Intermittent pneumatic compression and pharmacologic thrombosis prophylaxis.

PURPOSE OF REVIEW

Deep vein thrombosis and pulmonary embolism, together referred to as venous thromboembolism, represent a common, very serious healthcare concern. The Surgeon General recently issued a 'call to action' for venous thromboembolism, and the Joint Commission for Accreditation of Healthcare Organizations and the Surgical Care Improvement Project developed and implemented measures regarding thrombosis prophylaxis. Despite these measures, only about 50% of the 'at-risk' patients worldwide receive appropriate thrombosis prophylaxis.

RECENT FINDINGS

New data are available regarding intermittent pneumatic compression. Several novel laboratory-synthesized anticoagulants have demonstrated both efficacy and safety in orthopedic surgery patients and are in various stages of approval. These drugs are pills and have a similar or improved efficacy/safety profile as traditional anticoagulants, including vitamin K antagonists.

SUMMARY

Intermittent pneumatic compression in conjunction with currently available parenteral anticoagulants has shown the greatest efficacy in very-high-risk surgical patients. The new oral anticoagulants have similar efficacy and safety profiles as existing parenteral anticoagulants and allow easy and cost-effective outpatient administration without the need for monitoring. Since it has been shown that most venous thromboembolism events occur following hospital discharge, these new anticoagulants may result in very significant reduction in the overall incidence of venous thromboembolism events.