Caprini JA, Scurr JH, Hasty JH.
Role of compression modalities in a prophylactic program for deep vein thrombosis.
Semin Thromb Hemost 1988;14 Suppl:77-87

During the past decade, we have learned a great deal about the etiology,
pathogenesis, diagnosis, and treatment of thromboembolic disease. Subcutaneous
heparin has emerged as a major deterrent worldwide for thrombosis prevention but
is associated with the potential risk of bleeding and cannot be used in certain
patient situations. External compression modalities have emerged as major
alternate forms of prophylaxis. We have learned that these devices stimulate the
fibrinolytic system, prevent stasis and the endothelial injury that can accompany
extreme venous distention. Since they are not associated with bleeding or other
serious complications, they are attractive methods for most surgeons, including
those performing delicate or complex surgical procedures. Independent studies
worldwide have demonstrated their effectiveness in reducing deep vein thrombosis,
as recognized by the NIH Consensus Development Panel, and the evidence is
compelling that DVT efficacy is a valid marker for PE efficacy. Since these
devices reduce the incidence of deep vein thrombosis, they almost certainly must
prevent pulmonary emboli; however, a properly designed protocol should be
conducted to validate these assumptions. Evidence suggests that full-leg
sequential compression is superior to calf compression, but further study is
necessary. We believe that a hospital-wide plan, including risk-factor assessment
and application of clinical management guidelines, including all available
modalities, is important to provide the maximum protection of patients with the
lowest risk of side effects. Such a program has been very successful in our
community.