A study by Mark I. Froimson, MD, MBA, Trevor G. Murray, MD, and Alice F. Fazekas, PA-C

Abstract

This study compares a miniaturized, portable, sequential, pneumatic compression device (ActiveCare continuous enhanced circulation therapy [CECT] system) (Medical Compression Systems Ltd, Or Aqiva, Israel), with a nonmobile, nonsequential device on the ability to prevent postoperative deep venous thrombosis (DVT) after joint arthroplasty. All patients were treated with low-molecular-weight heparin, application of 1 of the 2 devices perioperatively, and routine duplex screening. The CECT system had better compliance (83% of the time vs 49%), lower rates of DVT (1.3% compared with 3.6%), reduction in clinically important pulmonary embolism (0 compared to 0.66%), and shorter length of hospital stay (4.2 vs. 5.0 days). The portable CECT system proved significantly more effective than the standard intermittent pneumatic compression when used in conjunction with low-molecular-weight heparin for DVT prevention in high-risk orthopedic patients.

Results

During a 15-month interval, 1810 consecutive joint arthroplasty patients were available for review. This period included the 12 months before the conversion from Flowtron to the CECT device and the 3 months of CECT use. All patients in this group survived surgery, and there were no deaths during 30 days of follow-up. One thousand five hundred sixty patients, who were operated upon during the first 12 months of the study, received the Flowtron device for DVT prophylaxis; 1354 remained in the study at time of analysis. All patients followed our DVT prophylaxis standard protocol, which is based upon a combination of enoxaparin and IPCs. During the last 3 months of the study, the standard stationary IPC system was replaced by the CECT system. Two hundred fifty patients were enrolled in the CECT arm of the study. At time of analysis, 223 remained in the study. The approximate 10% exclusion rate in both groups was secondary to patients being included in the sequence but whose surgery was a procedure other than either a primary or revision arthroplasty. Patients treated for tumor, fracture, or resection arthroplasty were excluded from analysis. Baseline characteristics including age, gender, type of arthroplasty, and their comormidities were comparable in the two groups (Table 1). There were no statistically significant differences between the 2 treatment groups with regard to their DVT risk scores and their safety profiles.

This study was published in The Journal of Arthroplasty.

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