Clarke-Pearson DL, Dodge RK, Synan I, McClelland RC, Maxwell GL.
Venous thromboembolism prophylaxis: patients at high risk to fail intermittent
pneumatic compression.
Obstet Gynecol 2003 Jan;101(1):157-63

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke
University Medical Center, Durham, North Carolina 27710, USA. clark011@mc.duke.edu

To identify patients who fail intermittent pneumatic compression and who might be
considered for other more intense thromboembolic prophylaxis.We conducted a
retrospective review of consecutive gynecologic surgery patients treated with
intermittent pneumatic compression. Risk factors associated with thromboemboli
and demographic data were reviewed. Clinical suspicion of thromboemboli was
confirmed by established diagnostic techniques such as duplex Doppler ultrasound
and ventilation perfusion scanning. The association between individual risk
factors and the incidence of thromboemboli was identified. To control for
confounding of variables, multivariable stepwise logistic regression analysis was
performed.A total of 1862 patients undergoing gynecologic surgery between 1996
and 1997 were treated perioperatively with intermittent pneumatic compression.
The overall incidence of postoperative thromboemboli was 1.3% (15 cases of
clinically significant postoperative pulmonary emboli and nine deep venous
thrombosis). Risk factors associated with the occurrence of thromboemboli were:
cancer (P =.001), history of deep venous thrombosis (P =.03), hypertension (P
=.05), use of antihypertensives (P =.04), and age at least 60 years (P =.002).
Intraoperative risk factors included duration of anesthesia more than 3 hours (P
=.05). The multivariable regression analysis found that the diagnosis of cancer
(P =.001), history of deep venous thrombosis (P =.006), and age greater than 60
years (P =.04) were independent prognostic factors. Patients with two or three of
these variables had a 3.2% incidence of developing thromboemboli as compared with
a 0.6% incidence of thromboemboli if the patient had none or one risk
factor.Patients most likely to fail intermittent pneumatic compression
prophylaxis include those with cancer, a past history of deep venous thrombosis,
or who are 60 years or older. This information identifies a "higher-risk" group
of patients who should be considered for more intense prophylaxis programs.