Mechanical VTE prophylaxis

Mechanical prophylaxis for venous thromboembolism (VTE) (ie deep vein thrombosis [DVT] or pulmonary embolism [PE]) can be effective alone and has an additive effect when combined with pharmacological prophylaxis. Mechanical prophylaxis is preferred over pharmacological prophylaxis when the slightest local bleeding risk is unacceptable, such as after neurosurgery, ophthalmic surgery, some plastic surgery, head injury or haemorrhagic stroke.

Avoid mechanical prophylaxis in patients at risk of ischaemic skin necrosis, such as those with severe peripheral artery disease (especially chronic limb-threatening ischaemia) or peripheral neuropathy. Mechanical prophylaxis can be impractical in patients with lower-leg inflammation, oedema of the lower leg, severe lower-limb deformity or morbid obesity.

Methods of mechanical prophylaxis for VTE include:

• professionally fitted graduated compression stockings providing 16 to 20 mmHg pressure at the ankle (also known as antiembolism stockings)
• intermittent pneumatic compression devices
• pneumatic foot compression or pump.

For patients undergoing surgery, graduated compression stockings should be fitted and worn preoperatively, continuing postoperatively until the patient is fully mobile. Nonslip stockings are available for patients at risk of falling.