Kamran SI, Downey D, Ruff RL.
Pneumatic sequential compression reduces the risk of deep vein thrombosis in
stroke patients.
Neurology 1998 Jun;50(6):1683-8

Cleveland Department of Veterans Affairs Medical Center, Department of Neurology,
Case Western Reserve University, OH 44106, USA.

OBJECTIVE: To determine if pneumatic sequential compression devices (SCDs)
combined with subcutaneous heparin and antiembolic hose reduce the risk of deep
vein thrombosis (DVT) and pulmonary embolism (PE) in stroke patients. BACKGROUND:
DVTs and PEs are serious complications among hospitalized stroke patients.
Subcutaneous heparin and SCDs have both been used to prevent DVT. It is not known
if SCDs combined with subcutaneous heparin can improve the protection afforded by
heparin alone. METHODS: The study group was comprised of nonhemorrhagic stroke
patients admitted to the neurology service from October 1988 through June 1996.
From October 1988 through April 1991 (233 patients), and during February 1993 (16
patients), patients received 5,000 U subcutaneous heparin twice daily and
antiembolic hose. From June 1991 through January 1993 and from March 1993 through
June 1996 (432 patients) all nonambulatory stroke patients had SCDs applied to
both legs in addition to subcutaneous heparin and antiembolic hose. RESULTS:
Twenty-three of 249 patients (9.2%; 21 of 233 and two of 16 patients) treated
with heparin alone developed DVT and six patients (2.4%) developed PE (six of 233
and zero of 16). Half the PE cases (three of six) were fatal and all PEs were in
patients with DVT. Eighty-three of the 249 patients were nonambulatory.
Twenty-two of the 23 DVTs and all the PEs developed in nonambulatory patients.
Only one DVT (0.23%) and no PEs occurred among the 432 patients (148
nonambulatory) treated with SCDs as well as heparin. The addition of SCDs
resulted in more than a 40-fold reduction in the risk of DVT. CONCLUSIONS:
Nonambulatory stroke patients have an increased risk for DVT and PE. Adding SCDs
to treatment with subcutaneous heparin and antiembolic hose reduced the risks of
DVTs and PEs. SCDs should be considered for adjunctive DVT prophylaxis in
nonambulatory stroke patients.