Date of Graduation

Summer 8-8-2015

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Annjanette Sommers, PA-C, MS

Abstract

Background: Venous thromboembolisms (VTE) are an important complication following arthroplasty of the knees and hips, and proper prophylaxis protocol continues to be a source of debate in the medical community. In the past patients have been managed with pharmaceutical anticoagulants (eg, LMWH), mechanical compression, or a combination of the two. The inability to use mechanical compression on an outpatient basis has limited its use in the past, but the introduction of an outpatient mobile compression devices (MCDs) that monitors compliance has brought mobile compression devices to the forefront of VTE prophylaxis research. The aim of this review is to evaluate the use of MCDs as compared to pharmaceutical anticoagulants.

Methods: Exhaustive search was conducted using Medline-OVID, CINAHL, and Web of Science using the keywords: mobile compression. All results were reviewed and selected according to the predefined eligibility criteria. Relevant articles were assessed for quality using GRADE.

Results: Two studies met inclusion criteria and were included in this systematic review. A randomized control trial with 414 participants was unable to determine equivalency between the MCD and LMWH at VTE prophylaxis due to small sample size. They were however able to demonstrate a significant decrease in major bleeding events with use of the MCD. A prospective observational study with 23 260 participants demonstrated statistically noninferior VTE prophylaxis between the MCD group and the pharmaceutical anticoagulant group.

Conclusion: Use of a MCD following a total joint arthroplasty (TJA) in the lower extremity may provide statistically noninferior VTE prevention rates when compared to the current pharmacological treatment options. Unlike pharmacologic anticoagulants, the use of a MCD does not increase the ris of a major bleeding event. This elimination of major bleeding complications makes implementation of MCD use following a TJA instead of anticoagulants a promising option for cost effective VTE prophylaxis.

Keywords: Mobile compression, Arthroplasty, Venous thromboembolism, pharmaceutical anticoagulants

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