Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis
Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis
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DOI：
10.1056/nejmoa1816150
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发表时间：
2019-04-04
影响因子：
158.5
通讯作者：
Al-Dawood, A.
中科院分区：
文献类型：
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作者：
Arabi, Y. M.;Al-Hameed, F.;Al-Dawood, A.
对于接受药物血栓预防的危重患者，连续间歇性气动加压是否会导致深静脉血栓形成的发生率低于单独的药物血栓预防尚不确定。方法我们根据参与研究中心的当地标准随机分配被认为是成年人的患者（>= 14，>= 16，或>= 18岁），在进入重症监护室（ICU）后48小时内，除普通肝素或低分子量肝素的药物血栓预防外，每天接受至少18小时的间歇性气动压缩（气动压缩组）或单独的药物血栓预防（对照组）。主要结局是事件（即，新的）近端下肢深静脉血栓形成，自随机化后第三个日历日后每周两次下肢超声检查发现，直至ICU出院、死亡、达到完全活动能力或试验第28天（以先发生者为准）。结果共2003例患者接受随机分组，其中991例被分配到气动加压组，1012例被分配到对照组。间歇性气动加压平均每天22小时（四分位距，21 - 23），平均7天（四分位距，4 - 13）。气动加压组957例患者中有37例（3.9%）发生主要结局，对照组985例患者中有41例（4.2%）发生主要结局（相对风险，0.93; 95%置信区间[CI]，0.60 - 1.44; P=0.74）。静脉血栓栓塞（肺栓塞或任何下肢深静脉血栓形成）发生在991例患者中的103例气动压缩组中有95例（10.4%），1012例患者中有95例对照组为9.4%（相对危险度，1.11; 95% CI，0.85 - 1.44），990例患者中有258例在90天时发生全因死亡（26.1%）和1011例患者中的270例（26.7%）（相对风险，0.98; 95%CI，0.84至1.13）。结论：在接受药物血栓预防的危重患者中，连续间歇性气动压迫并没有导致近端下肢深静脉血栓形成的发生率比单独药物血栓预防显著降低。（由阿卜杜拉国王科技城和阿卜杜拉国王国际医学研究中心资助; PREVENT ClinicalTrials.gov编号，;当前对照试验编号，。
Background Whether adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in a lower incidence of deep-vein thrombosis than pharmacologic thromboprophylaxis alone is uncertain. Methods We randomly assigned patients who were considered adults according to the local standards at the participating sites (>= 14, >= 16, or >= 18 years of age) within 48 hours after admission to an intensive care unit (ICU) to receive either intermittent pneumatic compression for at least 18 hours each day in addition to pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin (pneumatic compression group) or pharmacologic thromboprophylaxis alone (control group). The primary outcome was incident (i.e., new) proximal lower-limb deep-vein thrombosis, as detected on twice-weekly lower-limb ultrasonography after the third calendar day since randomization until ICU discharge, death, attainment of full mobility, or trial day 28, whichever occurred first. Results A total of 2003 patients underwent randomization - 991 were assigned to the pneumatic compression group and 1012 to the control group. Intermittent pneumatic compression was applied for a median of 22 hours (interquartile range, 21 to 23) daily for a median of 7 days (interquartile range, 4 to 13). The primary outcome occurred in 37 of 957 patients (3.9%) in the pneumatic compression group and in 41 of 985 patients (4.2%) in the control group (relative risk, 0.93; 95% confidence interval [CI], 0.60 to 1.44; P=0.74). Venous thromboembolism (pulmonary embolism or any lower-limb deep-vein thrombosis) occurred in 103 of 991 patients (10.4%) in the pneumatic compression group and in 95 of 1012 patients (9.4%) in the control group (relative risk, 1.11; 95% CI, 0.85 to 1.44), and death from any cause at 90 days occurred in 258 of 990 patients (26.1%) and 270 of 1011 patients (26.7%), respectively (relative risk, 0.98; 95% CI, 0.84 to 1.13). Conclusions Among critically ill patients who were receiving pharmacologic thromboprophylaxis, adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone. (Funded by King Abdulaziz City for Science and Technology and King Abdullah International Medical Research Center; PREVENT ClinicalTrials.gov number, ; Current Controlled Trials number, .)