First, I want to thank the authors, faculty, and residents for their participation and for making this educational activity possible. Now let’s begin!
Many experts recommend combined methods for deep venous thrombosis prophylaxis (pharmacologic and mechanical) in ICU patients, but the evidence is scarce. The Prevent trial, a multicenter randomized controlled study assessed whether adjunctive intermittent pneumatic compression (IPC) in critically ill patients receiving pharmacologic prophylaxis would result in lower incidence of proximal lower limb DVT than pharmacologic thromboprophylaxis alone. The study demonstrated that IPC + heparin/LMWH did not result in a significant (P= 0.74) lower incidence of DVT compared to heparin/LMWH alone. An incidence of proximal DVT occurred 3.9% in the intervention group and 4.2% in the control group, in the modified intention to treat analysis. In previous studies, the estimated incidence of DVT in critically ill patients is around 5 to 20% (1-4) despite pharmacologic thromboprophylaxis. The incidence of the control group was lower than expected and it is possible that the trial may have been underpowered to detect a difference between the groups, a limitation that the authors acknowledge. I would like to hear the group thoughts about the possible explanations of the lower incidence of DVT in this population compared to the previous ones? This is a great opportunity to go over the background and patient’s baseline characteristics.
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