Treatment Options

What are the non-pharmacological means of preventing VTE?

Mechanical methods include:

Graduated compression stockings (GCS):
GCS apply more pressure at the ankle and less up the leg and closer to the knee. This pressure prevents backflow of blood and clot formation. There are knee-length and thigh-length GCS; they have similar physiological effects but the former is easier to apply and more comfortable.
Venous foot pumps:
Venous foot pumps stimulate the physiological venous foot pump by means of compressed air supplied by a pump unit through inflatable garments placed around the foot
Intermittent pneumatic compression (IPC):
IPC apply a controlled pressure to the extremities by means of compressed air supplied by a pump unit through inflatable garments: knee- or thigh-high
Act by increasing venous outflow and reducing stasis within the leg veins

Indications

Table 1. Advantages and Limitations of Mechanical Thromboprophylaxis

Advantages	Limitations
Do not increase the risk of bleeding	Not as intensively studied as pharmacologic thromboprophylaxis (fewer studies and smaller)
Can be used in patients at high bleeding risk	No established standards for size, pressure, or physiologic features
Efficacy has been demonstrated in a number of patient groups	Many specific mechanical devices have never been assessed in any clinical trial
May enhance the effectiveness of anticoagulant thromboprophylaxis	Almost all mechanical thromboprophylaxis trials were unblended and therefore have a potential for bias
May reduce leg swelling	In high-risk groups are less effective than anticoagulant thromboprophylaxis
	Greater effect in reducing calf DVT than proximal DVT
	Effect on PE and death unknown
	May reduce or delay the use of more effective anticoagulant thromboprophylaxis
	Compliance by patients and staff often poor
	Trials may overestimate the protection compared with routine use
	Cost: associated with purchase, storage, dispensing, and cleaning of the devices, as well as ensuring optimal compliance

Table reference: Geerts et al. Chest 2008; 133; 381-453

Stimulation of venous return is best achieved by walking

Vena cava filters

Vena cava filters prevent the migration of thrombi into the pulmonary circulation
Two types: permanent or retrievable
Generally not used for the primary prevention of VTE
Indicated for the prevention of PE in patients with DVT in whom anticoagulant treatment is contraindicated or ineffective
Main drawback: increased risk of DVT and post-thrombotic syndrome following insertion