Опубликовать статью

Информационное партнерство

Инфоресурсы

Контакты

«

Vol. 14, Art. 50 (pp. 599-618)    |    2013       

»

The role of electrical calf stimulation in combined prophylaxis of venous thromboembolism in high risk surgical patients

Barinov V., Lobastov K., Tsaplin S., Schastlivtsev I., Boyarintsev V.

1. Clinical Hospital № 1 Office of the President of the Russian Federation, Moscow
2. Russian National Research University. NI Pirogov, Department of General Surgery and Radiology Medical Faculty

Brief summary

The aim of the study was to evaluate efficacy and safety of electrical calf muscle stimulation (EMS) in combined prophylaxis of postoperative venous thromboembolism (VTE) in high risk patients. Materials and methods. It was a prospective randomized controlled study included 150 surgical patients with high risk of VTE, which underwent major abdominal surgery (56%) or neurosurgery (44%) and had 3 and more individual risk factors. According to VTE prevention protocol all patients were randomized into two groups: the main and the control (n=75). In all groups compression bandage was applied on the shin and direct anticoagulants were administrated in standard prophylactic doses. In the main group electrical stimulation of shin muscles was used by means of «Veinoplus» devise also. Each session of EMS lasted 20 minutes and was performed not less than 5 times (100 minutes) per day. The primary end points were: the rate postoperative DVT, confirmed with duplex ultrasound, the rate of PE, conformed with lung scintigraphy and/or heart ultrasound, total postoperative mortality. The secondary end point was the compliance in EMS using, calculated as a proportion of real amount of sessions per day to the target amount, which was 10 sessions per day. Results. The rate of postoperative DVT in the main group was 4,0% (95% CI: 1,4-11,1%) against 20,0 % (95% CI: 12,5-30,4%) in the control group (p=0,005), of proximal DVT: 0% (95% CI: 0-4,9%) against 8,0% (95% CI: 3,7-16,4%, р=0,028), without any significant differences for the rate of PE. The maximum reduction in DVT relative risk was found in patients with leg paralysis: 88,1%. Also in the main group was found significant reduction in the rate of isolated gastrocnemius and soleus veins thrombosis. Postoperative mortality was significantly decreased by means of EMS using: 10,7% (95% CI: 5,5-19,7%) against 25,3% (95% CI: 16,8-36,2%, р=0,032). The compliance in EMS using was 65-70% for medical staff and 70% for patients.


Key words

venous thrombosis, pulmonary embolism. Prophylaxis, high risk, electrical calf stimulation

Reference list

1. Lobastov K.V., Barmotin N.A, Barinov V.E., Laberko L.A., Kyznecov N.A. Regionarnaya venoznaya gemodinamiki na fone nespecificheskih metodov profilaktiki venoznih tromboembolii. Flebologiya, 2012, №4, 16-23


2. Griffin M., Nicolaides A.N., Bond D, Geroulakos G., Kalodiki E. The efficacy of a new stimulation technology to increase venous flow and prevent venous stasis. Eur. J. Vasc. Endovasc. Surg. 2010 Dec.; 40(6):766-71.


3. Williams K.J., Moore H.M., Ellis M., Davies A.H. Comparing the venous haemodynamic effect of a neuromuscular stimulation device to intermittent pneumatic compression in healthy subjects. 14th Meeting of European Venous Forum. 27-30 June 2013, Belgrade, Serbia. Scientific programme and book of abstracts. Edizionu Minerva medica, Turin. p.6


4. Guyatt G.H., Akl E.A., Crowther M., Gutterman D.D., Schuünemann H.J.; American College of Chest Physicians Antithrombotic Therapy and Prevention ofThrombosis Panel. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb; 141(2 Suppl):7S-47S.


5. Savelev V.S., Chazov E.I., Gysev E.I., Kirienko A.I. Rossiiskie klinicheskie rekomendacii po diagnostike, lecheniu i profilaktike venoznih tromboembolicheskih oslojnenii. Flebologiya 2010; 1:2:5-6


6. Prevention and treatment of venous thromboembolism - International Consensus Statement. International Angiology 2013 April; 32(2)111-260


7. Laberko L.A., Lobastov K.V., Barinov V.E., Obolenskii V.N., Gorshkov K.M., Asratyan S.A. Algoritm primeneniya elektro-mishechnoi stimylyacii v sostave kompleksnoi profilaktiki venoznih tromboembolicheskih oslojnenii. Flebologiya, 2012, №2, s.107.


8. Doran F.S., White H.M. A demonstration that the risk of postoperative deep venous thrombosis is reduced by stimulating the calf muscles electrically during the operation. Brit. J. Surg. 1967; 54:686-90.


9. Doran F.S., White M., Drury M. A clinical trial designed to test the relative value of two simple methods of reducing the risk of venous stasis in the lower limbs during surgical operations, the danger of thrombosis, and a subsequent pulmonary embolus, with a survey of the problem. Br. J. Surg. 1970 Jan.; 57(1):20-30.


10. Nicolaides N., Kakkar V.V., Field E.S., Fish P. Optimal Electrical Stimulus for Prevention of Deep Vein, Thrombosis British Medical Journal, 1972, 3, 756-758


11. Becker J., Schampi B. The incidence of postoperative venous thrombosis of the legs. A comparative study on the prophylactic effect of dextran 70 and electrical calf-muscle stimulation. Acta. Chir. Scand. 1973; 139(4):357-67.


12. Pollock A.V. Calf-muscle stimulation as a prophylactic method against deep vein thrombosis. Triangle. 1977; 16(1):41-5.


13. Browse N.L., Negus D. Prevention of postoperative leg vein thrombosis by electrical muscle stimulation:an evaluation with 125I-labelled fibrinogen. Br. Med. J. 1970; 3:615-8.


14. Rosenberg I.L., Evans M., Pollock A.V. Prophylaxis of postoperative leg vine thrombosis by low dose subcutaneous heparin or peroperative calf muscle stimulation: a controlled clinical trial. Br. Med. J. 1975 Mar 22; 1(5959):649-51.


15. Dejode L.R., Khurshid M., Walther W.W. The influence of electrical stimulation of the leg during surgical operations on the subsequent development of deep-vein thrombosis. Br. J. Surg. 1973 Jan.; 60(1):31-2.


16. Reed B. The physiology of neuromuscular electrical stimulation. Pediatr. Phys. Ther. 1997; 9: 96-102


17. Lyons G.M., Leane G.E., Grace P.A. The effect of electrical stimulation of the calf muscle and compression stocking on venous blood flow velocity. Eur. J. Vasc. Endovasc. Surg. 2002 Jun.; 23(6):564-6.


18. Janssen T.W., Hopman M.T. Blood flow response to electrically induced twitch and tetanic lower-limb muscle contractions. Arch. Phys. Med. Rehabil. 2003 Jul.; 84(7):982-7.


19. Clarke Moloney M., Lyons G.M., Breen P., Burke P.E., Grace P.A. Haemodynamic study examining the response of venous blood flow to electrical stimulation of the gastrocnemius muscle in patients with chronic venous disease. Eur. J. Vasc. Endovasc. Surg. 2006; 31:300–5


20. Broderick B.J., Corley G.J., Quondamatteo F., et al. Venous emptying from the foot: influences of weight bearing, toe curls, electrical stimulation, passive compression, and posture. J. Appl. Physiol. 2010 Oct.; 109(4):1045-52.


21. Bogachev V.U., Golovanova O.V., Kyznecov A.N. Elektromishechnaya stimylyaciya – novii metod lecheniya hronicheskoi venoznoi nedostatochnosti, Flebologiya 2010 1:4:22-27


22. Le Toik A., Bastyan E., Pujo M i dr. Vliyanie elektrostimylyacii na venoznii ottok iz nijnih konechnostei y beremennih. Predvaritelnoe issledovanie. Flebologiya 2009 2:3:18-26


23. Andrianov O.V., Shahsyvaryan S.B., Mirozyan E.I. i dr. Innovacionnie metodi kompleksnoi reabilitacii uolnih s postektomicheskim sindromom. Materiali VIII Mejdynarodnoi konferencii Associacii flebologov Rossii, Moskva 2010


24. Zuccarelli F., Launay J., Magrex J., et al. Activation of the calf muscle pump action by electro-stimulation with veinoplus device. Angeologie 2005; 57(2), 48-54.


25. Zuccarelli F., Le Magrex J., Pujo M. Sur un cas de guerison d’une ulceration chronique de 50 ans d’age par utilization de Veinoplus. Angeologie 2006: 58;3-33


26. Soriano C., Moll S., Deal A. Efficacy and Optimal Use of a Portable Electrical Muscle Stimulator (VeinoPlus®) to Improve Symptoms of Postthrombotic Syndrome. Presented at the "Hemophilia and Thrombosis Research Society" Annual Symposium in April 2010


27. Papaioannou T.G., Stefanadis C. Vascular wall shear stress: basic principles and methods. Hellenic. J. Cardiol. 2005 Jan-Feb; 46(1):9-15


28. Comerota A.J., Chouhan V., Harada R.N., et al. The fibrinolytic  effects of intermittent  pneumatic compression: mechanism of enhancedfibrinolysis. Ann. Surg. 1997 Sep.; 226(3):306-13; discussion 313-4.


29. Chouhan V.D., Comerota A.J., Sun L., et al. Inhibition of tissue factor pathway during intermittent pneumatic compression: A possible mechanism for antithrombotic effect. Arterioscler. Thromb. Vasc. Biol. 1999 Nov.; 19(11):2812-7.


30. Comerota A.J., Katz M.L., White J.V. Why does prophylaxis with external pneumatic compression for deep vein thrombosis fail? Am. J. Surg. 1992 Sep.; 164(3):265-8.


31. Cornwell E., Chang D., Velmahos G., et al. Compliance with sequential compression device prophylaxis in at-risk trauma patients: a prospective analysis. Am. Surg. 2002; 68:470–3.


32. Bockheim H.M., McAllen K.J., Baker R., Barletta J.F. Mechanical prophylaxis to prevent venous thromboembolism in surgical patients: aprospective trial  evaluating  compliance. J. Crit. Care. 2009 Jun.; 24(2):192-6.


33. Froimson M.I., Murray T.G., Fazekas A.F. Venous thromboembolic disease reduction with a portable pneumatic compression device. J. Arthroplasty. 2009 Feb.; 24(2):310-6.