ABSTRACT
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism,
is a leading health-care problem whose pathogenesis is usually related to the so-called
Virchow's triad and involves a variety of factors classified as inherited or acquired,
predisposing, or triggers. The main goal of thromboprophylaxis is to reduce mortality
and morbidity associated with VTE risk factors. Although striking evidence now indicates
that the various pharmacological anticoagulant therapies can substantially lower the
risk, this benefit might be offset by a small but definite risk of hemorrhage in some
circumstances. Mechanical prophylaxis methods have been suggested because they counteract
most of the components of the Virchow's triad and are not associated with any bleeding
risk. Although early and frequent ambulation has been historically advised for preventing
VTE, this measure is inadequate per se and frequently not feasible as the sole means
of mechanical thromboprophylaxis. Accordingly, additional measures are being used
in clinical practice, including graded compression stockings, intermittent pneumatic
compression devices, and venous foot pumps. Although the efficiency of these measures
has been extensively assessed in several clinical studies, there remain unanswered
questions, including their suboptimal use and the lack of unequivocal clinical evidence
supporting real benefits for preventing VTE. Overall, mechanical compression methods
can reduce the risk of VTE by nearly two thirds when used as the only form of thromboprophylaxis
and by about half when combined with a pharmacological approach. The main mechanism
of action appears to be related to a milking (wavelike) effect to evacuate leg veins
and reduce venous stasis because an effect on the enhancement of fibrinolysis remains
unproven. Although the biological and clinical evidence suggests that graduate compression
stockings are an effective, relatively cheap, and more comfortable thromboprophylactic
measure, they appear less effective overall than intermittent pneumatic compression.
In conclusion, although the preventive benefits of mechanical prophylaxis on VTE might
be circumscribed to select medical and surgical settings, there appears to exist no
clinical reason to discourage adoption of these measures when indicated.
KEYWORDS
Thrombosis - prophylaxis - graded compression stockings - intermittent pneumatic compression
devices - venous foot pumps
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Professor Giuseppe LippiM.D. U.O.
Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria di Parma
Via Gramsci 14, 43126 Parma, Italy
eMail: glippi@ao.pr.it
eMail: ulippi@tin.it
