Thread by @WellingtonICU

This week's #ICUtwitterjournalclub on a trial evaluating calf compression devices for venous thrombophylaxis was prepared by @RobynLester12
nejm.org/doi/full/10.10…

Prevention of DVT is an important part of caring for the critically ill. This study examines whether the addition of pneumatic compression devices to pharmacologic thromboprophylaxis will lower DVT incidence

This was a multicentre, unblinded RCT. Patients received either intermittent pneumatic compression (IPC) & a pharmacologic agent, or pharmacologic agent alone.

Study was carried out in 20 sites in Saudi Arabia, Canada, Australia & India

Inclusion criteria: age ≥14/16/18 years (centre dependent), weight >45kg, ICU stay >72 hrs, no contraindications to treatment, enrolled within 48hrs of admission

Primary outcome: New proximal DVT – detected via twice weekly lower limb USS

Secondary outcomes: % of patients with prevalent proximal DVT, occurrence of any lower limb DVT, PE, death or combination of above.

Safety outcomes: Lower limb skin injury, ischaemia, any serious adverse event, modified ITT

Numbers: 2003 patients were randomized – 991 in intervention group, 1012 in control group – patient characteristics between groups was comparable.

IPC used for median of 22 hrs in 972 IPC group pts for 7 days, and 103 control groups patients for median of 0 hours

Results:
Primary outcome: incident proximal DVT in 3.9% of IPC group, vs 4.2% in control group (RR 0.93, 95% CI, 0.6-1.44, P=0.74)

Secondary outcome results:
Any PE or DVT – 10.4% IPC group vs 9.4% control group.
Death from any cause at 90 days – 26.1% vs 26.7%

Strengths: Randomisation, large multi-centre, intention to treat trial.

Limitations: Incidence of DVT in control group was lower than expected – decreased trial power, therefore doesn’t exclude clinically significant treatment effect

Randomisation was not blinded; some patients in control group had IPCs during an interruption in control group treatment; some receipt of IPCs before randomization; differing types of IPCs utilised

Conclusion: In this trial, no additional benefit of adjunctive IPC in the treatment of DVT was found, however further research indicated. What does your ICU do routinely?

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