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Original Research: Pulmonary Vascular Disease |

Use of Intermittent Pneumatic Compression and Not Graduated Compression Stockings Is Associated With Lower Incident VTE in Critically Ill PatientsMechanical Prophylaxis in Critically Ill Patients: A Multiple Propensity Scores Adjusted Analysis

Yaseen M. Arabi, MD, FCCP; Mohammad Khedr, MD, FCCP; Saqib I. Dara, MD, FCCP; Gousia S. Dhar, MBBS; Shaila A. Bhat, MBBS; Hani M. Tamim, MPH, PhD; Lara Y. Afesh, RN, MSN
Author and Funding Information

From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Correspondence to: Yaseen M. Arabi, MD, FCCP, Intensive Care Unit 1425, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, Riyadh 14611, Saudi Arabia; e-mail: arabi@ngha.med.sa


Funding/Support: The study was sponsored in part by an unrestricted grant from sanofi-aventis, Saudi Arabia.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(1):152-159. doi:10.1378/chest.12-2028
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Background:  A limited amount of data exist regarding the effect of intermittent pneumatic compression (IPC) and graduated compression stockings (GCS) on the incidence of VTE in the ICU setting. The objective of this study was to examine the association of mechanical thromboprophylaxis with IPC or GCS with the risk of VTE and hospital mortality among critically ill medical-surgical patients.

Methods:  In this prospective cohort study of patients admitted to the ICU of a tertiary-care medical center between July 2006 and January 2008, we used multiple propensity scores adjustment to examine the association of IPC and GCS with VTE. The primary outcome was incident VTE, including DVT and pulmonary embolism. The following data were collected: patient demographics, admission physiologic data, VTE risk factors, pharmacologic thromboprophylaxis, and mechanical thromboprophylaxis.

Results:  Among 798 patients enrolled in the study, incident VTE occurred in 57 (7.1%). The use of IPC was associated with a significantly lower VTE incidence compared with no mechanical thromboprophylaxis (propensity scores adjusted hazard ratio, 0.45; 95% CI, 0.22-0.95; P = .04). GCS were not associated with decreased VTE incidence. No significant interaction was found between the mechanical thromboprophylaxis group and the type of prophylactic heparin used (P = .99), recent trauma (P = .66), or recent surgery (P = .07) on VTE risk.

Conclusions:  The use of IPC, but not GCS, was associated with a significantly lower VTE risk. This association was consistent regardless of the type of prophylactic heparin used and was not modified by trauma or surgical admission.

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