静脉血栓栓塞事件(VTE)是住院患者常见的并发症,也是医院可预防死亡的主要原因。药物预防是在有风险的患者中预防VTE的标准护理,间歇性气动压缩(IPC)的附加值是不确定的。我们旨在评估将IPC添加到药物预防以预防住院成人VTE的有效性。
方法:我们搜索了Cochrane中央对照试验登记册,Embase,MEDLINE,护理和相关健康文献的累积指数,ClinicalTrials.gov,和国际临床试验注册平台从成立到2022年7月。
方法:我们纳入了随机对照试验,比较了在住院成年人中使用IPC以及药理学血栓预防与单独的药理学血栓预防。
方法:进行Meta分析以计算VTE的风险比(RR)。深静脉血栓形成(DVT),和肺栓塞(PE)。我们使用Cochrane偏差风险工具进行随机试验,版本2和使用建议等级评估的证据质量,开发和评估方法。
结果:我们纳入了17项试验,招募了8,796名参与者。IPC主要应用于大腿,药理学血栓预防主要是低分子量肝素。辅助IPC与VTE风险降低相关(15项试验,RR=0.53;95%CI[0.35-0.81])和DVT(14项试验,RR=0.52;95%CI[0.33-0.81]),但不是PE(7项试验,RR=0.73;95%CI[0.32-1.68])。证据质量等级较低,因偏见和不一致的风险而降级。中等和非常低质量的证据,分别,提示辅助IPC不太可能改变全因死亡或不良事件的风险.亚组分析表明,在行业资助的试验中有更明显的明显益处。
结论:结果表明低质量的证据支持IPC用于预防VTE和DVT的药物血栓预防。需要进一步的大型高质量随机试验来支持其使用,并确定可能对其有益的患者亚组。
Venous thromboembolic events (VTE) are frequent complications in hospitalized patients and a leading cause of preventable death in hospital. Pharmacologic prophylaxis is a standard of care to prevent VTE in patients at risk, the additional value of intermittent pneumatic compression (IPC) is uncertain. We aimed to evaluate the efficacy of adding IPC to pharmacologic prophylaxis to prevent VTE in hospitalized adults.
METHODS: We searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and the International Clinical Trials Registry Platform from inception to July 2022.
METHODS: We included randomized controlled trials comparing the use of IPC in addition to pharmacological thromboprophylaxis to pharmacological thromboprophylaxis alone in hospitalized adults.
METHODS: Meta-analyses were performed to calculate risk ratio (RR) of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE). We assessed the risk of bias using the Cochrane Risk of Bias Tool for Randomized Trials, Version 2 and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS: We included 17 trials enrolling 8,796 participants. The IPC was mostly applied up to the thigh and pharmacological thromboprophylaxis was primarily low-molecular-weight heparin. Adjunctive IPC was associated with a decreased risk of VTE (15 trials, RR = 0.53; 95% CI [0.35-0.81]) and DVT (14 trials, RR = 0.52; 95% CI [0.33-0.81]) but not PE (seven trials, RR = 0.73; 95% CI [0.32-1.68]). The quality of evidence was graded low, downgraded by risk of bias and inconsistency. Moderate and very low-quality evidence, respectively, suggests that adjunctive IPC is unlikely to change the risk of all-cause mortality or adverse events. Subgroup analyses indicate a more evident apparent benefit in industry-funded trials.
CONCLUSIONS: Results indicate low-quality evidence underpinning the additional use of IPC to pharmacological thromboprophylaxis for prevention of VTE and DVT. Further large high-quality randomized trials are warranted to support its use and to identify patient subgroups for whom it could be beneficial.