Combined modalities in the prevention of venous thromboembolism: a review of the literature

Objective: Despite recent advances in the field of venous thromboembolism (VTE) prophylaxis and adherence to guideline recommendations, VTE remains a serious problem, especially in high-risk groups. The aim of the present review was to summarize the evidence supporting the use of combined modalities, both physical and pharmacological, in VTE prevention. Methods: Using Medline, original studies on the value of combined modalities in VTE prevention were identified. Keywords used for physical methods included elastic stockings and intermittent pneumatic compression, and for pharmacological methods included unfractionated and low molecular weight heparin. Relevant articles from their bibliography were also retrieved. Results: Combined pharmacological and physical modalities were more effective than each modality alone in a variety of specialties, including orthopaedic, general and cardiac surgery, as shown by 14 of the 18 randomized or case-control studies retrieved. Mean reduction in VTE incidence was 69% (range 16-100%). Conclusion: Combined modalities are more effective than single modalities in VTE prophylaxis. These results endorse their use, especially in high-risk patients, and support this otherwise typical recommendation of the consensus documents on VTE prophylaxis.