ORIGINAL ARTICLE

Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis

Yaseen M. Arabi, Fahad Al-Hameed, Karen E.A. Burns, et al

N Engl J Med February 18, 2019
DOI: 10.1056/NEJMoa1816150

BACKGROUND 背景

Whether adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in a lower incidence of deep-vein thrombosis than pharmacologic thromboprophylaxis alone is uncertain.

对于使用药物预防血栓的危重病患者，辅助性间断气动加压与单纯药物预防血栓相比，能否降低DVT发生率尚不明确。

METHODS 方法

We randomly assigned patients who were considered adults according to the local standards at the participating sites (≥14, ≥16, or ≥18 years of age) within 48 hours after admission to an intensive care unit (ICU) to receive either intermittent pneumatic compression for at least 18 hours each day in addition to pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin (pneumatic compression group) or pharmacologic thromboprophylaxis alone (control group). The primary outcome was incident (i.e., new) proximal lower-limb deep-vein thrombosis, as detected on twice-weekly lower-limb ultrasonography after the third calendar day since randomization until ICU discharge, death, attainment of full mobility, or trial day 28, whichever occurred first.

我们将ICU收治48小时内的成年患者（根据参研中心当地标准有所不同，年龄≥14， ≥16 或 ≥18 岁）随机分组，一组患者除普通肝素或低分子肝素药物预防外，还接受间断气动加压每天至少18个小时（气动加压组），另一组患者单纯接受血栓药物预防（对照组）。主要预后终点为近端新发DVT，于随机分组后第3天每周2次进行下肢超声检查，直至从ICU转出，死亡，达到完全活动状态，或第28天（以先发生事件为准）。

RESULTS 结果

A total of 2003 patients underwent randomization — 991 were assigned to the pneumatic compression group and 1012 to the control group. Intermittent pneumatic compression was applied for a median of 22 hours (interquartile range, 21 to 23) daily for a median of 7 days (interquartile range, 4 to 13). The primary outcome occurred in 37 of 957 patients (3.9%) in the pneumatic compression group and in 41 of 985 patients (4.2%) in the control group (relative risk, 0.93; 95% confidence interval [CI], 0.60 to 1.44; P=0.74). Venous thromboembolism (pulmonary embolism or any lower-limb deep-vein thrombosis) occurred in 103 of 991 patients (10.4%) in the pneumatic compression group and in 95 of 1012 patients (9.4%) in the control group (relative risk, 1.11; 95% CI, 0.85 to 1.44), and death from any cause at 90 days occurred in 258 of 990 patients (26.1%) and 270 of 1011 patients (26.7%), respectively (relative risk, 0.98; 95% CI, 0.84 to 1.13).

共有2003名患者接受随机分组—991名患者分至气动加压组，1012名患者分至对照组。每日使用间断气动加压中位时间为22小时（四分位区间21-23），中位疗程7天（四分位区间4-13）。气动加压组957名患者中37名(3.9%)及对照组985名患者中41名(4.2%)发生主要预后终点（相对危险度，0.93; 95%可信区间[CI], 0.60 to 1.44; P=0.74）。气动加压组991名患者中103名(10.4%)及对照组1012名患者中95名(9.4%)发生静脉血栓栓塞（肺栓塞或任何下肢DVT）（相对危险度，1.11; 95% CI, 0.85 to 1.44），气动加压组990名患者中258名(26.1%)以及对照组1011名患者中270名(26.7%)在90天内死亡（相对危险度0.98；95% CI, 0.84 to 1.13）。

CONCLUSIONS 结论

Among critically ill patients who were receiving pharmacologic thromboprophylaxis, adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone.

对于接受药物预防血栓的危重病患者，与单纯药物预防相比，辅助性间断气动加压不能显著降低近端下肢DVT的发生率。

(Funded by King Abdulaziz City for Science and Technology and King Abdullah International Medical Research Center; PREVENT ClinicalTrials.gov number, NCT02040103; Current Controlled Trials number, ISRCTN44653506.)