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Mechanical Compression Versus Subcutaneous Heparin Therapy in Postoperative and Posttrauma Patients: A Systematic Review and Meta-Analysis

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Abstract

Background

The risk of postoperative venous thromboembolic disease is as high as 30%, with an associated fatality risk of 1%. Therefore, prophylaxis is essential, but the optimal regimen remains controversial. This study was designed to systematically review and quantitatively summarize the impact of mechanical compression versus subcutaneous heparin on venous thromboembolic disease and posttreatment bleeding in postsurgical and posttrauma patients.

Methods

Computerized searches of the MEDLINE and EMBASE databases through November 2008 were performed and supplemented with manual searches. We included studies that had: (1) a patient population undergoing surgery or admitted immediately posttrauma, (2) a randomized comparison of prophylaxis with mechanical compression versus subcutaneous heparin, (3) outcome measured in terms of deep vein thrombosis (DVT), pulmonary embolism (PE), or bleeding.

Results

Two reviewers independently extracted data from the original articles, which represented 16 studies, including a total of 3,887 subjects. Meta-analysis was performed using a random effects model. The pooled relative risk for mechanical compression compared with subcutaneous heparin was 1.07 (95% confidence interval [CI] 0.72, 1.61) for DVT and 1.03 (95% CI 0.48, 2.22) for PE. Mechanical compression was associated with a significantly reduced risk of postoperative bleeding compared with subcutaneous heparin (risk ratio 0.47; 95% CI 0.31, 0.70). Subgroup analyses by heparin type suggested that low molecular weight heparin may reduce risk of DVT compared with compression (relative risk 1.80; 95% CI 1.16, 2.79) but remains similarly associated with an increased risk of bleeding.

Conclusions

These results suggest that the overall bleeding risk profile favors the use of compression over heparin, with the benefits in term of venous thromboembolic disease prophylaxis being similar between groups. Subgroup analyses suggest that low molecular weight heparin may have a differential effect; this observation should be further evaluated in future studies.

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Acknowledgments

Jennifer J. Shin thanks Mr. Thomas Y. Lin for his assistance during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of Iowa, 200 Hawkins Drive, Iowa, IA, 52242-1078, USA

    Robert W. Eppsteiner

  2. Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA

    Jennifer J. Shin

  3. Department of Otolaryngology, University of Pittsburgh School of Medicine, 203 Lothrop Street, Pittsburgh, PA, 15213, USA

    Jonas Johnson

  4. Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA

    Rob M. van Dam

Authors
  1. Robert W. Eppsteiner
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  2. Jennifer J. Shin
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Corresponding author

Correspondence to Jennifer J. Shin.

Additional information

Drs. Eppsteiner and Shin are first co-authors and contributed equally to the work.

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Eppsteiner, R.W., Shin, J.J., Johnson, J. et al. Mechanical Compression Versus Subcutaneous Heparin Therapy in Postoperative and Posttrauma Patients: A Systematic Review and Meta-Analysis. World J Surg 34, 10–19 (2010). https://doi.org/10.1007/s00268-009-0284-z

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