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May 2, 1990, Vol 263, No. 17 >
ARTICLE | May 2, 1990

Effectiveness of Intermittent Pneumatic Leg Compression for Preventing Deep Vein Thrombosis After Total Hip Replacement FREE

Russell D. Hull, MBBS, MSc; Gary E. Raskob, MSc; Michael Gent, MSc; Dermot McLoughlin, MBBS; Denise Julian, MSc; Frank C. Smith, MB, ChB; N. Ian Dale, MBBS; Roy Reed-Davis, MD; Robert N. Lofthouse, MD; Christine Anderson, RN
[+] Author Affiliations

Reprint requests to the University of Calgary, Department of Medicine, Foothills Hospital, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1 (Dr Hull).


JAMA. 1990;263(17):2313-2317. doi:10.1001/jama.1990.03440170035032
Text Size: A A A
Published online
Article
References

A randomized trial was performed in consecutive patients undergoing total hip replacement to evaluate the effectiveness of sequential intermittent calf and thigh compression for preventing venous thrombosis compared with a control group given no prophylaxis. Both groups underwent case finding for deep vein thrombosis using combined fibrinogen I 125 leg scanning, impedance plethysmography, and venography. Deep vein thrombosis by venography was present in 77 (49%) of 158 control patients compared with 36 (24%) of 152 patients given intermittent compression. Proximal vein thrombosis was present in 42 controls (27%) compared with 22 patients (14%) given intermittent compression. Combined impedance plethysmography and leg scanning was insensitive in this patient group (sensitivity, 46%); venography was required to detect more than half the patients with venous thrombosis. Sequential intermittent leg compression clinically and statistically significantly reduced the frequency of both proximal vein and calf vein thrombosis. Case finding resulted in early detection and treatment of patients with venous thrombosis.

(JAMA. 1990;263:2313-2317)

REFERENCES

1 +
Stamatakis JD, Kakkar VV, Sagar S, Lawrence D, Nairn D, Bentley PG.  Femoral vein thrombosis and total hip replacement . Br Med J. 1977;;2:223-225.
2 +
Harris WH, Salzman EW, Athanasoulis CA, Waltman AC, DeSanctis RW.  Aspirin prophylaxis of venous thromboembolism after total hip replacement . N Engl J Med. 1977;;297:1246-1249.
3 +
Johnson R, Carmichael JHE, Almond HGA, Loynes RP.  Deep venous thrombosis following Charnley arthroplasty . Clin Orthop. 1978;;132:24-30.
4 +
Nillius AS, Nylander G.  Deep-vein thrombosis after total hip replacement: a clinical and phlebographic study . Br J Surg. 1979;;66:324-326.
5 +
Evarts CM, Feil EJ.  Prevention of thromboembolic disease after elective surgery of the hip . J Bone Joint Surg Am. 1971;;53:1271-1280.
6 +
Kakkar VV, Flanc C, Howe CT, et al.  Natural history of post-operative deep-vein thrombosis . Lancet. 1969;;2:230-233.
7 +
Moser KM, LeMoine JR.  Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med. 1981;;94:439-444.
8 +
Coventry MB, Nolan DR, Beckenbaugh RD.  Delayed prophylactic anticoagulation: a study of results and complications in 2012 total hip arthroplasties . J Bone Joint Surg Am. 1973;;55:1487-1492.
9 +
Roberts VC, Sabri S, Beely AH, Cotton LT.  The effect of intermittently applied external pressure on the hemodynamics of the lower limb in man . Br J Surg. 1972;;59:223-226.
10 +
Nicolaides AN, Fernandes E, Fernandes J, Pollock AV.  Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis . Surgery. 1980;;87:69-76.
11 +
Knight MTN, Dawson R.  Effect of intermittent compression of the arms on deep venous thrombosis in the legs . Lancet. 1976;;2:1265-1268.
12 +
Sabri S, Roberts VC, Cotton LT.  Prevention of early postoperative deep-vein thrombosis by intermittent compression of the leg during surgery . Br Med J. 1971;;4:394-396.
13 +
Roberts VC, Cotton LT.  Prevention of postoperative deep-vein thrombosis in patients with malignant disease . Br Med J. 1974;;1:358-360.
14 +
Clark WB, MacGregor AB, Prescott RJ, Ruckley CV.  Pneumatic compression of the calf and postoperative deep-vein thrombosis . Lancet. 1974;; 2:5-7.
15 +
Skillman JJ, Collins RE, Coe NP, et al.  Prevention of deep-vein thrombosis in neurosurgical patients: a controlled, randomized trial of external pneumatic compression boots . Surgery. 1978;;83: 354-358.
16 +
Turpie AGG, Delmore T, Hirsh J, et al.  Prevention of venous thrombosis by intermittent sequential calf compression in patients with intracranial disease . Thromb Res. 1979;;15:611-616.
17 +
Coe NP, Collins REC, Klein LA, et al.  Prevention of deep-vein thrombosis in urological patients: a controlled, randomized trial of low-dose heparin and external pneumatic compression boots . Surgery. 1978;;83:230-234.
18 +
Hull R, Delmore T, Hirsh J, et al.  Effectiveness of intermittent pulsatile elastic stockings for the prevention of calf and thigh thrombosis in patients undergoing elective knee surgery . Thromb Res. 1979;;16:37-45.
19 +
Gallus A, Raman K, Darby T.  Venous thrombosis after elective hip replacement: the influence of preventive intermittent calf compression and of surgical technique . Br J Surg. 1983;;70:17-19.
20 +
Paiement G, Wessinger SJ, Waltman WC, Harris WH.  Low-dose warfarin versus external pneumatic compression for prophylaxis against venous thromboembolism following total hip replacement . J Arthroplasty. 1987;;2:23-26.
21 +
Simon TL, Stengle JM.  Antithrombotic practice in orthopedic surgery: results of a survey . Clin Orthop. 1974;;102:181-187.
22 +
Morris GK.  Prevention of venous thromboembolism: a survey of methods used by orthopedic and general surgeons . Lancet. 1980;;2:572-574.
23 +
Paiement GD, Wessinger SJ, Harris WH.  Survey of prophylaxis against venous thromboembolism in adults undergoing hip surgery . Clin Orthop. 1987;;223:188-193.
24 +
Hull R, Van Aken WG, Hirsh J, et al.  Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis . Circulation. 1976;;53:696-700.
25 +
Hull R, Taylor DW, Hirsh J, et al.  Impedance plethysmography: the relationship between venous filling and sensitivity and specificity for proximalvein thrombosis . Circulation. 1978;;58:898-902.
26 +
Gallus AS, Hirsh J, Tuttle RJ, et al.  Small subcutaneous doses of heparin in prevention of venous thrombosis . N Engl J Med. 1973;;288:545-551.
27 +
Harris WH, Salzman EW, Athanasoulis C, et al.  Comparison of 125I-fibrinogen count scanning with phlebography for detection of venous thrombosis after elective hip surgery . N Engl J Med. 1975;;292:665-667.
28 +
Harris WH, Athanasoulis C, Waltman AC, Salzman EW.  Cuff-impedance phlebography and 125I-fibrinogen scanning versus roentgenographic phlebography for diagnosis of thrombophlebitis following hip surgery . J Bone Joint Surg Am. 1976;;58: 939-944.
29 +
Rabinov K, Paulin S.  Roentgen diagnosis of venous thrombosis in the leg . Arch Surg. 1972;; 104:134-144.
30 +
Hull R, Raskob G, Hirsh J, et al.  Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis . N Engl J Med. 1986;; 315:1109-1114.
31 +
Hull R, Hirsh J, Jay R, et al.  Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis . N Engl J Med. 1982;;307:1676-1681.
32 +
McNeil BJ.  Ventilation-perfusion studies and the diagnosis of pulmonary embolism . J Nucl Med. 1980;;21:319-323.
33 +
Hull R, Hirsh J, Carter CJ, et al.  Diagnostic value of ventilation-perfusion lung scanning in patients with suspected pulmonary embolism . Chest. 1985;;88:819-828.
34 +
Sackett DL.  Bias in analytic research . J Chronic Dis. 1979;;32:51-63.
35 +
Paiement GD, Bell D, Wessinger SJ, Harris WH.  New advances in the prevention, diagnosis and cost-effectiveness of venous thromboembolic disease in patients with total hip replacement . Hip. 1987;:94-119.
36 +
Harris WH, Athanasoulis CA, Waltman AC, Salzman EW.  Prophylaxis of deep-vein thrombosis after total hip replacement: dextran and external pneumatic compression compared with 1.2 or 0.3 gram of aspirin daily . J Bone Joint Surg Am. 1985;;67:57-62.
37 +
Harris WH, Salzman EW, Athanasoulis C, Waltman AC, Baum S, DeSanctis RW.  Comparison of warfarin, low molecular weight dextran, aspirin, and subcutaneous heparin in prevention of venous thromboembolism following total hip replacement . J Bone Joint Surg Am. 1974;;56;1552-1562.
38 +
Francis CW, Marder VJ, Evarts CM, Yaukoulbodi S.  Two-step warfarin therapy: prevention of post-operative venous thrombosis without excessive bleeding . JAMA. 1983;;249:374-378.
39 +
Leyvraz PF, Richard J, Bachmann F, et al.  Adjusted versus fixed-dose subcutaneous heparin in the prevention of deep-vein thrombosis after total hip replacement . N Engl J Med. 1983;;309:954-958.
40 +
Turpie AGG, Levine MN, Hirsh J, et al.  A randomized controlled trial of low molecular weight heparin (Enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery . N Engl J Med. 1986;;315:925-929.
41 +
Collins R, Scrimgeour A, Yusef S, Peto R.  Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin . N Engl J Med. 1988;;318:1162-1173.
42 +
Paiement G, Wessinger SJ, Waltman AC, Harris WH.  Surveillance of deep-vein thrombosis in asymptomatic total hip replacement patients: impedance phlebography and fibrinogen scanning versus roentgenographic phlebography . Am J Surg. 1988;;155:400-404.
43 +
Comerota AJ, Katz ML, Grossi RJ, et al.  The comparative value of non-invasive testing for diagnosis and surveillance of deep-vein thrombosis . J Vase Surg. 1988;;7:40-49.
44 +
Hull R, Hirsh J, Sackett D, Powers P, Turpie AG, Walker I.  Combined use of leg scanning and impedance plethysmography in suspected venous thrombosis: an alternative to venography . N Engl J Med. 1977;;296:1497-1500.
45 +
Moser KM, LeMoine JR.  Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med. 1981;;94:439-444.
46 +
Hull R, Hirsh J, Sackett D, et al.  Replacement of venography in suspected venous thrombosis by impedance plethysmography and 125I-fibrinogen leg scanning . Ann Intern Med. 1981;;94:12-15.
47 +
Hull R, Hirsh J, Carter C, et al.  Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis: a randomized trial . Ann Intern Med. 1985;;102:21-28.
48 +
Hull R, Hirsh J, Sackett DL, et al.  The value of adding impedance plethysmography to 125I-fibrinogen leg scanning for the detection of deep-vein thrombosis in high risk surgical patients: a comparative study between patients undergoing general surgery and hip surgery . Thromb Res. 1979;;15:227-234.
49 +
Salzman EW, Davies GC.  Prophylaxis of venous thromboembolism: analysis of cost-effectiveness . Ann Surg. 1980;;191:207-218.
50 +
Hull R, Hirsh J, Sackett DL, Stoddart G.  Cost-effectiveness of primary and secondary prevention of fatal pulmonary embolism in high-risk surgical patients . Can Med Assoc J. 1982;;127:990-995.
51 +
Sullivan ED, Peter DJ, Cranley JJ.  Real-time B-mode venous ultrasound . J Vase Surg. 1984;; 1:465-471.
52 +
Cronan JJ, Dorfman GS, Scola FH, Schepps B, Alexander J.  Deep venous thrombosis: US assessment using vein compression . Radiology. 1987;; 162:191-194.
53 +
Lensing AW, Prandoni P, Brandjes D, et al.  Detection of deep-vein thrombosis by real-time B-mode ultrasonography . NEngl J Med. 1989;;320: 342-345.
54 +
White RH, McGahan JP, Daschbach MM, Hartling RP.  Diagnosis of deep-vein thrombosis using duplex ultrasound . Ann Intern Med. 1989;;111:297-304.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Stamatakis JD, Kakkar VV, Sagar S, Lawrence D, Nairn D, Bentley PG.  Femoral vein thrombosis and total hip replacement . Br Med J. 1977;;2:223-225.
2 +
Harris WH, Salzman EW, Athanasoulis CA, Waltman AC, DeSanctis RW.  Aspirin prophylaxis of venous thromboembolism after total hip replacement . N Engl J Med. 1977;;297:1246-1249.
3 +
Johnson R, Carmichael JHE, Almond HGA, Loynes RP.  Deep venous thrombosis following Charnley arthroplasty . Clin Orthop. 1978;;132:24-30.
4 +
Nillius AS, Nylander G.  Deep-vein thrombosis after total hip replacement: a clinical and phlebographic study . Br J Surg. 1979;;66:324-326.
5 +
Evarts CM, Feil EJ.  Prevention of thromboembolic disease after elective surgery of the hip . J Bone Joint Surg Am. 1971;;53:1271-1280.
6 +
Kakkar VV, Flanc C, Howe CT, et al.  Natural history of post-operative deep-vein thrombosis . Lancet. 1969;;2:230-233.
7 +
Moser KM, LeMoine JR.  Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med. 1981;;94:439-444.
8 +
Coventry MB, Nolan DR, Beckenbaugh RD.  Delayed prophylactic anticoagulation: a study of results and complications in 2012 total hip arthroplasties . J Bone Joint Surg Am. 1973;;55:1487-1492.
9 +
Roberts VC, Sabri S, Beely AH, Cotton LT.  The effect of intermittently applied external pressure on the hemodynamics of the lower limb in man . Br J Surg. 1972;;59:223-226.
10 +
Nicolaides AN, Fernandes E, Fernandes J, Pollock AV.  Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis . Surgery. 1980;;87:69-76.
11 +
Knight MTN, Dawson R.  Effect of intermittent compression of the arms on deep venous thrombosis in the legs . Lancet. 1976;;2:1265-1268.
12 +
Sabri S, Roberts VC, Cotton LT.  Prevention of early postoperative deep-vein thrombosis by intermittent compression of the leg during surgery . Br Med J. 1971;;4:394-396.
13 +
Roberts VC, Cotton LT.  Prevention of postoperative deep-vein thrombosis in patients with malignant disease . Br Med J. 1974;;1:358-360.
14 +
Clark WB, MacGregor AB, Prescott RJ, Ruckley CV.  Pneumatic compression of the calf and postoperative deep-vein thrombosis . Lancet. 1974;; 2:5-7.
15 +
Skillman JJ, Collins RE, Coe NP, et al.  Prevention of deep-vein thrombosis in neurosurgical patients: a controlled, randomized trial of external pneumatic compression boots . Surgery. 1978;;83: 354-358.
16 +
Turpie AGG, Delmore T, Hirsh J, et al.  Prevention of venous thrombosis by intermittent sequential calf compression in patients with intracranial disease . Thromb Res. 1979;;15:611-616.
17 +
Coe NP, Collins REC, Klein LA, et al.  Prevention of deep-vein thrombosis in urological patients: a controlled, randomized trial of low-dose heparin and external pneumatic compression boots . Surgery. 1978;;83:230-234.
18 +
Hull R, Delmore T, Hirsh J, et al.  Effectiveness of intermittent pulsatile elastic stockings for the prevention of calf and thigh thrombosis in patients undergoing elective knee surgery . Thromb Res. 1979;;16:37-45.
19 +
Gallus A, Raman K, Darby T.  Venous thrombosis after elective hip replacement: the influence of preventive intermittent calf compression and of surgical technique . Br J Surg. 1983;;70:17-19.
20 +
Paiement G, Wessinger SJ, Waltman WC, Harris WH.  Low-dose warfarin versus external pneumatic compression for prophylaxis against venous thromboembolism following total hip replacement . J Arthroplasty. 1987;;2:23-26.
21 +
Simon TL, Stengle JM.  Antithrombotic practice in orthopedic surgery: results of a survey . Clin Orthop. 1974;;102:181-187.
22 +
Morris GK.  Prevention of venous thromboembolism: a survey of methods used by orthopedic and general surgeons . Lancet. 1980;;2:572-574.
23 +
Paiement GD, Wessinger SJ, Harris WH.  Survey of prophylaxis against venous thromboembolism in adults undergoing hip surgery . Clin Orthop. 1987;;223:188-193.
24 +
Hull R, Van Aken WG, Hirsh J, et al.  Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis . Circulation. 1976;;53:696-700.
25 +
Hull R, Taylor DW, Hirsh J, et al.  Impedance plethysmography: the relationship between venous filling and sensitivity and specificity for proximalvein thrombosis . Circulation. 1978;;58:898-902.
26 +
Gallus AS, Hirsh J, Tuttle RJ, et al.  Small subcutaneous doses of heparin in prevention of venous thrombosis . N Engl J Med. 1973;;288:545-551.
27 +
Harris WH, Salzman EW, Athanasoulis C, et al.  Comparison of 125I-fibrinogen count scanning with phlebography for detection of venous thrombosis after elective hip surgery . N Engl J Med. 1975;;292:665-667.
28 +
Harris WH, Athanasoulis C, Waltman AC, Salzman EW.  Cuff-impedance phlebography and 125I-fibrinogen scanning versus roentgenographic phlebography for diagnosis of thrombophlebitis following hip surgery . J Bone Joint Surg Am. 1976;;58: 939-944.
29 +
Rabinov K, Paulin S.  Roentgen diagnosis of venous thrombosis in the leg . Arch Surg. 1972;; 104:134-144.
30 +
Hull R, Raskob G, Hirsh J, et al.  Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis . N Engl J Med. 1986;; 315:1109-1114.
31 +
Hull R, Hirsh J, Jay R, et al.  Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis . N Engl J Med. 1982;;307:1676-1681.
32 +
McNeil BJ.  Ventilation-perfusion studies and the diagnosis of pulmonary embolism . J Nucl Med. 1980;;21:319-323.
33 +
Hull R, Hirsh J, Carter CJ, et al.  Diagnostic value of ventilation-perfusion lung scanning in patients with suspected pulmonary embolism . Chest. 1985;;88:819-828.
34 +
Sackett DL.  Bias in analytic research . J Chronic Dis. 1979;;32:51-63.
35 +
Paiement GD, Bell D, Wessinger SJ, Harris WH.  New advances in the prevention, diagnosis and cost-effectiveness of venous thromboembolic disease in patients with total hip replacement . Hip. 1987;:94-119.
36 +
Harris WH, Athanasoulis CA, Waltman AC, Salzman EW.  Prophylaxis of deep-vein thrombosis after total hip replacement: dextran and external pneumatic compression compared with 1.2 or 0.3 gram of aspirin daily . J Bone Joint Surg Am. 1985;;67:57-62.
37 +
Harris WH, Salzman EW, Athanasoulis C, Waltman AC, Baum S, DeSanctis RW.  Comparison of warfarin, low molecular weight dextran, aspirin, and subcutaneous heparin in prevention of venous thromboembolism following total hip replacement . J Bone Joint Surg Am. 1974;;56;1552-1562.
38 +
Francis CW, Marder VJ, Evarts CM, Yaukoulbodi S.  Two-step warfarin therapy: prevention of post-operative venous thrombosis without excessive bleeding . JAMA. 1983;;249:374-378.
39 +
Leyvraz PF, Richard J, Bachmann F, et al.  Adjusted versus fixed-dose subcutaneous heparin in the prevention of deep-vein thrombosis after total hip replacement . N Engl J Med. 1983;;309:954-958.
40 +
Turpie AGG, Levine MN, Hirsh J, et al.  A randomized controlled trial of low molecular weight heparin (Enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery . N Engl J Med. 1986;;315:925-929.
41 +
Collins R, Scrimgeour A, Yusef S, Peto R.  Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin . N Engl J Med. 1988;;318:1162-1173.
42 +
Paiement G, Wessinger SJ, Waltman AC, Harris WH.  Surveillance of deep-vein thrombosis in asymptomatic total hip replacement patients: impedance phlebography and fibrinogen scanning versus roentgenographic phlebography . Am J Surg. 1988;;155:400-404.
43 +
Comerota AJ, Katz ML, Grossi RJ, et al.  The comparative value of non-invasive testing for diagnosis and surveillance of deep-vein thrombosis . J Vase Surg. 1988;;7:40-49.
44 +
Hull R, Hirsh J, Sackett D, Powers P, Turpie AG, Walker I.  Combined use of leg scanning and impedance plethysmography in suspected venous thrombosis: an alternative to venography . N Engl J Med. 1977;;296:1497-1500.
45 +
Moser KM, LeMoine JR.  Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med. 1981;;94:439-444.
46 +
Hull R, Hirsh J, Sackett D, et al.  Replacement of venography in suspected venous thrombosis by impedance plethysmography and 125I-fibrinogen leg scanning . Ann Intern Med. 1981;;94:12-15.
47 +
Hull R, Hirsh J, Carter C, et al.  Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis: a randomized trial . Ann Intern Med. 1985;;102:21-28.
48 +
Hull R, Hirsh J, Sackett DL, et al.  The value of adding impedance plethysmography to 125I-fibrinogen leg scanning for the detection of deep-vein thrombosis in high risk surgical patients: a comparative study between patients undergoing general surgery and hip surgery . Thromb Res. 1979;;15:227-234.
49 +
Salzman EW, Davies GC.  Prophylaxis of venous thromboembolism: analysis of cost-effectiveness . Ann Surg. 1980;;191:207-218.
50 +
Hull R, Hirsh J, Sackett DL, Stoddart G.  Cost-effectiveness of primary and secondary prevention of fatal pulmonary embolism in high-risk surgical patients . Can Med Assoc J. 1982;;127:990-995.
51 +
Sullivan ED, Peter DJ, Cranley JJ.  Real-time B-mode venous ultrasound . J Vase Surg. 1984;; 1:465-471.
52 +
Cronan JJ, Dorfman GS, Scola FH, Schepps B, Alexander J.  Deep venous thrombosis: US assessment using vein compression . Radiology. 1987;; 162:191-194.
53 +
Lensing AW, Prandoni P, Brandjes D, et al.  Detection of deep-vein thrombosis by real-time B-mode ultrasonography . NEngl J Med. 1989;;320: 342-345.
54 +
White RH, McGahan JP, Daschbach MM, Hartling RP.  Diagnosis of deep-vein thrombosis using duplex ultrasound . Ann Intern Med. 1989;;111:297-304.

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