Mechanical Prevention of Venous Thromboembolism

The pathogenesis of venous thromboembolism (VTE) is related to hypercoagulability, venous stasis and endothelial damage. Therefore, prevention of VTE is based on the use of pharmacological agents which counteract hypercoagulability and mechanical methods, aiming to improve venous flow and reduce stasis. These methods may be used separately or combined, depending on the potential thrombotic and haemorrhagic risk of the patient. The most popular mechanical methods are graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) of the lower extremities. Both are effective for the prevention of postoperative deep vein thrombosis (DVT) in different surgical patients, as shown by several clinical trials and meta-analyses. However, there is no solid evidence that they prevent fatal PE. According to most current recommendations and guidelines, mechanical prophylaxis should be used alone in patients with contraindications to receive anticoagulants and in combination with pharmacological methods in patients at very high risk of VTE.