A new study has documented what many orthopedic surgeons know from their practices, patients do NOT like those VTE pumps—no matter how firmly they or, for that matter, AAOS (American Academy of Orthopaedic Surgeons) and other societies insist that VTE pumps are good medical practice in order to reduce the risk of venous thromboembolism (VTE).
A team of researchers from the West Virginia University School of Medicine and MedStar Georgetown University Hospital in Washington, D.C. collected compliance data from patients who had recently been treated with total joint arthroplasty (TJA).
Their work, “Randomized Trial of Postoperative Venous Thromboembolism Prophylactic Compliance: Aspirin and Mobile Compression Pumps”, was published in the October 15, 2022, edition of the Journal of the American Academy of Orthopaedic Surgeons.
“Most of the prior work looking at this topic has been focused on the use of compression devices in the inpatient setting,” explained Matthew J. Dietz, M.D., associate professor in the Department of Orthopaedics at West Virginia University School of Medicine in Morgantown. “Prior research has shown the importance of compliance to gain the most effect from the devices. This has set a threshold—we would recommend that patients wear it for ~20hrs/day.”
The team collected data as part of a prospective randomized study involving two groups:
- Patients treated with aspirin alone and
- Patients treated with aspirin with a compression pump.
The team documented aspirin and pump compliance, VTE events, and satisfaction with pump use. They were then able to determine patient compliance using an internal device monitor and drug log.
“Each group had 40 patients and greater than 94% compliance with aspirin use—no difference between groups.”
“Pump compliance, however, during the first 14 days after hospital discharge was 51%—significantly worse than aspirin compliance at 99%.”
“Only 10 patients were compliant (>20 hr/d) with recommended pump use throughout the recommended period,” stated the authors. “The team found no notable association between aspirin compliance and VTE within 90 days. There was no notable association between pump compliance and VTE at 90 days.”
“However, average pump use compliance was 20% in patients with VTE and 54% in patients without VTE within 90 days. With the numbers available in this compliance study, there was no significant difference.”
“We found that there was 51% compliance with the use of the pumps,” said Dr. Dietz to OTW. “The patients tolerated the aspirin well and were compliant with its use. So, they aren’t just ‘non-compliant’ patients but the modality we were recommending just wasn’t being used. Interestingly, we couldn’t find one specific factor that patients didn’t like that led to their noncompliance with the pumps.”
“The impetus for this study was when my partner replaced my Dad’s knee. Despite having read him the riot act regarding the importance of preventing a DVT [deep vein thrombosis], my Dad joked that he might put the pumps on the dog so he would get credit for them being worn (and we wouldn’t yell at him) but didn’t have to deal with the hassle of the pumps.”
“This has already altered our practice. We have discontinued the use of the pumps currently. Patients were having to pay out of pocket for a prophylactic device they were not using. We’ve been pleased thus far with our results of using aspirin and early mobilization as our primary means of DVT prophylaxis.”
