Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis

被引:155
|
作者
Arabi, Y. M. [1 ,2 ,10 ]
Al-Hameed, F. [11 ,12 ]
Burns, K. E. A. [18 ,20 ]
Mehta, S. [19 ,20 ]
Alsolamy, S. J. [1 ,2 ,3 ,10 ]
Alshahrani, M. S. [14 ]
Mandourah, Y. [4 ]
Almekhlafi, G. A. [5 ]
Almaani, M. [6 ]
Al Bshabshe, A. [15 ]
Finfer, S. [21 ,22 ,24 ]
Arshad, Z. [26 ]
Khalid, I. [13 ]
Mehta, Y. [27 ]
Gaur, A. [25 ]
Hawa, H. [7 ]
Buscher, H. [23 ,24 ]
Lababidi, H. [6 ]
Al Aithan, A. [16 ,17 ]
Abdukahil, S. A. I. [1 ,2 ,10 ]
Jose, J. [8 ]
Afesh, L. Y. [9 ]
Al-Dawood, A. [1 ,2 ,10 ]
机构
[1] King Saud Bin Abdulaziz Univ Hlth Sci, Coll Med, Riyadh, Saudi Arabia
[2] Minist Def, Mil Med Serv, Dept Intens Care, Riyadh, Saudi Arabia
[3] Minist Def, Mil Med Serv, Dept Emergency Med, Riyadh, Saudi Arabia
[4] Minist Def, Mil Med Serv, Minist Natl Guard Hlth Affairs, Riyadh, Saudi Arabia
[5] Prince Sultan Mil Med City, Dept Intens Care Serv, Riyadh, Saudi Arabia
[6] King Fahad Med City, Dept Pulm & Crit Care Med, Riyadh, Saudi Arabia
[7] King Faisal Specialist Hosp & Res Ctr, Crit Care Med Dept, Riyadh, Saudi Arabia
[8] King Abdullah Int Med Res Ctr, Dept Biostat & Bioinformat, Riyadh, Saudi Arabia
[9] King Abdullah Int Med Res Ctr, Res Off, Riyadh, Saudi Arabia
[10] King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia
[11] King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Coll Med, Jeddah, Saudi Arabia
[12] Minist Natl Guard Hlth Affairs, Dept Intens Care, Jeddah, Saudi Arabia
[13] King Faisal Specialist Hosp & Res Ctr, Dept Med, Crit Care Sect, Jeddah, Saudi Arabia
[14] Imam Abdulrahman Bin Faisal Univ, King Fahd Hosp Univ, Coll Med, Dept Emergency & Crit Care Med, Dammam, Saudi Arabia
[15] King Khalid Univ, Asir Cent Hosp, Dept Crit Care Med, Abha, Saudi Arabia
[16] King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Al Hasa, Saudi Arabia
[17] King Abdulaziz Hosp, Dept Med, Intens Care Div, Al Hasa, Saudi Arabia
[18] Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
[19] Univ Toronto, Dept Med, Sinai Hlth Syst, Toronto, ON, Canada
[20] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
[21] Univ New South Wales, George Inst Global Hlth, Sydney, NSW, Australia
[22] St Vincents Hosp, George Inst Global Hlth, Sydney, NSW, Australia
[23] St Vincents Hosp, Dept Intens Care Med, Ctr Appl Med Res, Sydney, NSW, Australia
[24] Univ New South Wales, Sydney, NSW, Australia
[25] Gosford Hosp, Intens Care Dept, Gosford, NSW, Australia
[26] King Georges Med Univ, Dept Anesthesiol & Crit Care, Lucknow, Uttar Pradesh, India
[27] Medanta Medicity, Inst Crit Care & Anesthesiol, Gurgaon, India
来源
NEW ENGLAND JOURNAL OF MEDICINE | 2019年 / 380卷 / 14期
关键词
CRITICALLY-ILL PATIENTS; DEEP-VEIN THROMBOSIS; THROMBOEMBOLISM PROPHYLAXIS; AMERICAN-COLLEGE; PREVENTION; VTE;
D O I
10.1056/NEJMoa1816150
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Whether adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in a lower incidence of deep-vein thrombosis than pharmacologic thromboprophylaxis alone is uncertain. Methods We randomly assigned patients who were considered adults according to the local standards at the participating sites (>= 14, >= 16, or >= 18 years of age) within 48 hours after admission to an intensive care unit (ICU) to receive either intermittent pneumatic compression for at least 18 hours each day in addition to pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin (pneumatic compression group) or pharmacologic thromboprophylaxis alone (control group). The primary outcome was incident (i.e., new) proximal lower-limb deep-vein thrombosis, as detected on twice-weekly lower-limb ultrasonography after the third calendar day since randomization until ICU discharge, death, attainment of full mobility, or trial day 28, whichever occurred first. Results A total of 2003 patients underwent randomization - 991 were assigned to the pneumatic compression group and 1012 to the control group. Intermittent pneumatic compression was applied for a median of 22 hours (interquartile range, 21 to 23) daily for a median of 7 days (interquartile range, 4 to 13). The primary outcome occurred in 37 of 957 patients (3.9%) in the pneumatic compression group and in 41 of 985 patients (4.2%) in the control group (relative risk, 0.93; 95% confidence interval [CI], 0.60 to 1.44; P=0.74). Venous thromboembolism (pulmonary embolism or any lower-limb deep-vein thrombosis) occurred in 103 of 991 patients (10.4%) in the pneumatic compression group and in 95 of 1012 patients (9.4%) in the control group (relative risk, 1.11; 95% CI, 0.85 to 1.44), and death from any cause at 90 days occurred in 258 of 990 patients (26.1%) and 270 of 1011 patients (26.7%), respectively (relative risk, 0.98; 95% CI, 0.84 to 1.13). Conclusions Among critically ill patients who were receiving pharmacologic thromboprophylaxis, adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone. (Funded by King Abdulaziz City for Science and Technology and King Abdullah International Medical Research Center; PREVENT ClinicalTrials.gov number, ; Current Controlled Trials number, .)
引用
收藏
页码:1305 / 1315
页数:11
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