The role of electrical calf stimulation in combined prophylaxis of venous thromboembolism in high risk surgical patients
Barinov V., Lobastov K., Tsaplin S., Schastlivtsev I., Boyarintsev V.
1. Clinical Hospital № 1 Office of the President of the Russian Federation, Moscow
2. Russian National Research University. NI Pirogov, Department of General Surgery and Radiology Medical Faculty
The aim of the study was to evaluate efficacy and safety of electrical calf muscle stimulation (EMS) in combined prophylaxis of postoperative venous thromboembolism (VTE) in high risk patients.
Materials and methods. It was a prospective randomized controlled study included 150 surgical patients with high risk of VTE, which underwent major abdominal surgery (56%) or neurosurgery (44%) and had 3 and more individual risk factors. According to VTE prevention protocol all patients were randomized into two groups: the main and the control (n=75). In all groups compression bandage was applied on the shin and direct anticoagulants were administrated in standard prophylactic doses. In the main group electrical stimulation of shin muscles was used by means of «Veinoplus» devise also. Each session of EMS lasted 20 minutes and was performed not less than 5 times (100 minutes) per day. The primary end points were: the rate postoperative DVT, confirmed with duplex ultrasound, the rate of PE, conformed with lung scintigraphy and/or heart ultrasound, total postoperative mortality. The secondary end point was the compliance in EMS using, calculated as a proportion of real amount of sessions per day to the target amount, which was 10 sessions per day.
Results. The rate of postoperative DVT in the main group was 4,0% (95% CI: 1,4-11,1%) against 20,0 % (95% CI: 12,5-30,4%) in the control group (p=0,005), of proximal DVT: 0% (95% CI: 0-4,9%) against 8,0% (95% CI: 3,7-16,4%, р=0,028), without any significant differences for the rate of PE. The maximum reduction in DVT relative risk was found in patients with leg paralysis: 88,1%. Also in the main group was found significant reduction in the rate of isolated gastrocnemius and soleus veins thrombosis. Postoperative mortality was significantly decreased by means of EMS using: 10,7% (95% CI: 5,5-19,7%) against 25,3% (95% CI: 16,8-36,2%, р=0,032). The compliance in EMS using was 65-70% for medical staff and 70% for patients.
venous thrombosis, pulmonary embolism. Prophylaxis, high risk, electrical calf stimulation
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