Effect of Intermittent Pneumatic
Compression on Preventing Deep Vein
Thrombosis Among Stroke Patients: A
Systematic Review and Meta-Analysis
Dongdong Zhang, MM • Fenfen Li, MM • Xiaotian Li, PhD • Ganqin Du, MD
Background: Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) are common
complications of stroke. However, the effect of intermittent pneumatic compression (IPC) for
patients after stroke is uncertain.
Objectives: To assess the effectiveness and safety of IPC in reducing the risk of DVT, PE, and
mortality in stroke patients.
Methods: We searched leading medical databases including Medline, EMBASE, Cochrane Li-
brary, Wanfang, CNKI, and CBM, from inception to June 2, 2017. Studies comparing IPC with
no IPC in stroke patients were included. Agreement was measured using simple agreement and
kappa statistics. The rates of PE, DVT, and mortality were compared. The results were pooled
using a ﬁxed effects model to evaluate the differences between the IPC and control groups. If
there was signiﬁcant heterogeneity in the pooled result, a random effect model was used.
Results: We identiﬁed seven randomized controlled trials that included 3,551 stroke patients. The
average calculated κ for the various parameters was κ = 0.96 (0.70–1). Overall, IPC signiﬁcantly
reduced the incidence of DVT in stroke patients (risk ratio [RR] = 0.50; 95% conﬁdence interval
[CI 0.27, 0.94]). At the same time, IPC increased IPC-related adverse events (RR = 5.71; 95% CI
[3.40, 9.58]). Though IPC was associated with a signiﬁcant increase in survival by 4.5 days during
6 months of follow-up (148–152 days; 95% CI [–0.2, 9.1]), there was a mean gain of only 0.9 days
(26.7–27.6 days; 95% CI [2.1, 3.9]) in quality-adjusted survival during the 6-month follow-up.
Overall, sensitivity analyses did not alter these ﬁndings.
Linking Evidence to Action: This review provides an important basis for preventing DVT in
stroke patients, especially in hemorrhagic stroke patients. IPC signiﬁcantly reduces the risk of
DVT and signiﬁcantly improves survival in a wide variety of patients who are immobile after
stroke. However, IPC does not signiﬁcantly improve quality-adjusted survival. Clinicians should
take functional status and quality of life into consideration when making decisions for stroke
Deep vein thrombosis (DVT) and pulmonary embolism (PE)
are known to be the most important, preventable event among
hospitalized patients (Dennis, 2013). Patients after stroke who
have signiﬁcant weakness of the leg or are immobile appear
to be at great risk. Evidence shows that 40% of stroke patients
appear to demonstrate DVTs in the ﬁrst three weeks and
above-knee DVT accounts for 18% of DVTs (Dennis, 2013).
Clinically evident PE varies from 1% to 30%. The prevention
techniques for DVT in stroke patients include mechanical
thromboprophylaxis and pharmacological thromboprophy-
laxis. Though there is evidence showing that the use of
anticoagulation in patient after acute stroke signiﬁcantly
reduces the incidence of DVT (with a risk reduction 54–71%;
Naccarato, Chiodo Grandi, Dennis, & Sandercock, 2010), its
beneﬁt was offset by extracranial hemorrhages. The overlap of
factors that predict venous thrombosis with those that predict
bleeding risk resulted in the underuse of anticoagulation and
the high risk of DVT in patients who were not treated with
anticoagulation in a timely fashion.
Due to the uncertainties about the net beneﬁt of anticoag-
ulation for patients after stroke, interest in mechanical throm-
boprophylaxis to prevent DVTs has increased. Intermittent
pneumatic compression (IPC), as one part of mechanical
thromboprophylaxis, includes inﬂatable sleeves that can be ap-
plied to the calf, thigh, or both. IPC was thought to reduce
Worldviews on Evidence-Based Nursing, 2018; 15:3, 189–196.
2018 Sigma Theta Tau International