patients by two thirds when used as monotherapy and by an additional 50% when added to drug prophylaxis. 8 A meta-analysis of 57 studies found that intermittent pneumatic compression devices for the thigh and calf were effective in reducing rates of DVT when compared with placebo (from 29% to 11%) and with graduated compression stockings alone (from 15% to 8%). 7Īdditionally, a recent randomised but non-blinded clinical trial found that the use of graduated compression stockings in patients with DVT reduced the risk of post-thrombotic syndrome from 49% to 26%. In nine studies comparing graduated compression stockings with no prophylaxis, rates of DVT were reduced from 27% to 13%, and in seven studies the addition of the stockings to background prophylaxis further reduced DVT rates from 15% to 2%. How well do the mechanical methods of prophylaxis work?Ī Cochrane review found that graduated compression stockings were effective in reducing rates of DVT for general medical and surgical patients whether they were used alone or in addition to other DVT prophylaxis. ![]()
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