Options
Early Mobilisation +
Compression Stockings
Pneumatic Compression Devices
Foot Pumps
1. Graduated Compression Stockings
Mechanism
Antiembolism stockings
- apply graded compression
- highest at ankle
- lowest above knee
- attempt to increase flow
- may cause venous stasis if improperly fitted or roll down
Precaution
Check pulses
- not to be used if vascular compromise
- ABI < 1.0
Size correctly
Results
Sachdeva et al Cochrane Database Review 2010
- 8 x RCT's of GCS alone v no GCS
- rates DVT 13% v 26%
- 10 x RCT's of GCS + another method v other method alone
- rates DVT 4% v 16%
2. Pneumatic Compression Devices
Results
Kakkos et al Cochrane Database Review 2008
- RCT of PCD alone v PCD + another method
- PCD alone had incidence symptomatic PE 3% and DVT 4%
- PCD + another method incidence symptomatic PE 1% and DVT 1%
- pharmacological alone had DVT 4% v pharmacological + PCD DVT 1%
3. Foot pump
Disadvantage
Not tolerated by some patients
- uncomfortable
- disturbs sleep
Results
Warwick et al JBJS Am 1998
- RCT of enoxeparin v foot pumps
- DVT rate of 13% enoxeparin and 18% foot pumps
- no major proximal DVT in either group