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Pneumatic Compression for Prevention of Deep Vein Thrombosis Following Knee Arthroplasty

November 20, 2018

Health Problem: A venous thromboembolism (VTE) is a blood clot resulting from slowed circulation, which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). A DVT forms in a deep vein, usually the leg or pelvis, increasing the risk of morbidity and mortality after orthopedic surgery. Following total knee arthroplasty (TKA), 40% to 84% of patients develop a DVT, which poses a risk for PE. There is a 1-month mortality rate of 6% for DVT and 12% for PE.

Technology Description: Pneumatic compression (PC) devices are comprised of an inflatable garment for the leg and an electrical or battery-powered pneumatic pump that fills the garment with compressed air. The garment is intermittently inflated and deflated with cycle times and pressures that vary among devices. These mechanical modalities act primarily by increasing the velocity of venous blood flow through the legs, counteracting the clotting process that can occur in blood that is moving slowly or that has temporarily stopped flowing through veins. The devices are applied during or after TKA and typically used until the patient is discharged, although in some cases, PC use continues at home.

Controversy: There is some controversy about whether DVT is the most important outcome measure to assess in patients undergoing PC after TKA or whether it is simply a surrogate outcome for PE and that PE should be the study endpoint for evaluations of thromboprophylaxis technologies.

Key Questions:

  • How does PC therapy alone and in combination compare with other methods of DVT prevention for reducing the incidence of DVT and PE following TKA?
  • How does PC therapy compare with other methods of DVT prevention with respect to safety, including blood loss in patients undergoing TKA?
  • Have definitive patient selection criteria for PC therapy for prevention of DVT in patients undergoing TKA been established?