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Comparative efficacy and safety of pharmacological prophylaxis and intermittent pneumatic compression for prevention of venous thromboembolism in adult undergoing neurosurgery: a systematic review and network meta-analysis

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Abstract

Whether intermittent pneumatic compression (IPC) is a more effective form of thromboprophylaxis than anticoagulants in individuals undergoing neurosurgery remains controversial. Relevant studies are sparse and inconsistent. Therefore, direct comparisons are difficult to perform and impractical. Hence, we summarized and compared the efficacy and safety of IPC and anticoagulants for the prevention of venous thromboembolism (VTE) in adults undergoing cranial or spinal procedures. Several electronic databases were searched for randomized controlled trials on the use of IPC and anticoagulants for thromboembolism prevention in neurosurgical patients, from inception to August 6, 2019. Studies reporting the selected endpoints were included in direct and Bayesian network meta-analyses to estimate the relative effects of the interventions. Overall, our analysis included 18 trials comprising 2474 patients. Both IPC (RR, 0.41; 95% CrI, 0.26–0.60) and chemical prophylaxis (RR, 0.48; 95% CrI, 0.28–0.68) were found to be more efficacious than the placebo in reducing the risk of deep vein thrombosis (DVT). In addition, our analysis also demonstrated that both IPC (RR, 0.10; 95% CrI, 0.01–0.60) and chemical prophylaxis (RR, 0.31; 95% CrI, 0.05–1.00) reduced the risk of pulmonary embolism (PE) significantly more than the placebo. Based on the available evidence of moderate-to-good quality, IPC is equivalent to anticoagulants for thromboprophylaxis in terms of efficacy. Evidence to support or negate the use of pharmacological prophylaxis in terms of safety is lacking. The results of ongoing and future large randomized clinical trials are needed.

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Funding

This work was funded by the 1.3.5 Project for Disciplines of Excellence of West China Hospital of Sichuan University (grant number: ZY2016102).

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Authors and Affiliations

  1. Department of neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Xing Wang, Yu Zhang, Fang Fang & Chao You

  2. Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China

    Lu Jia

  3. Sichuan University Library, Chengdu, Sichuan, China

    Ping Xu

  4. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Andrew Faramand

Authors
  1. Xing Wang
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Contributions

Dr. Fang was the guarantor of the review. Dr. You received the funding.

Project design: Wang, Zhang, and Fang; data collection: Wang, Zhang, Fang, Jia, Faramand, You, and Xu; manuscript drafting: Wang, Zhang, Fang, Jia, Faramand, You, and Xu; statistical analysis: Wang, Zhang, Fang, Jia, Faramand, You, and Xu; manuscript revision: Wang, Zhang, Fang, Faramand, and You. Supervision: Wang, Zhang, and Fang.

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Correspondence to Fang Fang.

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Wang, X., Zhang, Y., Fang, F. et al. Comparative efficacy and safety of pharmacological prophylaxis and intermittent pneumatic compression for prevention of venous thromboembolism in adult undergoing neurosurgery: a systematic review and network meta-analysis. Neurosurg Rev 44, 721–729 (2021). https://doi.org/10.1007/s10143-020-01297-0

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