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Physical methods for preventing deep vein thrombosis in stroke

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Abstract

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 methods

We searched the Cochrane Stroke Group trials register (last searched June 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2003), MEDLINE (1966 to June 2003), EMBASE (1980 to June 2003) and CINAHL (1982 to June 2003). The reference lists of all relevant papers were screened for additional trials.

Selection criteria

Unconfounded randomised controlled trials comparing physical methods for the prevention of DVT with control, in which prophylaxis was started within seven days of the onset of stroke.

Data collection and analysis

Two review authors 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 during the treatment period in survivors (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.18 to 1.57) or death (OR 1.54, 95% CI 0.5 to 4.77).

Authors' conclusions

There is insufficient evidence from randomised trials to support the routine use of physical methods for preventing DVT in acute stroke.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Plain language summary

Physical methods for preventing deep vein thrombosis in stroke

There is no reliable evidence that graded compression stockings or pneumatic compression boots prevent deep vein thrombosis after stroke. After a stroke, blood clots can form in the veins of the leg (deep vein thrombosis or DVT). These clots can cause a number of complications. If the clots break off and reach the lungs (pulmonary embolism) this can be life threatening. A number of physical methods might reduce the formation of DVT after stroke: graded compression stockings, pneumatic compression devices and electrical stimulation of leg muscles. We found only one small completed trial of graded compression stockings and one small trial of an intermittent compression device after stroke. Both trials were inconclusive, but the trials were too small to provide reliable results. Until current large scale trials are completed, the balance of risk and benefit from the use of physical methods after stroke to prevent DVT remains uncertain.