| Background and Objective: venous thromboembolism(VTE), including deep vein thrombosis(DVT) and pulmonary thromboembolism(PTE), DVT and PTE are the VTE course of the two different stages of different clinical manifestations, its pathogenesis from asymptomatic to sudden death, etc., but it is also a completely preventable nosocomial acquired diseases. Anticoagulant drug and mechanical method are main ideas for thrombosis prevention in clinical, but the effect of former one had been confirmed. But for critically ill patients, especially in medical critically ill patients, did not received great importance to preventing thrombosis because of less clearly antithrombotic indications than surgical patients. Moreover, the use of anticoagulant drug was limited for them because of the severity of the disease may be at risk for the use of anticoagulants taboo or use drug of anticoagulant drugs may lead to higher risk of blood. So seeking effective alternative methods is needed for them. Physical and mechanical prevention is noninvasive, no bleeding risk and in critically ill patients with poor renal function does not need to monitor the blood drug concentration and the most common with intermittent pneumatic compression pumps(IPC), venous foot pump(VFP), graded compression stocking(GCS) or elastic stockings(ES). IPC is the most commonly used, had been widely used in various types of surgery patients to prove the validity of the thrombosis prevention [1,2], but its antithrombotic efficacy and safety are not clear for medical critically ill patients. And related researches for the IPC prevention efficacy evaluation were relatively single, not comprehensive, there were certain dispute on the prevention effect of PTE compared with anticoagulants, it’s necessary to need further study to clear IPC curative effect and security compared with anticoagulants.This study aims to explore the IPC efficacy and safety for medical critical ill patients to prevent VTE, which provide a reference to make full use it.Methods: Methods: Relevant randomized controlled trials(RCTs) were searched in Cochrane library, Web of Science, Pub Med, China Knowledge Resource Integrated Database(CNKI), China Biology Medicine Database(CBM), VIP, and Wan Fang Databases from inception to 31 December, 2015. Meanwhile we searched the dates through other means. RCTs of IPC for medical critical ill patients to prevention VTE were included. We evaluated the quality of these included studies and analyzed date by the Cochrane Collaboration’s Rev Man 5.3 software.Results: The original search identified 630 articles in electronic database. We excluded 486 studies after review of the title, abstract and repetition. 42 articles were assessed their accordance with the predefined inclusion criteria. Finally, 19 articles were considered eligible for inclusion in the Meta-analysis, 5 articles were published in English and 14 articles was published in Chinese.(1) IPC prevention for medical critically ill patients with lower extremity DVT: there were 19 articles including 17 articles for the IPC group compared with blank control group of Meta- analysis showed that: the IPC effectively in lower extremity DVT prevention was better than that of blank control group(Rate Risk, RR=0.25,P<0.0001 [95%CI:0.15-0.41]), for its large heterogeneity(I2= 63% > 50%, P = 0.0003), then we had the subgroup analysis according to the research on into interventions properties(whether in IPC group and the control group meanwhile giving other preventive measures, such as anticoagulants, GCS). The two subgroups results showed that the IPC was efficient for them in lower extremity DVT compared control groups(RR=0.17,P<0.00001 [95%CI: 0.11-0.27]),(RR=0.23,P=0.006 [95%CI: 0.16-0.33]). The other 2 articles for the IPC group compared with anticoagulation control of Meta-analysis showed that: the use of anticoagulants group of lower extremity DVT prevention effectiveness is not superior to the IPC group, its the RR and 95%CI in the IPC and anticoagulants compared effect across the invalid line, there is no statistical significance(RR=2.47, P=0.12 [95%CI:0.79-7.75]).(2) the IPC prevention for medical critically ill patients with PTE: there were 7 articles included to compare the incidence of PTE for medical critically ill patients, and the result showed IPC group was not better in prevention of PTE than the control group(RR=0.66, P=0.06 [95%CI: 0.43-1.02]) meanwhile there was no statistical heterogeneity between all the studies(I2 = 0%, P = 0.43).(3) the IPC prevention for medical critically ill patients with VTE: there are 7 articles into the analysis about incidence of VTE, five study for Meta-analysis of IPC was compared with the blank control group, the results showed that the IPC was better than blank control group for medicine critically ill patients in prevention VTE(RR=0.37, P=0.01 [95%CI: 0.17-0.79]), but the existence of large statistical heterogeneity(I2 = 73%, P = 0.005), according the implementation of the intervention measures length(category for 24 h a day are using the IPC, another kind of use 2 times a day, each time using 30-40 min),we had a subgroup analysis, the results showed that the IPC prevention effectiveness in VTE was still better than that of control group(RR=0.76,P=0.0002[95%CI:0.66-0.88]),(RR=0.15, P<0.00001 [95%CI: 0.07-0.35]); The other 2 articles compared the incidence of VTE between IPC group and anticoagulation control group and the outcome existed large heterogeneity(I2 = 53%, P = 0.14). We decided to undertake a descriptive analysis for them.(4) in the comparison of bleeding for IPC and anticoagulants: a total of 2 articles assessed the bleeding risk for using anticoagulants comparing with IPC, Meta-analysis results showed that the IPC was used anticoagulants to a certain extent reduce the risk of bleeding(RR = 0.42, P = 0.42 [95% CI: 0.20 0.91]).(5) the impact analysis of IPC for ICU patients with time of mechanical ventilation and ICU hospitalization: there are 3 studies using the IPC to prevent thrombosis in patients with time of mechanical ventilation and ICU hospitalization, the influence of the Meta-analysis results showed that the use of IPC in the prevention of thrombosis in ICU patients had no statistical signification [Mean Difference, MD = 1.00, P = 0.11, 95% CI(2.23- 0.23)], [MD = 0.70, P = 0.31, 95% CI(2.03- 0.64)].Conclusion: IPC can be safely and effectively in preventing the happen of VTE especially lower DVT for medical critical ill patients, meanwhile compared with anticoagulant drugs, it had same effective for preventing VTE in medical critical ill patients but without bleeding risk. In a words, IPC is worthy of clinical popularization and application. |
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