NEW YORK (Reuters Health) – How intermittent pneumatic compression compares to graduated compression stockings for preventing deep vein thrombosis (DVT) is still unclear, according to a systematic review published online January 15th in the Annals of Surgery.

Studies that directly compared the two approaches yielded only weak evidence that pneumatic compression was more effective than the stockings. Only 3 studies showed a statistically significant difference in DVT rates, and all 3 supported pneumatic compression.

However, the researchers caution, “insufficient evidence that one is more effective does not imply strong evidence of equivalency.”

In performing their review, Dr. Rhys J. Morris, from University Hospital of Wales, Cardiff, and Dr. John P. Woodcock, from Cardiff University, searched MEDLINE and other databases for relevant trial reports published between January 1970 and August 2008.

Nine of the 10 trials identified focused on surgical patients, while 1 involved patients with unstable angina. The largest study had 774 patients in the stocking group and 718 in the pneumatic compression group. Most trials, however, featured 50 patients or fewer in each arm.

The crude cumulated DVT rates for all of the studies were 5.9% for stockings and 2.8% for pneumatic compression.

Seven studies indicated lower DVT rates with pneumatic compression, and 3 showed lower rates with stockings. As noted, however, differences were statistically significant in just 3 of the 7 studies that favored pneumatic compression and in none of those favoring stockings. Notably, the largest study showed no significant difference between the 2.

However, after examining the authors’ findings as well as data from 2 studies not included in the review, editorialist Dr. Joseph A. Caprini, from Evanston Hospital, Illinois, advises clinicians “to use leg intermittent pneumatic compression for those at high risk of bleeding and, until further data appear, to avoid using graduated compression stockings interchangeably for thrombosis prophylaxis.”

Reference:
Ann Surg 2010.