Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism

Information

DOI:
https://doi.org/10.1002/14651858.CD005258.pub4Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 28 January 2022see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Vascular Group

Copyright:
  1. Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Article metrics

Altmetric:

Cited by:

Cited 0 times via Crossref Cited-by Linking

Collapse

Authors

  • Stavros Kakkos

    Correspondence to: Department of Vascular Surgery, University of Patras Medical School, Patras, Greece

    [email protected]

  • George Kirkilesis

    Department of Vascular Surgery, University of Patras Medical School, Patras, Greece

  • Joseph A Caprini

    NorthShore University HealthSystem, Evanston, USA

    Pritzker School of Medicine, Chicago, USA

  • George Geroulakos

    Department of Surgery and Cancer, Imperial College of Science Technology and Medicine, London, UK

    Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University, Athens, Greece

  • Andrew Nicolaides

    Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus

  • Gerard Stansby

    Northern Vascular Centre, Freeman Hospital, Newcastle, UK

  • Daniel J Reddy

    Department of Surgery, Wayne State University, Detroit, USA

Contributions of authors

SK: selected studies, assessed study quality, extracted data, wrote the review
GK: selected studies, assessed study quality, extracted data, wrote the review
JC: arbitrated disagreements
GG: selected studies, assessed study quality, and extracted data
AN: contributed to the text of the review
GS: contributed to the text of the review
DR: contributed to the text of the review 

Sources of support

Internal sources

  • No sources of support provided

External sources

  • Chief Scientist Office, Scottish Government Health Directorates, The Scottish Government, UK

    The Cochrane Vascular editorial base is supported by the Chief Scientist Office.

Declarations of interest

SK: has declared that his institution received payment for the Victoria Study (Pfizer), and that he received consulting fees for participation in a panel of experts (Medtronic) and as part of a speakers bureau (LEO, Alfasigma, Viatris). SK has published editorials in Annals of Translational Medicine
GK: none known
JC: has declared that he received payments for lectures (Sanofi, Arjo), consultancy fees (Recovery Force)
GG: none known
AN: none known
GS: none known
DR: none known

Acknowledgements

The review authors wish to thank Dr Ntouvas for his contributions to the previous version. We also wish to thank Dr Arabi for providing additional unpublished results regarding fatal PE in the PREVENT study.  We thank the Cochrane Vascular editorial base and editors for their input.

The review authors, and the Cochrane Vascular editorial base, are grateful to the following peer reviewers for their time and comments: Christos Stefanou, MD, PhD, EDIC, EDEC, Nicosia, Cyprus; Ankur Thapar, Consultant Vascular and Endovascular Surgeon, Mid and South Essex NHS Foundation Trust and Senior Lecturer, Anglia Ruskin University; Scott C Woller MD, Intermountain Medical Center, Intermountain Healthcare, USA; Dr Christopher Mathew, IMT (JRCPTB‐UK), Aster Wayanad, India.

Version history

Published

Title

Stage

Authors

Version

2022 Jan 28

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism

Review

Stavros Kakkos, George Kirkilesis, Joseph A Caprini, George Geroulakos, Andrew Nicolaides, Gerard Stansby, Daniel J Reddy

https://doi.org/10.1002/14651858.CD005258.pub4

2016 Sep 07

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism

Review

Stavros K Kakkos, Joseph A Caprini, George Geroulakos, Andrew N Nicolaides, Gerard Stansby, Daniel J Reddy, Ioannis Ntouvas

https://doi.org/10.1002/14651858.CD005258.pub3

2008 Oct 08

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high‐risk patients

Review

Stavros K Kakkos, Joseph A Caprini, George Geroulakos, Andrew N Nicolaides, Gerard Stansby, Daniel J Reddy

https://doi.org/10.1002/14651858.CD005258.pub2

2005 Apr 20

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high risk patients

Protocol

Stavros K Kakkos, George Geroulakos, Joseph A Caprini, Andrew N Nicolaides, Gerard P Stansby

https://doi.org/10.1002/14651858.CD005258

Differences between protocol and review

2021

We added the secondary outcome 'symptomatic DVT' as this was not considered appropriate to be described as a subgroup (as it was previously). We defined studies with a high or unclear risk of bias in any one or more domains as being at high risk overall. Given the high number of included studies at overall high risk of bias we were not able to carry out sensitivity analyses by risk of bias as previously planned. We clarified that we would investigate heterogeneity using subgroup analysis.

2016

The outcomes incidence of bleeding, incidence of major bleeding, and fatal bleeding are important adverse events of pharmacological prophylaxis and have been added to the review. The outcome fatal PE has been added to the review for completeness. The method of evaluating study quality has changed since the protocol was published; we used the Cochrane risk of bias (RoB 1) tool (Higgins 2011). We have also added summary of findings tables. Because risk stratification of study participants was not provided nor based on modern or any methodology, all types of participants were included and not only those considered as being at high risk of developing venous thromboembolism; however many studies included in this review included high‐risk patients such as those undergoing orthopaedic surgery.

Keywords

MeSH

Medical Subject Headings Check Words

Humans;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram

Figures and Tables -
Figure 1

Study flow diagram

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 1: Incidence of PE ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 1.1

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 1: Incidence of PE ‐ orthopaedic and non‐orthopaedic patients

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 2: Incidence of PE ‐ foot IPC or other IPC

Figures and Tables -
Analysis 1.2

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 2: Incidence of PE ‐ foot IPC or other IPC

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 3: Incidence of DVT ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 1.3

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 3: Incidence of DVT ‐ orthopaedic and non‐orthopaedic patients

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 4: Incidence of symptomatic DVT ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 1.4

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 4: Incidence of symptomatic DVT ‐ orthopaedic and non‐orthopaedic patients

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 5: Incidence of DVT ‐ by foot IPC or other IPC

Figures and Tables -
Analysis 1.5

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 5: Incidence of DVT ‐ by foot IPC or other IPC

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 6: Incidence of bleeding ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 1.6

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 6: Incidence of bleeding ‐ orthopaedic and non‐orthopaedic patients

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 7: Incidence of major bleeding ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 1.7

Comparison 1: IPC plus pharmacological prophylaxis versus IPC alone, Outcome 7: Incidence of major bleeding ‐ orthopaedic and non‐orthopaedic patients

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 1: Incidence of PE ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 2.1

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 1: Incidence of PE ‐ orthopaedic and non‐orthopaedic patients

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 2: Incidence of PE ‐ foot IPC or other IPC

Figures and Tables -
Analysis 2.2

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 2: Incidence of PE ‐ foot IPC or other IPC

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 3: Incidence of DVT ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 2.3

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 3: Incidence of DVT ‐ orthopaedic and non‐orthopaedic patients

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 4: Incidence of symptomatic DVT ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 2.4

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 4: Incidence of symptomatic DVT ‐ orthopaedic and non‐orthopaedic patients

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 5: Incidence of DVT ‐ foot IPC or other IPC

Figures and Tables -
Analysis 2.5

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 5: Incidence of DVT ‐ foot IPC or other IPC

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 6: Incidence of bleeding ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 2.6

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 6: Incidence of bleeding ‐ orthopaedic and non‐orthopaedic patients

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 7: Incidence of major bleeding ‐ orthopaedic and non‐orthopaedic patients

Figures and Tables -
Analysis 2.7

Comparison 2: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone, Outcome 7: Incidence of major bleeding ‐ orthopaedic and non‐orthopaedic patients

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 1: Incidence of PE

Figures and Tables -
Analysis 3.1

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 1: Incidence of PE

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 2: Incidence of DVT

Figures and Tables -
Analysis 3.2

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 2: Incidence of DVT

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 3: Incidence of symptomatic DVT

Figures and Tables -
Analysis 3.3

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 3: Incidence of symptomatic DVT

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 4: Incidence of bleeding

Figures and Tables -
Analysis 3.4

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 4: Incidence of bleeding

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 5: Incidence of major bleeding

Figures and Tables -
Analysis 3.5

Comparison 3: IPC plus pharmacological prophylaxis versus IPC plus aspirin, Outcome 5: Incidence of major bleeding

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 1: Incidence of PE

Figures and Tables -
Analysis 4.1

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 1: Incidence of PE

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 2: Incidence of DVT

Figures and Tables -
Analysis 4.2

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 2: Incidence of DVT

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 3: Incidence of symptomatic DVT

Figures and Tables -
Analysis 4.3

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 3: Incidence of symptomatic DVT

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 4: Incidence of DVT by foot IPC or other IPC

Figures and Tables -
Analysis 4.4

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 4: Incidence of DVT by foot IPC or other IPC

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 5: Incidence of bleeding

Figures and Tables -
Analysis 4.5

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 5: Incidence of bleeding

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 6: Incidence of major bleeding

Figures and Tables -
Analysis 4.6

Comparison 4: IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only, Outcome 6: Incidence of major bleeding

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 1: Incidence of PE

Figures and Tables -
Analysis 5.1

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 1: Incidence of PE

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 2: Incidence of DVT

Figures and Tables -
Analysis 5.2

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 2: Incidence of DVT

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 3: Incidence of symptomatic DVT

Figures and Tables -
Analysis 5.3

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 3: Incidence of symptomatic DVT

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 4: Incidence of DVT by foot IPC or other IPC

Figures and Tables -
Analysis 5.4

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 4: Incidence of DVT by foot IPC or other IPC

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 5: Incidence of bleeding

Figures and Tables -
Analysis 5.5

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 5: Incidence of bleeding

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 6: Incidence of major bleeding

Figures and Tables -
Analysis 5.6

Comparison 5: IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only, Outcome 6: Incidence of major bleeding

Comparison 6: IPC plus pharmacological prophylaxis versus IPC plus aspirin ‐ RCTs only, Outcome 1: Incidence of PE

Figures and Tables -
Analysis 6.1

Comparison 6: IPC plus pharmacological prophylaxis versus IPC plus aspirin ‐ RCTs only, Outcome 1: Incidence of PE

Comparison 6: IPC plus pharmacological prophylaxis versus IPC plus aspirin ‐ RCTs only, Outcome 2: Incidence of DVT

Figures and Tables -
Analysis 6.2

Comparison 6: IPC plus pharmacological prophylaxis versus IPC plus aspirin ‐ RCTs only, Outcome 2: Incidence of DVT

Summary of findings 1. IPC plus pharmacological prophylaxis versus IPC alone

Does combined intermittent pneumatic compression (IPC) plus pharmacological prophylaxis increase prevention of venous thromboembolism compared with IPC alone?

Patient or population: people undergoing surgery or at risk of developing VTE due to surgery, trauma or ICU stay

Settings: hospital 

Intervention: combined modalities ‐  IPC plus pharmacological prophylaxis

Comparison: IPC alone

Outcomes

Anticipated absolute effects * (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with IPC alone

Risk with combined modalities

Incidence of PEa

(early postoperative period)

16 per 1000

7 per 1000 (4 to 12)

OR 0.51 (0.29 to 0.91)

5462 (19)

⊕⊕⊝⊝
Lowb

 

Incidence of DVTc

(early postoperative period)

38 per 1000

20 per 1000 (14 to 28)

OR 0.51 (0.36 to 0.72)

5394 (18)

⊕⊕⊝⊝
Lowb

 

Incidence of bleedingd

(early postoperative period)

10 per 1000

55 per 1000 (36 to 83)

OR 6.02 (3.88 to 9.35)

4634 (13)

⊕⊝⊝⊝
Very lowe

 

Incidence of major bleedingf

(early postoperative period)

3 per 1000

19 per 1000 (10 to 39)

OR 5.77 (2.81 to 11.83)

4133 (12)

⊕⊝⊝⊝

Very lowe

 

* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: confidence interval;DVT: deep vein thrombosis;ICU: intensive care unit; IPC: intermittent pneumatic compression; OR: odds ratio; PE: pulmonary embolism; VTE: venous thromboembolism

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. 

aPulmonary embolism assessed by pulmonary angiography or scintigraphy, computed tomography (CT), angiography, or autopsy.
bDowngraded by two levels due to risk of bias concerns (high in one or more domains regarding all but one study) and due to imprecision as a result of a small number of overall events.
cDeep vein thrombosis assessed by ascending venography, I‐125 fibrinogen uptake test, and ultrasound scanning.
d Any type of bleeding as described by the study authors.
eDowngraded by three levels due to risk of bias concerns (high in one or more domains regarding all but one study), due to imprecision as a result of a small number of events overall, and indirectness because bleeding definitions were not uniform across the studies.
fMajor bleeding as defined by the study authors, but usually located at the surgical site or in a critical organ or site, requiring intervention or transfusion of at least units of blood, or leading to death.

Figures and Tables -
Summary of findings 1. IPC plus pharmacological prophylaxis versus IPC alone
Summary of findings 2. IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone

Does combined intermittent pneumatic compression (IPC) plus pharmacological prophylaxis increase prevention of venous thromboembolism compared with pharmacological prophylaxis alone?

Patient or population: people undergoing surgery or at risk of developing VTE because of surgery, trauma or ICU stay

Settings: hospital 

Intervention: combined modalities ‐ IPC plus pharmacological prophylaxis

Comparison: pharmacological prophylaxis alone

Outcomes

Anticipated absolute effects * (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with pharmacological prophylaxis alone

 

Risk with combined modalities

Incidence of PEa

(early postoperative period)

18 per 1000

9 per 1000 (6 to 13)

OR 0.46 (0.30 to 0.71)

6737 (15)

⊕⊕⊝⊝
Lowb

 

Incidence of DVTc

(early postoperative period)

93 per 1000

37 per 1000 (21 to 67)

OR 0.38 (0.21 to 0.70)

6151 (17)

⊕⊕⊕⊕
Highd

 

Incidence of bleedinge

(early postoperative period)

74 per 1000

65 per 1000 (43 to 98)

OR 0.87 (0.56 to 1.35

1314 (6)

⊕⊝⊝⊝

Very lowf

 

Incidence of major bleedingg

(early postoperative period)

11 per 1000

13 per 1000 (4 to 44)

OR 1.21 (0.35 to 4.18)

908 (5)

⊕⊝⊝⊝

Very lowf

 

* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: confidence interval;DVT: deep vein thrombosis;ICU: intensive care unit; IPC: intermittent pneumatic compression; OR: odds ratio; PE: pulmonary embolism; VTE: venous thromboembolism

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

aPulmonary embolism assessed by pulmonary angiography or scintigraphy, computed tomography (CT), angiography, single photon emission CT (SPECT) or autopsy.
bDowngraded by two levels due to risk of bias (which was high in one or more domains regarding all studies) and due to imprecision as a result of a small number of events overall.
cDeep vein thrombosis assessed predominantly by ascending venography, I‐125 fibrinogen uptake test, and ultrasound scanning.
dDowngraded by one level due to risk of bias (which was high in one or more domains regarding all but one study) and upgraded by one level because of a large magnitude of the effect.
eAny type of bleeding as described by the study authors.
fDowngraded by three levels due to risk of bias (which was high in one or more domains regarding all studies), due to imprecision as a result of a small number of events overall and a wide confidence interval, and indirectness because bleeding definitions were not uniform across the studies.
gMajor bleeding as defined by the study authors, but usually located at the surgical site or in a critical organ or site, requiring intervention or transfusion of at least units of blood, or leading to death.

Figures and Tables -
Summary of findings 2. IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone
Comparison 1. IPC plus pharmacological prophylaxis versus IPC alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Incidence of PE ‐ orthopaedic and non‐orthopaedic patients Show forest plot

19

5462

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.29, 0.91]

1.1.1 Orthopaedic patients

3

445

Odds Ratio (M‐H, Fixed, 95% CI)

Not estimable

1.1.2 Non‐orthopaedic patients

16

5017

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.29, 0.91]

1.2 Incidence of PE ‐ foot IPC or other IPC Show forest plot

19

5462

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.29, 0.91]

1.2.1 Foot IPC

1

50

Odds Ratio (M‐H, Fixed, 95% CI)

Not estimable

1.2.2 Other IPC

18

5412

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.29, 0.91]

1.3 Incidence of DVT ‐ orthopaedic and non‐orthopaedic patients Show forest plot

18

5394

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.36, 0.72]

1.3.1 Orthopaedic patients

3

445

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.38, 1.69]

1.3.2 Non‐orthopaedic patients

15

4949

Odds Ratio (M‐H, Fixed, 95% CI)

0.46 [0.31, 0.68]

1.4 Incidence of symptomatic DVT ‐ orthopaedic and non‐orthopaedic patients Show forest plot

10

4089

Odds Ratio (M‐H, Fixed, 95% CI)

0.48 [0.21, 1.10]

1.4.1 Orthopaedic patients

1

250

Odds Ratio (M‐H, Fixed, 95% CI)

1.50 [0.06, 37.33]

1.4.2 Non‐orthopaedic patients

9

3839

Odds Ratio (M‐H, Fixed, 95% CI)

0.44 [0.19, 1.04]

1.5 Incidence of DVT ‐ by foot IPC or other IPC Show forest plot

18

5395

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.36, 0.72]

1.5.1 Foot IPC

1

50

Odds Ratio (M‐H, Fixed, 95% CI)

Not estimable

1.5.2 Other IPC

17

5345

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.36, 0.72]

1.6 Incidence of bleeding ‐ orthopaedic and non‐orthopaedic patients Show forest plot

13

4634

Odds Ratio (M‐H, Fixed, 95% CI)

6.02 [3.88, 9.35]

1.6.1 Orthopaedic patients

2

400

Odds Ratio (M‐H, Fixed, 95% CI)

2.79 [0.77, 10.18]

1.6.2 Non‐orthopaedic patients

11

4234

Odds Ratio (M‐H, Fixed, 95% CI)

6.61 [4.14, 10.56]

1.7 Incidence of major bleeding ‐ orthopaedic and non‐orthopaedic patients Show forest plot

12

4133

Odds Ratio (M‐H, Fixed, 95% CI)

5.77 [2.81, 11.83]

1.7.1 Orthopaedic patients

2

400

Odds Ratio (M‐H, Fixed, 95% CI)

3.35 [0.13, 83.62]

1.7.2 Non‐orthopaedic patients

10

3733

Odds Ratio (M‐H, Fixed, 95% CI)

5.91 [2.83, 12.36]

Figures and Tables -
Comparison 1. IPC plus pharmacological prophylaxis versus IPC alone
Comparison 2. IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Incidence of PE ‐ orthopaedic and non‐orthopaedic patients Show forest plot

15

6737

Odds Ratio (M‐H, Fixed, 95% CI)

0.46 [0.30, 0.71]

2.1.1 Orthopaedic patients

8

1202

Odds Ratio (M‐H, Fixed, 95% CI)

0.58 [0.08, 4.49]

2.1.2 Non‐orthopaedic patients

7

5535

Odds Ratio (M‐H, Fixed, 95% CI)

0.46 [0.29, 0.71]

2.2 Incidence of PE ‐ foot IPC or other IPC Show forest plot

15

6737

Odds Ratio (M‐H, Fixed, 95% CI)

0.46 [0.30, 0.71]

2.2.1 Foot IPC

4

324

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 8.25]

2.2.2 Other IPC

11

6413

Odds Ratio (M‐H, Fixed, 95% CI)

0.47 [0.30, 0.72]

2.3 Incidence of DVT ‐ orthopaedic and non‐orthopaedic patients Show forest plot

17

6151

Odds Ratio (M‐H, Random, 95% CI)

0.38 [0.21, 0.70]

2.3.1 Orthopaedic patients

10

3075

Odds Ratio (M‐H, Random, 95% CI)

0.34 [0.18, 0.68]

2.3.2 Non‐orthopaedic patients

7

3076

Odds Ratio (M‐H, Random, 95% CI)

0.46 [0.13, 1.61]

2.4 Incidence of symptomatic DVT ‐ orthopaedic and non‐orthopaedic patients Show forest plot

7

3032

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.34, 2.01]

2.4.1 Orthopaedic patients

3

477

Odds Ratio (M‐H, Fixed, 95% CI)

2.09 [0.38, 11.50]

2.4.2 Non‐orthopaedic patients

4

2555

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.18, 1.66]

2.5 Incidence of DVT ‐ foot IPC or other IPC Show forest plot

16

4148

Odds Ratio (M‐H, Random, 95% CI)

0.34 [0.18, 0.63]

2.5.1 Foot IPC

4

324

Odds Ratio (M‐H, Random, 95% CI)

0.40 [0.05, 3.47]

2.5.2 Other IPC

12

3824

Odds Ratio (M‐H, Random, 95% CI)

0.31 [0.17, 0.54]

2.6 Incidence of bleeding ‐ orthopaedic and non‐orthopaedic patients Show forest plot

6

1314

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.56, 1.35]

2.6.1 Orthopaedic patients

3

550

Odds Ratio (M‐H, Fixed, 95% CI)

0.64 [0.20, 2.07]

2.6.2 Non‐orthopaedic patients

3

764

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.57, 1.47]

2.7 Incidence of major bleeding ‐ orthopaedic and non‐orthopaedic patients Show forest plot

5

908

Odds Ratio (M‐H, Fixed, 95% CI)

1.21 [0.35, 4.18]

2.7.1 Orthopaedic patients

3

551

Odds Ratio (M‐H, Fixed, 95% CI)

1.07 [0.21, 5.54]

2.7.2 Non‐orthopaedic patients

2

357

Odds Ratio (M‐H, Fixed, 95% CI)

1.42 [0.21, 9.49]

Figures and Tables -
Comparison 2. IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone
Comparison 3. IPC plus pharmacological prophylaxis versus IPC plus aspirin

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Incidence of PE Show forest plot

3

605

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.03, 3.19]

3.2 Incidence of DVT Show forest plot

3

605

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.48, 1.42]

3.3 Incidence of symptomatic DVT Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.4 Incidence of bleeding Show forest plot

3

616

Odds Ratio (M‐H, Fixed, 95% CI)

1.23 [0.27, 5.53]

3.5 Incidence of major bleeding Show forest plot

3

616

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.15, 4.17]

Figures and Tables -
Comparison 3. IPC plus pharmacological prophylaxis versus IPC plus aspirin
Comparison 4. IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Incidence of PE Show forest plot

13

4159

Odds Ratio (M‐H, Fixed, 95% CI)

0.54 [0.28, 1.07]

4.2 Incidence of DVT Show forest plot

13

4159

Odds Ratio (M‐H, Fixed, 95% CI)

0.53 [0.36, 0.77]

4.3 Incidence of symptomatic DVT Show forest plot

7

3064

Odds Ratio (M‐H, Fixed, 95% CI)

1.21 [0.15, 9.63]

4.4 Incidence of DVT by foot IPC or other IPC Show forest plot

17

5085

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.36, 0.74]

4.4.1 Foot IPC

1

50

Odds Ratio (M‐H, Fixed, 95% CI)

Not estimable

4.4.2 Other IPC

16

5035

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.36, 0.74]

4.5 Incidence of bleeding Show forest plot

10

4120

Odds Ratio (M‐H, Fixed, 95% CI)

5.45 [3.38, 8.80]

4.6 Incidence of major bleeding Show forest plot

9

3619

Odds Ratio (M‐H, Fixed, 95% CI)

5.90 [2.82, 12.33]

Figures and Tables -
Comparison 4. IPC plus pharmacological prophylaxis versus IPC alone ‐ RCTs only
Comparison 5. IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Incidence of PE Show forest plot

11

5758

Odds Ratio (M‐H, Fixed, 95% CI)

0.45 [0.29, 0.70]

5.2 Incidence of DVT Show forest plot

13

5172

Odds Ratio (M‐H, Random, 95% CI)

0.44 [0.22, 0.87]

5.3 Incidence of symptomatic DVT Show forest plot

5

2312

Odds Ratio (M‐H, Fixed, 95% CI)

1.02 [0.29, 3.54]

5.4 Incidence of DVT by foot IPC or other IPC Show forest plot

15

5431

Odds Ratio (M‐H, Random, 95% CI)

0.42 [0.23, 0.80]

5.4.1 Foot IPC

4

324

Odds Ratio (M‐H, Random, 95% CI)

0.40 [0.05, 3.47]

5.4.2 Other IPC

11

5107

Odds Ratio (M‐H, Random, 95% CI)

0.40 [0.20, 0.81]

5.5 Incidence of bleeding Show forest plot

4

594

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.30, 2.14]

5.6 Incidence of major bleeding Show forest plot

4

595

Odds Ratio (M‐H, Fixed, 95% CI)

1.21 [0.35, 4.18]

Figures and Tables -
Comparison 5. IPC plus pharmacological prophylaxis versus pharmacological prophylaxis alone ‐ RCTs only
Comparison 6. IPC plus pharmacological prophylaxis versus IPC plus aspirin ‐ RCTs only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Incidence of PE Show forest plot

2

405

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.03, 3.19]

6.2 Incidence of DVT Show forest plot

2

405

Odds Ratio (M‐H, Fixed, 95% CI)

0.79 [0.44, 1.39]

Figures and Tables -
Comparison 6. IPC plus pharmacological prophylaxis versus IPC plus aspirin ‐ RCTs only