Department of Intensive Care, Royal Perth Hospital, University of Western Australia, Wellington Street, Perth, WA 6000, Australia.
Circulation. 2013 Aug 27;128(9):1003-20. doi: 10.1161/CIRCULATIONAHA.113.002690. Epub 2013 Jul 12.
Optimal thromboprophylaxis for patients at risk of bleeding remains uncertain. This meta-analysis assessed whether intermittent pneumatic compression (IPC) of the lower limbs was effective in reducing venous thromboembolism and whether combining pharmacological thromboprophylaxis with IPC would enhance its effectiveness.
Two reviewers searched MEDLINE, EMBASE, and the Cochrane controlled trial register (1966-February 2013) for randomized, controlled trials and assessed the outcomes and quality of the trials independently. Trials comparing IPC with pharmacological thromboprophylaxis, thromboembolic deterrent stockings, no prophylaxis, and a combination of IPC and pharmacological thromboprophylaxis were considered. Trials that used IPC <24 hours or compared different types of IPC were excluded. A total of 16 164 hospitalized patients from 70 trials met the inclusion criteria and were subjected to meta-analysis. IPC was more effective than no IPC prophylaxis in reducing deep vein thrombosis (7.3% versus 16.7%; absolute risk reduction, 9.4%; 95% confidence interval [CI], 7.9-10.9; relative risk, 0.43; 95% CI, 0.36-0.52; P<0.01; I(2)=34%) and pulmonary embolism (1.2% versus 2.8%; absolute risk reduction, 1.6%; 95% CI, 0.9-2.3; relative risk, 0.48; 95% CI, 0.33-0.69; P<0.01; I(2)=0%). IPC was also more effective than thromboembolic deterrent stockings in reducing deep vein thrombosis and appeared to be as effective as pharmacological thromboprophylaxis but with a reduced risk of bleeding (relative risk, 0.41; 95% CI, 0.25-0.65; P<0.01; I(2)=0%). Adding pharmacological thromboprophylaxis to IPC further reduced the risk of deep vein thrombosis (relative risk, 0.54; 95% CI, 0.32-0.91; P=0.02; I(2)=0%) compared with IPC alone.
IPC was effective in reducing venous thromboembolism, and combining pharmacological thromboprophylaxis with IPC was more effective than using IPC alone.
对于有出血风险的患者，最佳的血栓预防措施仍不确定。本荟萃分析评估了下肢间歇性气动压迫（IPC）是否能有效减少静脉血栓栓塞，以及联合应用药理学血栓预防和 IPC 是否会增强其效果。
两位审阅者检索了 MEDLINE、EMBASE 和 Cochrane 对照试验登记库（1966 年-2013 年 2 月），以评估随机对照试验的结局和质量。比较 IPC 与药理学血栓预防、血栓预防袜、无预防和 IPC 与药理学血栓预防联合应用的试验被认为是相关的。IPC 持续时间<24 小时或比较不同类型 IPC 的试验被排除在外。来自 70 项试验的 16164 名住院患者符合纳入标准并进行了荟萃分析。IPC 比无 IPC 预防更有效地减少深静脉血栓形成（7.3%对 16.7%；绝对风险降低 9.4%；95%可信区间[CI]，7.9-10.9；相对风险，0.43；95%CI，0.36-0.52；P<0.01；I(2)=34%）和肺栓塞（1.2%对 2.8%；绝对风险降低 1.6%；95%CI，0.9-2.3；相对风险，0.48；95%CI，0.33-0.69；P<0.01；I(2)=0%）。IPC 也比血栓预防袜更有效地减少深静脉血栓形成，并且似乎与药理学血栓预防一样有效，但出血风险降低（相对风险，0.41；95%CI，0.25-0.65；P<0.01；I(2)=0%）。IPC 联合应用药理学血栓预防可进一步降低深静脉血栓形成的风险（相对风险，0.54；95%CI，0.32-0.91；P=0.02；I(2)=0%），与单独应用 IPC 相比。
IPC 能有效减少静脉血栓栓塞，联合应用药理学血栓预防和 IPC 比单独应用 IPC 更有效。
