Intermittent pneumatic compression to prevent venous thromboembolism in patients with high risk of bleeding hospitalized in intensive care units: the CIREA1 randomized trial

  title={Intermittent pneumatic compression to prevent venous thromboembolism in patients with high risk of bleeding hospitalized in intensive care units: the CIREA1 randomized trial},
  author={Philippe Vignon and Pierre François Dequin and Anne Renault and Armelle Mathonnet and Nicolas Paleiron and Audrey Imbert and Delphine Chatellier and Val{\'e}rie Gissot and Gw{\'e}na{\"e}lle Lh{\'e}ritier and Victor Aboyans and Gw{\'e}na{\"e}l Prat and Denis Garot and Thierry Boulain and J. L. Diehl and Luc Bressollette and Aur{\'e}lien Delluc and Karine Lacut and The Scandinavian Critical Care Trials Group},
  journal={Intensive Care Medicine},
PurposeVenous thromboembolism (VTE) is a frequent and serious problem in intensive care units (ICU). Anticoagulant treatments have demonstrated their efficacy in preventing VTE. However, when the bleeding risk is high, they are contraindicated, and mechanical devices are recommended. To date, mechanical prophylaxis has not been rigorously evaluated in any trials in ICU patients.MethodsIn this multicenter, open-label, randomized trial with blinded evaluation of endpoints, we randomly assigned… 
Meta-Analysis of the Role of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Critically Ill Patients
Among critically ill patients, IPC alone, anticoagulation alone, and IPC with anticoAGulation were associated with a significant reduction of VTE and DVT incidence compared with no treatment, however, there was no significant difference between these modalities when compared together.
Can Intermittent Pneumatic Compression Reduce the Incidence of Venous Thrombosis in Critically Ill Patients: A Systematic Review and Meta-Analysis
Intermittent pneumatic compression can reduce the incidence of VTE for critically ill patients, which is better than GCS and similar to LMWH, but it has no significant advantage as an adjunct therapy for thromboprophylaxis.
Does intermittent pneumatic compression PREVENT deep vein thrombosis in the ICU?
Stratified Meta-Analysis of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Hospitalized Patients
IPC was effective in reducing venous thromboembolism, and combining pharmacological thromboprophylaxis with IPC was more effective than using IPC alone.
European guidelines on perioperative venous thromboembolism prophylaxis: Intensive care.
An institution-wide protocol for the prevention of venous thromboembolism is recommended and the use of pharmacological prophylaxis in critically ill patients with severe liver dysfunction should be carefully balanced against the risk of bleeding.
European guidelines on perioperative venous thromboembolism prophylaxis: Mechanical prophylaxis.
This work recommends against the use of GCS alone without pharmacological thromboprophylaxis for prevention of VTE in patients at intermediate and high risk and suggests combined mechanical and pharmacological prophylaxis in selected patients at very high risk of V TE proplylaxis.
Pharmacological and Mechanical Thromboprophylaxis in Critically Ill Patients: a Network Meta-Analysis of 12 Trials
A meta-analysis of randomized controlled trials that compared the overall incidence of deep vein thrombosis (DVT) for between unfractionated heparin (UFH), low-molecular-weight heparine (LMWH), and intermittent pneumatic compression (IPC) in critically ill patients found the incidence of DVT was significantly lower in patients treated with UFH than in patients treating with LMWH.
Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis
Thromboprophylaxis is needed in all ICU patients, mainly with low molecular weight heparin, such as fragmine, which can be used even in cases of non-severe renal failure, Nevertheless, VTE can occur despite well-conducted thrombobembolism, which has to be used if anticoagulation is not possible.
A new device for the prevention of pulmonary embolism in critically ill patients: Results of the European Angel Catheter Registry
Early bedside placement of an IVC filter–catheter is possible, and the results suggest that this is a safe, effective alternative to short-term PE prophylaxis for high-risk patients with contraindications to anticoagulation.
Prévention de la thrombose veineuse chez les patients obèses en réanimation Thromboprophylaxis for Overweight Critically Ill Patients
Using low molecular weight heparin (L WMHs) is logical, because LWMHs remain the best-documented anticoagulant class in OP, and benefit of weight based dosing regimens for LMWH in VTE prevention is not proven for OP in ICU or in bariatric surgery.


Prevention of venous thrombosis in patients with acute intracerebral hemorrhage
Intermittent pneumatic compression significantly decreased the occurrence of asymptomatic deep vein thrombosis (DVT) for patients with intracerebral hemorrhage.
Venous thromboembolism and bleeding in critically ill patients with severe renal insufficiency receiving dalteparin thromboprophylaxis: prevalence, incidence and risk factors
In ICU patients with renal insufficiency, the incidence of DVT and major bleeding are considerable but appear related to patient comorbidities rather than to an inadequate or excessive anticoagulant from thromboprophylaxis with dalteparin.
Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD. The Association of Non-University Affiliated Intensive Care Specialist Physicians of France.
Low molecular weight heparins are as effective as unfractionated heparin in deep-vein thrombosis (DVT) prophylaxis for major surgery and subcutaneous nadroparin resulted in 45% decrease in incidence of DVT compared with placebo.
High risk of the critically ill for venous thromboembolism
  • J. Cade
  • Medicine
    Critical care medicine
  • 1982
The critically ill are at high risk of venous thromboembolism and low-dose heparin prophylaxis is warranted in those who have no hemostatic impairment, according to a randomized, double-blind study.
Deep vein thrombosis and its prevention in critically ill adults.
Critically ill patients commonly develop DVT, with rates that vary from 22% to almost 80%, depending on patient characteristics, so more potent prophylactic regimens other than unfractionated or low-molecular-weight heparins alone may be needed with higher-risk groups.
Deep venous thrombosis in medical-surgical critically ill patients: Prevalence, incidence, and risk factors
Despite universal thromboprophylaxis, medical-surgical critically ill patients remain at risk for lower extremity deep venousThrombosis, and further research is needed to evaluate the risks and benefits of more intense venous thromboembolism prophylaxis.
Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
Decisions regarding prophylaxis in nonsurgical patients should be made after consideration of risk factors for both thrombosis and bleeding, clinical context, and patients' values and preferences.
Mechanical thromboprophylaxis in critically ill patients: a systematic review and meta-analysis.
The limited evidence suggests that use of compressive and pneumatic devices yields results not significantly different from results obtained with no treatment or use of low-molecular-weight heparin.
Prevention of deep vein thrombosis in potential neurosurgical patients. A randomized trial comparing graduated compression stockings alone or graduated compression stockings plus intermittent pneumatic compression with control.
The results of this study indicate that graduated compression stockings alone or in combination with IPC are effective methods of preventing DVT in neurosurgical patients.
Dalteparin versus unfractionated heparin in critically ill patients.
Among critically ill patients, dalteparin was not superior to unfractionated heparin in decreasing the incidence of proximal deep-vein thrombosis and prespecified per-protocol analyses were similar to those of the main analyses.