Comparative efficacy and safety of pharmacological prophylaxis and intermittent pneumatic compression for prevention of venous thromboembolism in adult undergoing neurosurgery: a systematic review and network meta-analysis.

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Abstrakt

Tytuł:: Comparative efficacy and safety of pharmacological prophylaxis and intermittent pneumatic compression for prevention of venous thromboembolism in adult undergoing neurosurgery: a systematic review and network meta-analysis.
Autorzy:: Wang X; Department of neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Zhang Y; Department of neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Fang F; Department of neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China. .
Jia L; Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China.
You C; Department of neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Xu P; Sichuan University Library, Chengdu, Sichuan, China.
Faramand A; University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Źródło:: Neurosurgical review [Neurosurg Rev] 2021 Apr; Vol. 44 (2), pp. 721-729. Date of Electronic Publication: 2020 Apr 16.
Typ publikacji:: Comparative Study; Journal Article; Meta-Analysis; Systematic Review
Język:: English
Imprint Name(s):: Publication: Berlin : Springer Berlin Heidelberg
Original Publication: Berlin : Walter De Gruyter
MeSH Terms:: Intermittent Pneumatic Compression Devices*/trends
Anticoagulants/*administration & dosage
Neurosurgical Procedures/*methods
Pre-Exposure Prophylaxis/*methods
Venous Thromboembolism/*prevention & control
Humans ; Network Meta-Analysis ; Neurosurgical Procedures/adverse effects ; Pre-Exposure Prophylaxis/trends ; Randomized Controlled Trials as Topic/methods ; Treatment Outcome ; Venous Thromboembolism/diagnosis
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Grant Information:: ZY2016102 the 1.3.5 project for disciplines of excellence of West China Hospital of Sichuan University
Contributed Indexing:: Keywords: Anticoagulants; IPC; Network meta-analysis; Neurosurgery; Thromboprophylaxis
Substance Nomenclature:: 0 (Anticoagulants)
Entry Date(s):: Date Created: 20200418 Date Completed: 20210614 Latest Revision: 20210614
Update Code:: 20240104
DOI:: 10.1007/s10143-020-01297-0
PMID:: 32300889
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Whether intermittent pneumatic compression (IPC) is a more effective form of thromboprophylaxis than anticoagulants in individuals undergoing neurosurgery remains controversial. Relevant studies are sparse and inconsistent. Therefore, direct comparisons are difficult to perform and impractical. Hence, we summarized and compared the efficacy and safety of IPC and anticoagulants for the prevention of venous thromboembolism (VTE) in adults undergoing cranial or spinal procedures. Several electronic databases were searched for randomized controlled trials on the use of IPC and anticoagulants for thromboembolism prevention in neurosurgical patients, from inception to August 6, 2019. Studies reporting the selected endpoints were included in direct and Bayesian network meta-analyses to estimate the relative effects of the interventions. Overall, our analysis included 18 trials comprising 2474 patients. Both IPC (RR, 0.41; 95% CrI, 0.26-0.60) and chemical prophylaxis (RR, 0.48; 95% CrI, 0.28-0.68) were found to be more efficacious than the placebo in reducing the risk of deep vein thrombosis (DVT). In addition, our analysis also demonstrated that both IPC (RR, 0.10; 95% CrI, 0.01-0.60) and chemical prophylaxis (RR, 0.31; 95% CrI, 0.05-1.00) reduced the risk of pulmonary embolism (PE) significantly more than the placebo. Based on the available evidence of moderate-to-good quality, IPC is equivalent to anticoagulants for thromboprophylaxis in terms of efficacy. Evidence to support or negate the use of pharmacological prophylaxis in terms of safety is lacking. The results of ongoing and future large randomized clinical trials are needed.

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