PREVENT (mechanical thromboprophylaxis)
Trial question
What is the role of adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
43.0% female
57.0% male
N = 2003
2003 patients (855 female, 1148 male).
Inclusion criteria: adult patients within 48 hours after admission to an ICU.
Key exclusion criteria: ICU admittance > 48 hours, contraindications to pharmacologic thromboprophylaxis, inability or contraindication to applying intermittent pneumatic compression to both legs.
Interventions
N=991 pneumatic compression (intermittent pneumatic compression for at least 18 hours each day plus pharmacologic thromboprophylaxis).
N=1012 control (pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin alone).
Primary outcome
Incident proximal deep vein thrombosis
3.9%
4.2%
4.2 %
3.2 %
2.1 %
1.1 %
0.0 %
Pneumatic
compression
Control
No significant
difference ↔
No significant difference in incident proximal DVT (3.9% vs. 4.2%; RR 0.93, 95% CI 0.6 to 1.44).
Secondary outcomes
No significant difference in VTE (10.4%% vs. 9.4%%; RR 1.11, 95% CI 0.85 to 1.44).
No significant difference in lower-limb DVT, PE, or death from any cause at 28 days (23.3% vs. 24%; RR 0.97, 95% CI 0.83 to 1.14).
No significant difference in death from any cause at 90 days (26.1% vs. 26.7%; RR 0.98, 95% CI 0.84 to 1.13).
Safety outcomes
No significant differences in lower limb skin injury, limb ischemia.
Conclusion
In adult patients within 48 hours after admission to an ICU, pneumatic compression was not superior to control with respect to incident proximal DVT.
Reference
Yaseen M Arabi, Fahad Al-Hameed, Karen E A Burns et al. Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis. N Engl J Med. 2019 Apr 4;380(14):1305-1315.
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