Alternative physical treatments for deep venous thrombosis prophylaxis in surgical patients: a systematic review

Introduction Venous thromboembolism (VTE) represents a major cause of morbidity and mortality. A variety of novel physical therapies have been proposed for patients in whom standard prophylaxis, including early mobilisation, is contraindicated. This article presents a systematic literature review of alternative physical treatments for VTE prophylaxis, focusing on surgical and trauma patients. Methods Following protocol registration in PROSPERO, a systematic review was conducted in accordance with PRISMA. MEDLINE and EMBASE databases were searched for all studies indexed before 27th of July 2019. Two authors independently screened these articles. Data gathering for eligible articles was also undertaken in parallel by two authors. A formal risk of bias assessment was conducted for each study along with an assessment on the quality of the evidence using the GRADE framework. Results A total of 272 abstracts were identified. After exclusion of duplicates and non-eligible articles, 10 publications were reviewed in detail. Two studies involving electrostimulation, another using a portable intermittent compression device and one study using post-operative calf massage reported a statistically significant reduction in the incidence of deep venous thrombosis when used in conjunction with LMWH. The remaining six articles did not show any significant benefits. Discussion All studies reporting significant benefits have methodological flaws, with a high risk of bias. The evidence base informing alternative physical treatments as prophylactic measures in VTE is limited. Our data suggest that the use of these physical modalities can be beneficial in patients who also received LMWH, whilst these alone are of no benefit. Level of Evidence: II–Systematic Review Contribution of paper: Besides early mobilisation and graduate compression stockings, a variety of non-pharmacological physical therapies have demonstrated a prophylactic benefit for preventing lower limb deep venous thrombosis (DVT) following surgery and trauma. These include electrostimulation, portable automatic pneumatic compression and manual calf massage. According to our findings, these interventions only proved to have a statistically significant benefit when given in conjunction with low-molecular weight heparin (LMWH). There is no evidence to support the use of these interventions alone for DVT prophylaxis, such as in patients with a higher risk of bleeding in which LMWH may be contraindicated