Deep Venous Thrombosis (DVT) in Trauma: a Literature Review

Sequential Compression Devices (SCDs)

First Author	Year	Reference Title	Class	Conclusions
Inada K	1988	Effects of intermittent leg compression for prevention of postoperative deep venous thrombosis with special reference to fibrinolytic activity. Am J Surg 155:602-5	II	Prospective, non-randomized study from Japan. Overall DVT incidence of 6.25% attributed to shortening of the euglobulin lysis time during first 48 hours postop and activating fibrinolysis.
Pidala MJ	1992	A prospective study on intermittent pneumatic compression in the prevention of deep vein thrombosis in patients undergoing total hip or total knee replacement. Surg Gynecol Obstet 175:47-51	III	Prospective but unfortunately uncontrolled study of SCDs in elective joint replacement surgery. Overall DVT incidence 4% by IPG with duplex confirmation. Authors believed, but did not prove that SCDs contributed to the low DVT incidence.
Knudson MM	1992	Thromboembolism following multiple trauma. J Trauma 32:2-11	II	Prospective comparison of 113 trauma patients prophylaxed with SCDs (76) or LDH (37). Thromboembolic complications occurred in 12% and 8%, respectively.
Lachmann EA	1992	Complications associated with intermittent pneumatic compression. Arch Phys Med Rehabil 73:482-5	III	Case report (x2) of SCD complications, both with SCDs worn during surgery. Peroneal nerve compression in setting of weight loss and compartment syndrome with legs in the lithotomy position.
Keith SL	1992	Do graduated compression stockings and pneumatic boots have an additive effect on the peak velocity of venous blood flow? Arch Surg 127:727-30	II	Good study demonstrates SCD effect of increased peak venous velocity in femoral vein not augmented by addition of graduated compression stockings.
Dennis JW	1993	Efficacy of deep venous thrombosis prophylaxis in trauma patients and identification of high-risk groups. J Trauma 35:132-9	III	SCDs were comparable to the effect of LDH in significantly lowering DVT incidence compared to controls with no prophylaxis. Some randomization problems.

Sequential Compression Devices (SCDs)

First Author	Year	Reference Title	Class	Conclusions
Caprini JA	1994	Prevention of venous thromboembolism in North America: Results of a survey among general surgeons. J Vasc Surg 20:751-8	III	Most recent ACS survey documents SCDs as the most frequently used prophylaxis (75% of respondents) with efficacy and safety cited as reasons why.
Knudson MM	1994	Prevention of venous thromboembolism in trauma patients. J Trauma 37:480-7	II	SCDs significantly reduced DVT complications vs control in neurotrauma group only.
Gersin K	1994	The efficacy of sequential compression devices in multiple trauma patients with severe head injury. J Trauma 37:205-8	III	Small numbers, and no description of randomization limits the value of this study.
Gibbons GH	1994	The emerging concept of vascular remodeling. N Engl J Med 330:1431-8	III	Excellent review article on humoral mediators, adhesion molecules, and neointima formation at the endothelial level.
Woolson ST	1991	Intermittent pneumatic compression to prevent proximal deep venous thrombosis during and after total hip replacement. A prospective, randomized study of compression alone, compression and aspirin, and compression and low-dose warfarin. J Bone Joint Surg 73A:507-12	II	The addition of aspirin or Coumadin to SCDs does not improve DVT or PE prophylaxis in elective hip replacement surgery.
Christen Y	1995	Hemodynamic effects of intermittent pneumatic compression of the lower limbs during laparoscopic cholecystectomy. Am J Surg 170:395-8	II	Femoral vein flow velocity, decreased by pneumoperitoneum, was restored by SCDs. SCDs did not restore normal vessel diameter or pressure.
Fisher CG	1995	Effectiveness of pneumatic leg compression devices for the prevention of thromboembolic disease in orthopaedic trauma patients: A prospective, randomized study of compression alone versus no prophylaxis. J Orthop Trauma 9:1-7	II	304 ortho-trauma patient showed venous thromboembolic event in 4% prophylaxed vs 11% control, with subgroup differences among hip vs pelvic fracture patients. Mechanical prophylaxis effective only in hip fracture group.

Sequential Compression Devices (SCDs)

First Author	Year	Reference Title	Class	Conclusions
Hoppensteadt DA	1995	The role of tissue factor pathway inhibitor in the mediation of the antithrombotic actions of heparin and low-molecular-weight heparin. Blood Coagul Fibrinolysis 6:S57-S64	III	TFPI, tissue factor pathway inhibitor, inhibits the extrinsic pathway of coagulation. SCDs worn for 1 hour doubles the TFPI concentration in volunteersí blood.
Ramos R	1996	The efficacy of pneumatic compression stockings in the prevention of pulmonary embolism after cardiac surgery. Chest 109:82-5	II	Prospective, randomized study of cardiac patients. The addition of SCDs to LMWH vs LMWH alone significantly reduced PE rates.
Hull RD	1996	Intermittent compression for the prevention of venous thromboembolism (Editorial). Chest 109:6-9	III	An editorial summary of SCD evidence and a critique of Ramosí paper in the same volume.
Jacobs DG	1996	Hemodynamic and fibrinolytic consequences of intermittent pneumatic compression: Preliminary results. J Trauma 40:710-7	II	A well-designed and well-described study of the effect of SCDs on the plasma levels of various compounds involved in the regulation of fibrinolysis. The discussion in the paper describes these components well.