Alternating pneumocompression — effective physiotherapeutic method for the prevention of venous thromboembolic complications in patients of medium and high risk in the acute period of the stroke

Close metadata

Recommended articles:

Dynamics of motor and functional disorders in the early recovery period after ischemic stroke. Problems of Balneology, Physiotherapy and Exercise Therapy. 2024;(5):13-22

Electromagnetic stimulation in diaphragm dysfunction: repetitive peripheral magnetic stimulation as a method of choice during the rehabilitation period after stroke. (Literature review). Problems of Balneology, Physiotherapy and Exercise Therapy. 2024;(5):57-65

Differentiated approach to cognitive rehabilitation of patients after stroke. Problems of Balneology, Physiotherapy and Exercise Therapy. 2024;(6):5-11

Influence of intermittent pneumatic compression on microvasculature condition in lymphedema. Prospective randomized clinical trial. Problems of Balneology, Physiotherapy and Exercise Therapy. 2024;(6):48-53

Comparison of the effectiveness of non-immunogenic staphylokinase and alteplase for intravenous thrombolysis in ischemic stroke: analysis of hospital registry data. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(7):139-144

Artificial ventilation in patients with stroke: main results of the Russian multicenter observational clinical trial RETAS. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(8-2):5-13

The impact of the impairment of social cognitive functions in acute stage of stroke on its functional outcomes. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(8-2):21-25

Possibilities of mirror therapy in cognitive rehabilitation after stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(8-2):64-71

Stroke: current state of the problem. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11):7-18

Evaluation of the effectiveness of the drug Cortexin in combination with the use of the application Aphasia.No (Afaziyam.Net) in the correction of speech disorders in patients with cerebral infarction. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11):147-151

Background: the patients presenting with severe post-stroke in the acute period of this condition are characterized by the high risk of venous thromboembolic complications (VTEC), with the most dangerous of them being pulmonary embolism that makes an appreciable contribution to the mortality rate of such patients at the hospital stage of their treatment. Among the physical methods for the prevention of VTE, such as wearing graduated compression stockings (GCS), myoelectrostimulation (MES), pneumatic intermittent compression (PIC), only the latter technique has been shown to be efficient when applied for the treatment of surgical patients during the post-stroke period with the level of evidence 2B and the very uncertain parameters of the impact. Aim. The objective of the present study was to evaluate the advantages of the PIC in comparison with that of GCS and MES, substantiate the choice of the former method for the management of the high-risk post-stroke patients, and determine the impact parameters of PIC during the peracute and acute periods of the disease. Material and methods. We conducted a series of analyses of the results of several controlled randomized studies and relevant reviews of the literature with a view to determining the feasibility and effectiveness of application of one or another approach and clarifying the parameters of the exposure to GCS, MES, and PIC for the prevention of VTEC. Results and discussion. The results of these studies gave evidence that the effectiveness of the GCS and MES is insufficient in contrast to that of PIC that was found to decrease the relative risk of deep vein thrombosis (DVT) by 62% compared with placebo and by 47% in comparison with GCS. The low risk of DVT associated with the application of PIC was apparent from the low OR value of 0.45 and the absolute reduction in the risk of DVT by 3.6%. The analysis of the parameters being used made it possible to identify side effects and thereby allowed to formulate the optimal method for the application of PIC for the purpose of prevention of VTEC in the post-stroke patients during the peracute and acute periods of the disease. Conclusion. Only PIC of all the currently available methods for the physical prevention of VTEC in the group of high risk post-stroke patients during the peracute and acute periods of this condition can be practiced in the reliable evidence-based manner. The most rational PIC modality consists of exerting the external pressure on the lower extremities within the first 12—24 hours after stroke with the use of the cuffs of the «lower leg» type (i.e. at a pressure of 40—50 mm Hg in the wave mode with memorization for the multi-sectional cuffs, daily in the continuous manner throughout the daytime till the patient is downgraded to the group at lower risk of VTEC or actually till the discharge from the hospital.

Keywords:

stroke

prophylaxis of venous thromboembolism

intermittent pneumatic compression

graduated compression stockings

myoelectrostimulation

Authors:

Galyaev I.Yu.

S.V.Ochapovsky Regional Clinic Hospital of Krasnodar Region, Krasnodar, Russia

List of references:

Russian clinical recommendations for diagnosis, treatment and prevention of venous thromboembolic complications. Flebologiya. 2015;9(4,Suppl.2). (In Russ.)
Lippi G, Favaloro EJ, Cervellin G. Prevention of venous thromboembolism: focus on mechanical prophylaxis. Semin Thromb Hemost. 2011;37(3):237-251. https://doi.org/10.1055/s-0031-1273088
Muir KW, Watt A, Baxter G, Grosset DG, Lees KR. Randomized trial of graded compression stockings for prevention of deep-vein thrombosis after acute stroke. QJM. 2000;93(6):359-364. https://doi.org/10.1093/qjmed/93.6.359
Mazzone C, Chiodo GF, Sandercock P, Miccio M, Salvi R. Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev. 2004;(4):CD001922. https://doi.org/10.1002/14651858.cd001922.pub2
CLOTS Trials Collaboration, Dennis M, Sandercock PA, Reid J, Graham C, Murray G, Venables G, Rudd A, Bowler G. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomized controlled trial. Lancet. 2009;373(9679): 1958-1965. https://doi.org/10.1016/S0140-6736(09)60941-7
CLOTS (Clots in Legs Or sTockings after Stroke) Trial Collaboration.Thigh-length versus below-knee stockings for deep venous thrombosis prophylaxis after stroke: a multicentre, randomised controlled trial. Ann Intern Med. 2010;153(9):553-562. https://doi.org/10.7326/0003-4819-153-9-201011020-00280
Xu B. DVT in acute stroke — the use of graduated compression stockings. Aust Fam Physician. 2010;39(7):485-487.
Naccarato M, Chiodo Grandi F, Dennis M, Sandercock PA. Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev. 2010;(8):CD001922. https://doi.org/10.1002/14651858.CD001922.pub3
Broderick BJ, O’Briain DE, Breen PP, Kearns SR, Olaighin G. A pilot evaluation of a neuromuscular electrical stimulation (NMES) based methodology for the prevention of venous stasis during bed rest. Med Eng Phys. 2010;32(4):349-355. https://doi.org/10.1016/j.medengphy.2010.01.006.
Griffin M, Nicolaides AN, Bond D, Geroulakos G, Kalodiki E. The efficacy of a new stimulation technology to increase venous flow and prevent venous stasis. Eur J Vasc Endovasc Surg. 2010;40(6):766-771. https://doi.org/10.1016/j.ejvs.2010.06.019
Izumi M, Ikeuchi M, Mitani T, Taniguchi S, Tani T. Prevention of venous stasis in the lower limb by transcutaneous electrical nerve stimulation. Eur J Vasc Endovasc Surg. 2010;39(5):642-645. https://doi.org/10.1016/j.ejvs.2009.11.035
Broderick BJ, Breathnach O, Condon F, Masterson E, Ólaighin G. Haemodynamic performance of neuromuscular electrical stimulation (NMES) during recovery from total hip arthroplasty. J Orthop Surg Res. 2013;8:3. https://doi.org/10.1186/1749-799X-8-3
Clarke Moloney M, Lyons GM, Breen P, Burke PE, Grace PA. Haemodynamic study examining the response of venous blood flow to electrical stimulation of the gastrocnemius muscle in patients with chronic venous disease. Eur J Vasc Endovasc Surg. 2006;31(3):300-305.
Hajibandeh S, Hajibandeh S, Antoniou GА, Scurr JR, Torella F. Neuromuscular electrical stimulation for thromboprophylaxis: A systematic review. Phlebology. 2015;30(9):589-602. https://doi.org/10.1177/0268355514567731
Hajibandeh S, Hajibandeh S, Antoniou GA, Scurr JR, Torella F. Neuromuscular electrical stimulation for the prevention of venous thromboembolism (Protocol). Cochrane Database Syst Rev. 2015;(6):CD011764. https://doi.org/10.1002/14651858.CD011764
Vanek VW. Meta-analysis of effectiveness of intermittent pneumatic compression devices with a comparison of thigh high to knee-high sleeves. Am Surg. 1998;64(11):1050-1058.
CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration, Dennis M, Sandercock P, Reid J, Graham C, Forbes J, Murray G. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomized controlled trial. Lancet. 2013;382(9891):516-524. https://doi.org/10.1016/S0140-6736(13)61050-8
Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby G, Reddy DJ, Ntouvas I. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev. 2016;9: CD005258. https://doi.org/10.1002/14651858.CD005258.pub3
Pambianco G, Orchard T, Landau P. Deep vein thrombosis: prevention in stroke patients during rehabilitation. Arch Phys Med Rehabil. 1995;76(4):324-330. https://doi.org/10.1016/s0003-9993(95)80657-1
Delis KT, Slimani G, Hafez HM, Nicolaides AN. Enhancing venous outflow in the lower limb with intermittent pneumatic compression. A comparative haemodynamic analysis on the effect of foot vs. calf vs. foot and calf compression. Eur J Vasc Endovasc Surg. 2000;19(3):250-260.
Ryabinkina YuV, Piradov MA, Maksimova MYu, Gnedovskaya EV, Prokazova PR. The problems pertaining to the prophylaxis of venous thromboembolism following severe stroke. Flebologiya. 2015;(1):35-39. (In Russ.) https://doi.org/10.17116/flebo20159135-39
Shulgina LE, Lyadgina TV, Eyrikh AR, Fedyanin SA. Vascular ultrasonography and D-dimer in the diagnosis of deep vein thrombosis in patients with central pareses and paralyses. Flebologiya. 2014;8(2):10-15. (In Russ.)

Close metadata