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Prevention of venous thrombosis in patients with acute intracerebral hemorrhage

From the Groupe d’Etude de la Thrombose de Bretagne Occidentale, Equipe d’Accueil 3878 (Drs. Lacut, Le Gal, Mottier, and Oger), the Vascular Ultrasonography Unit (Dr. Bressollette), the Neurosurgical Intensive Care Unit (Dr. Etienne), the Surgical Intensive Care Unit (Dr. De Tinteniac), the Medical Intensive Care Unit (Dr. Renault), the Department of Neurology (Dr. Rouhart), the Department of Neurosurgery (Dr. Besson), Cavale Blanche Hospital; and the Department of Radiology (Dr. Garcia), Clermont-Tonnerre Military Hospital, Brest, France.

address correspondence and reprint requests to Dr. Karine Lacut, Department of Internal Medicine and Chest Diseases, Cavale Blanche Hospital, 29609 Brest Cedex, France; email: karine.lacut{at}chu-brest.fr

Objective: To assess intermittent pneumatic compression (IPC) in the prevention of venous thromboembolism (VTE).

Methods: The authors randomly allocated patients with a documented intracerebral hemorrhage (ICH) to elastic stockings (ES) alone or combined with IPC. The primary outcome was a combined criteria assessed at day 10: a symptomatic and well-documented VTE, or a death arising before day 10 and related to pulmonary embolism (PE), or an asymptomatic deep vein thrombosis (DVT) of the lower limbs detected by compression ultrasonography (CUS). Outcome assessment was blinded.

Results: One hundred fifty-one patients were randomized; 133 (88%) patients were evaluated at day 10. No clinical suspicion of VTE arose before day 10. Fourteen patients died before having a CUS but no death was definitely related to PE. Fourteen asymptomatic DVT were detected by CUS: three (4.7%) in the ES + IPC group (all distal) and 11 (15.9%) in the ES group (three proximal and eight distal). ES combined with IPC is associated with a reduced risk of asymptomatic DVT compared to ES alone: relative risk, 0.29 (95% CI 0.08 to 1.00).

Conclusions: Asymptomatic deep vein thrombosis (DVT) was detected at day 10 in 15.9% of patients wearing elastic stockings alone. Intermittent pneumatic compression significantly decreased the occurrence of asymptomatic DVT for patients with intracerebral hemorrhage.

*See the Appendix for a list of Group members.

Supported by grants from Agence Française de Sécurité Sanitaire des Produits de Santé, Ministère de la santé, and Sanofi-Synthelabo, and Tyco Healthcare France S.A.S.

Disclosure: The authors report no conflicts of interest.

Received February 14, 2005. Accepted in final form June 10, 2005.

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