Journal of thrombosis and haemostasis : JTH, 25 4 2025, Pages S1538-7836(25)00269-7 Intermittent compression devices as antithrombotic strategy in neurosurgical interventions: a prospective randomised controlled trial (TIPOTEE). Zhang Z, Marcano A, Huisman MV, van Schaik J, Cannegieter S, Vleggeert-Lankamp CLA
Objective
To assess the effectiveness of limb intermittent compression devices (ICD) combined with subcutaneous low molecular weight heparin (LMWH) compared to LMWH alone as a prophylactic strategy for venous thromboembolism (VTE).
Methods
Patients undergoing elective lengthy neurosurgical procedures were randomised to perioperative 48-hour ICD + LMWH or to LMWH alone. Duplex ultrasonography was performed postoperatively to evaluate the presence of VTE ('VTE systematic screening'). Two months after surgery clinical signs of VTE during the postoperative period were appraised ('VTE clinical symptoms') and quality of life was evaluated. Possible risk factors for VTE were evaluated.
Results
A total of 283 patients were included in the study. The VTE incidence in the treatment arm 'ICD + LMWH' was 2.5% based on clinical symptoms, and 0% based on systematic screening, while the VTE incidence in the control arm 'LMWH' was 3.1% (risk difference: - 0.6% (CI 95% - 4.5 to 3.4)) based on clinical symptoms, and 1.0% (risk difference: - 1.0% (CI 95% -3.0 to 1.0)) based on systematic screening. In total, the relative risk for VTE in the 'ICD + LMWH' treatment vs 'LMWH' was 0.7 (CI 95% 0.2 to 3.3), corrected for age and sex.
Conclusion
Limb intermittent compression therapy in addition to LMWH as antithrombotic therapy in the perioperative setting is not likely to lead to less venous thromboembolic events in lengthy neurosurgical interventions. The start of administration of LMWH preoperatively rather than postoperatively seems beneficial.
