Intensive Care Medicine

, Volume 39, Issue 5, pp 872–880

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

Authors

  • Philippe Vignon
    • Réanimation PolyvalenteCHU Dupuytren
    • INSERM, CIC-P 0801CHU Dupuytren
    • Université de Limoges
  • Pierre-François Dequin
    • Université François Rabelais et service de Réanimation MédicaleCHU de Tours–Hôpital Bretonneau
  • Anne Renault
    • Service de Réanimation MédicaleCHU de la Cavale Blanche
  • Armelle Mathonnet
    • RéanimationCHR–Hôpital de la Source
  • Nicolas Paleiron
    • Service des maladies respiratoiresHIA Clermont-Tonnerre
  • Audrey Imbert
    • Réanimation MédicaleHEGP AP-HP
  • Delphine Chatellier
    • Service de Réanimation MédicaleCHU de Poitiers
  • Valérie Gissot
    • Service de Réanimation PolyvalenteCH D’Angoulême
  • Gwenaelle Lhéritier
    • Réanimation PolyvalenteCHU Dupuytren
    • INSERM, CIC-P 0801CHU Dupuytren
    • Université de Limoges
  • Victor Aboyans
    • Service de CardiologieCHU de Limoges
  • Gwenael Prat
    • Service de Réanimation MédicaleCHU de la Cavale Blanche
  • Denis Garot
    • Université François Rabelais et service de Réanimation MédicaleCHU de Tours–Hôpital Bretonneau
  • Thierry Boulain
    • RéanimationCHR–Hôpital de la Source
  • Jean-Luc Diehl
    • Réanimation MédicaleHEGP AP-HP
    • INSERM U765Université Paris Descartes
  • Luc Bressollette
    • EA3878Université de Bretagne Occidentale
    • Unité de Médecine VasculaireCHU Brest
  • Aurélien Delluc
    • EA3878Université de Bretagne Occidentale
    • Département de Médecine Interne et PneumologieCHU Brest
    • EA3878Université de Bretagne Occidentale
    • INSERM, CIC 0502
    • CIC 0502, Hôpital de la Cavale Blanche
  • The Clinical Research in Intensive Care and Sepsis Group (CRICS Group)
Original

DOI: 10.1007/s00134-013-2814-2

Cite this article as:
Vignon, P., Dequin, P., Renault, A. et al. Intensive Care Med (2013) 39: 872. doi:10.1007/s00134-013-2814-2

Abstract

Purpose

Venous 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.

Methods

In this multicenter, open-label, randomized trial with blinded evaluation of endpoints, we randomly assigned 407 patients with a high risk of bleeding to receive intermittent pneumatic compression (IPC) associated with graduated compression stockings (GCS) or GCS alone for 6 days during their ICU stay. The primary endpoint was the occurrence of a VTE between days 1 and 6, including nonfatal symptomatic documented VTE, or death due to a pulmonary embolism, or asymptomatic deep vein thrombosis detected by ultrasonography systematically performed on day 6.

Results

The primary outcome was assessed in 363 patients (89.2 %). By day 6, the incidence of the primary outcome was 5.6 % (10 of 179 patients) in the IPC + GCS group and 9.2 % (17 of 184 patients) in the GCS group (relative risk 0.60; 95 % confidence interval 0.28–1.28; p = 0.19). Tolerance of IPC was poor in only 12 patients (6.0 %). No intergroup difference in mortality rate was observed.

Conclusions

With the limitation of a low statistical power, our results do not support the superiority of the combination of IPC + GCS compared to GCS alone to prevent VTE in ICU patients at high risk of bleeding.

Keywords

Intermittent pneumatic compression devicesElastic stockingsVenous thromboembolismVenous thrombosisIntensive care units

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013