Nonpharmacologic Therapy

Ambulation as soon as possible following surgery lowers the incidence of VTE in low-risk patients.2 Walking increases venous blood flow and promotes the flow of natural antithrombotic factors into the lower extremities. Graduated compression stockings (GCS) reduce the incidence of VTE by approximately 60% following general surgery, neurosurgery, and stroke. Compared with anticoagulant drugs, GCS are relatively inexpensive and safe; however, in higher risk patients they are less effective then pharmacologic agents. They are a good choice in low-to moderate-risk patients when pharmacologic interventions are contraindicated. When combined with pharmacolo-gic interventions, GCS have an additive effect. However, some patients are unable to wear compression stockings because of the size or shape of their legs.

Similar to GCS, intermittent pneumatic compression (IPC) devices increase the velocity of blood flow in the lower extremities. These devices sequentially inflate a series of cuffs wrapped around the patient's legs from the ankles to the thighs and then deflate in 1-to 2-minute cycles. IPC has been shown to reduce the risk of VTE by more than 60% following general surgery, neurosurgery, and orthopedic surgery. Although IPC is well tolerated and safe to use in patients who have contraindications to pharmacologic therapies, it does have a few drawbacks: It is more expensive than the use of GCS, it is a relatively cumbersome technique, and some patients may have difficulty sleeping while using it. To be effective, IPC needs to be used throughout the day. In practice, this has been difficult to achieve and special efforts should be made to ensure that the devices are worn and operational for the majority of the day.

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