Mazzone C, Chiodo Grandi F, Sandercock P, Miccio M, Salvi R.
Physical methods for preventing deep vein thrombosis in stroke.
Cochrane Database Syst Rev 2002;(1):CD001922

U.C.O. Clinica Neurologica, University of Trieste, Ospedale di Cattinara,
Trieste, Italy, 34100. fabio.chiodograndi@aots.sanita.fvg.it

BACKGROUND: Deep vein thrombosis (DVT) and resulting pulmonary embolism (PE) are
uncommon but important complications of stroke. There is good evidence that
anticoagulants can reduce the risk of DVT and PE after stroke, but this benefit
is offset by a small but definite risk of serious haemorrhages. Physical methods
to prevent DVT and PE (such as compression stockings applied to the legs) are not
associated with any bleeding risk and are effective in some categories of medical
and surgical patients. We sought to assess their effects in stroke patients.
OBJECTIVES: To assess the effectiveness and safety of physical methods of
preventing the onset of deep vein thrombosis and fatal or non fatal pulmonary
embolism in patients with recent stroke. SEARCH STRATEGY: We searched the
Cochrane Stroke Group Trials Register (last searched October 2001). In addition
we searched the following electronic bibliographic databases: Cochrane Controlled
Trials Register (1999, Issue 3), MEDLINE (1966- Jan 2001), EMBASE (1980- Jan
2001) and CINAHL (1982-May 1999). The reference lists of all relevant papers were
screened for additional trials. SELECTION CRITERIA: All completed randomised
unconfounded trials or controlled clinical trials comparing physical methods in
patients allocated to receive physical methods, applied within one week of onset
of stroke, with patients allocated to no physical methods. DATA COLLECTION AND
ANALYSIS: Two reviewers independently searched for relevant trials and three
others independently checked the results. MAIN RESULTS: We identified two small
trials which included 123 patients. In one trial of 97 patients, compression
stockings were associated with a non significant trend towards a reduction in DVT
detected by Doppler ultrasound. In one trial of 26 patients, an intermittent
pneumatic compression device was not associated with a significant reduction in
DVT detected by 125-I-fibrinogen scanning. Overall, physical methods were not
associated with a significant reduction in DVT (Odds ratio 0.59, 95%.CI
0.24-1.48) or death (Odds ratio 5.06, 95% CI 0.96-26.78). REVIEWER'S CONCLUSIONS:
There is insufficient evidence from randomised trials to support the routine use
of physical methods for preventing DVT in acute stroke.