تجاوز إلى المحتوى الرئيسي

 Intermittent pneumatic compression (IPC) devices are used to aid in preventing blood clots in the deep veins of the limbs through improving venous circulation of patients who suffer deep vein thrombosis (DVT), pulmonary embolism (PE), and edema [3]. However, a recently published study reported that among critically ill patients who received pharmacologic thromboprophylaxis, adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone [1]. Therefore, the purpose of this study was to provide an evaluation for the efficacy of the IPC devices that are available in the Saudi market, when these devices are used as intended by the manufacturers.  



Indications for using IPC (DVT, PE, and Edema):

Deep vein thrombosis (DVT) is a blood clot (thrombus) that forms in one or more of the deep veins in the body (usually in legs). This can also happen if patients are immobile for a long period of time. In some cases, a deep clot in a leg vein can run through the blood circulation and penetrate in the lung vessel, which can cause a blockage in the vessel called a pulmonary embolism. Pulmonary embolism can cause severe shortness of breath and even sudden death. Edema, on the other hand, refers to the leakage of blood from vessels into the surrounding tissues [4]. Figure 1 below shows the formation of DVT and PE:



Using of IPC for treatment:
Intermittent pneumatic compression (IPC) devices uses cuffs around the legs that fill with air and squeeze the legs. The cuffs are attached to a pneumatic pump that supplies compressed air to inflate and deflate the cuff. The system offers sequential inflation and propels the vein blood from limb to heart, therefore enhance the blood circulation and helps prevent blood clots. IPC is used most often for people who have just had surgery. It may also be used after a stroke or to help treat lymphedema [3].



A recently published study reported that among critically ill patients who received pharmacologic thromboprophylaxis, adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone  [1].


 The effectiveness of Intermittent pneumatic compression (IPC) devices for the treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and edema were evaluated considering three directions: a review of the recently published papers in the topic, opinions of specialized societies and the feedbacks of Saudi related experts.
Part 1: Clinical paper review
1.1 An overview of the search criteria
 The data for the last five years were retrieved for all clinical studies that discuss the research question. As a result, 63 articles were acquired, and screened first for duplication, and then through scanning the abstract as guided by the clarified inclusion criteria. Lastly, 31 recent and specific articles were obtained and read in full, as shown in figure 3.




1.2 Current-evidence in the efficacy of IPC for lymphedema.
IPC seems to be an effective treatment option for lymphedema, as revealed by multiple studies (Ref.[1], [4], [12], [37], [38], and [59]). However, one study [34] showed that IPC is a moderately effective and one study [40] have shown that IPC is not effective.
1.3 Current-evidence in the efficacy of IPC for Deep Vein Thrombosis (DVT).
Overall, IPC was shown to be an effective treatment option for Deep Vein Thrombosis (DVT), as reflected by multiple studies (Ref. [16], [36], [39], [43], [47], and [58]). Nevertheless, other studies (Ref. [21] and [62]) show that IPC is moderately effective.
1.4 Current-evidence in the efficacy of IPC for embolism.
The review includes two big meta-analyses that were designed to investigate the efficacy of IPC to treat embolism (Ref. [24] and [56]). Both studies indicate that IPC is an effective treatment option to the treatment of embolism.
1.5 Current-evidence in the efficacy of IPC for radiocephalic fistulas.
There were two studies addressing the effectiveness of IPC for radiocephalic fistulas (Ref. [2] and [3]), where IPC is revealed to be moderately effective.

Part 2: Specialized Societies
First, The Asian venous thromboembolism guidelines recommended to utilize IPC system as an option for patients undergoing general or gynecological surgery with moderate risk of (DVT) and (PE). It was recommended to use the device in combination with aspirin for patients undergoing major orthopedic surgeries like total hip replacement, total knee replacement and proximal hip fracture surgery. [7] According to the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, it was suggested to use mechanical prophylaxis, preferably with (IPC) for patients at low and moderate risk for VTE. Also, it was suggested to use IPC for patients at moderate to high risk for VTE who are at high risk for major bleeding complications. [8] [9] Similar results were provided in the clinical guideline for VTE by the National Institute for Health and Clinical Excellence (NICE). [10]
According to the Australian and New Zealand working party on the management and prevention of venous thromboembolism guideline, IPC reduces the incidence of DVT and more effective than other mechanical techniques in high risk patients in combination with anticoagulants, or when anticoagulants are contraindicated. [11] The German Society of Phlebology believes that IPC is a safe and effective treatment method for thromboembolism prophylaxis, decongestive therapy for edema, and to positively influence arterial and venous circulation to improve clinical symptoms and accelerate ulcer healing in both the outpatient and inpatient care setting. In conclusion, these clinical guidelines illustrate that the use of IPC is effective whenever the device is used as intended for the treatment of DVT, PE, and edema.

Part 3: Saudi user experience
A Saudi user experience was obtained by sending a survey to the hospitals, whose were chosen depending on their high number of IPC purchases among other hospitals in Saudi Arabia. The analysis of the obtained responses show that the device is significantly effective and they notice an improvement for reducing the blood clots when using IPC. In addition, they found that the device is easy to use and effective as indicated.


From the literature review, it was concluded that the IPC is working as intended.  Thus, no extra regulatory action should be applied.


Recommendations for healthcare professions:


o Intermittent pneumatic compression (IPC) is an effective and inexpensive method of reducing the risk of deep vein thrombosis (DVT).

o Intermittent pneumatic compression devices are appropriate for venous thromboembolism (VTE) when used in accordance to current clinical guidelines.

o Among patients with postoperative leg edema, local tissue blood perfusion can be improved by the use of IPC, which can result in decreased local leg swelling. In addition, the current evidence suggested that IPC effectively helps to reduce a phlebolymphedema.

o Adverse events are extremely rare if IPC is used correctly. The device is safe and effective treatment option if the indication and application are correct -also as an add-on therapy-, especially for the treatment of the described vascular diseases and edema as well as thrombosis prophylaxis.


Grateful thanks to Eng. Yassir Alsaab for designing, reviewing the up to date articles, and writing up the context of this study. Eng. Bader Aloufi verified the study methodology and supervised the study progress. With the appreciation to the post-market clinical evaluation team for their efforts in conducting this work.
 For further information or inquiries related to this study, you may contact us at: cia.md@sfda.gov.sa 


[1]  Yaseen M. Arabi, M.D., Fahad Al-Hameed, M.D., Karen E.A. Burns, M.D., Sangeeta Mehta, M.D., Sami J. Alsolamy, M.D., M.P.H., Mohammed S. Alshahrani, M.D., Yasser Mandourah, M.D., Ghaleb A. Almekhlafi, M.D., Mohammed Almaani, M.D., Ali Al Bshabshe, M.D., Si, "Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis," Tne new england journal of medicine, 2019. 
[2]  Sahar Abo Shaheen, 03 03 2019. [Online]. Available: https://makkahnewspaper.com/article/1097922. [Accessed 10 03 2019].
[3]  Johns Hopkins, "DVT Prevention: Intermittent Pneumatic Compression Devices," [Online]. [Accessed 06 2019].
[4]  Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM, ""Prevention of VTE in Nonorthopedic Surgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines".," Chest, vol. 141, no. 2. 
[5]  Sickkids staff, "Deep vein thrombosis," AboutKidsHealth, 2019.
[6]  Primer | Published: 17 May 2018 Pulmonary embolism Menno V. Huisman, Stefano Barco, Suzanne C. Cannegieter, Gregoire Le Gal, Stavros V. Konstantinides, Pieter H. Reitsma, Marc Rodger, Anton Vonk Noordegraaf & Frederikus A. Klok, "Pulmonary embolism," Nature, vol. 18028, 2018. 
[7]  Liew NC1, Chang YH, Choi G, Chu PH, Gao X, Gibbs H, Ho CO, Ibrahim H, Kim TK, Kritpracha B, Lee LH, Lee L, Lee WY, Li YJ, Nicolaides AN, Oh D, Pratama D, Ramakrishnan N, Robless PA, Villarama-Alemany G, Wong R; Asian Venous Thrombosis Forum, "Asian venous thromboembolism guidelines: prevention of venous thromboembolism," Int Angiol., vol. 31, no. 6, pp. 501-16, 2012. 
[8]  Gould MK1, Garcia DA2, Wren SM3, Karanicolas PJ4, Arcelus JI5, Heit JA6, Samama CM7., "Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.," Chest., vol. 141, no. 2, pp. 11-2297., 2012. 
[9]  Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, "Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.," vol. 141, no. 2, pp. e195S-226S, 2012. 
[10]  National Institute for Health and Clinical Excellence (NICE)., "Venous thromboembolism: reducing the risk. Clinical Guideline," 2010. 
[11]  T. A. a. N. Z. w. party, "Prevention of venous thromboembolism," The Australian Society for thrombosis and Haemostasis.
[12]  Schwahn-Schreiber C1, Breu FX2, Rabe E3, Buschmann I4, Döller W5, Lulay GR6, Miller A7, Valesky E8, Reich-Schupke S9., "guideline on intermittent pneumatic compression (IPC)," Hautarzt., vol. 69, no. 8, pp. 662-673, 2018. 
[13]  Zaleska MT1,2, Olszewski WL2., "The Effectiveness of Intermittent Pneumatic Compression in Therapy of Lymphedema of Lower Limbs: Methods of Evaluation and Results. (2019)," Lymphat Res Biol., vol. 17, no. 1, pp. 60-69, 2019. 
[14]  Sullivan B1, Desai S2, Singh TM3, Mitra A4., "Early application of an intermittent pneumatic compression device assists dilation of radiocephalic fistulas.," J Vasc Access. , vol. 20, no. 2, pp. 146-152, 2019. 
[15]  Desai S1, Mitra A2, Arkans E3, Singh TM4., "Early application of an intermittent pneumatic compression device is safe and results in proximal arteriovenous fistula enlargement.," J Vasc Access. , vol. 20, no. 1, pp. 24-30, 2019. 
[16]  Tessari M1, Tisato V2, Rimondi E2, Zamboni P3, Malagoni AM3., "Effects of intermittent pneumatic compression treatment on clinical outcomes and biochemical markers in patients at low mobility with lower limb edema.," J Vasc Surg Venous Lymphat Disord. , vol. 6, no. 4, 2018. 
[17]  K. A. S. A. Karafa M1, "The effect of different compression pressure in therapy of secondary upper extremity lymphedema in women after breast cancer surgery.," Lymphology. , vol. 51, no. 1, pp. 28-37, 2018. 
[18]  Arabi YM1, Burns KEA2, Al-Hameed F3, Alsolamy S4, Almaani M5, Mandourah Y6, Almekhlafi GA6, Al Bshabshe A7, Alshahrani M8, Khalid I9, Hawa H10, Arshad Z11, Lababidi H12, Al Aithan A13, Jose J14, Abdukahil SAI1, Afesh LY15, Al-Dawood A1  and the PREVENT tr, "Surveillance or no surveillance for deep venous thrombosis and outcomes of critically ill patients: A study protocol and statistical analysis plan.," Medicine (Baltimore). , vol. 97, no. 36, 2018. 
[19]  M. J. O. J. G. J. Martín BC1, "The Effect of Hyperoxygenated Fatty Acids in Preventing Skin Lesions Caused by Surgical Pneumatic Tourniquets.," Adv Skin Wound Care. , vol. 31, no. 5, 2018. 
[20]  Heapy AM1, Hoffman MD2,3,4, Verhagen HH5, Thompson SW1, Dhamija P1, Sandford FJ6, Cooper MC1., "A randomized controlled trial of manual therapy and pneumatic compression for recovery from prolonged running - an extended study.," Res Sports Med. , vol. 26, no. 3, 2018. 
[21]  Berliner JL1, Ortiz PA1, Lee YY2, Miller TT3, Westrich GH1., "Venous Hemodynamics After Total Hip Arthroplasty: A Comparison Between Portable vs Stationary Pneumatic Compression Devices and the Effect of Body Position.," J Arthroplasty. , vol. 33, no. 1, 2018. 
[22]  Overmayer RG, Driller MW., "Pneumatic Compression Fails to Improve Performance Recovery in Trained Cyclists.," Int J Sports Physiol Perform., vol. 13, no. 4, 2018. 
[23]  Bok SK1, Jeon Y1, Lee JA1, Ahn SY1., "Evaluation of Stiffness in Postmastectomy Lymphedema Using Acoustic Radiation Force Impulse Imaging: A Prospective Randomized Controlled Study for Identifying the Optimal Pneumatic Compression Pressure to Reduce Stiffness.," Lymphat Res Biol. , vol. 16, no. 1, 2018. 
[24]  Abdul Alim M1, Domeij-Arverud E1,2, Nilsson G1,3, Edman G4, Ackermann PW5,6., "Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis.," Knee Surg Sports Traumatol Arthrosc. , vol. 26, no. 7, 2018. 
[25]  Tran K, Argáez C., "Intermittent Pneumatic Compression Devices for the Management of Lymphedema: A Review of Clinical Effectiveness and Guidelines [Internet].," Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; , 2017. 
[26]  Credeur DP1, Vana LM1, Kelley ET1, Stoner L2, Dolbow DR1., "Effects of Intermittent Pneumatic Compression on Leg Vascular Function in People with Spinal Cord Injury: A Pilot Study.," J Spinal Cord Med. , vol. 3, no. 1, 2017. 
[27]  Feng JP1, Xiong YT2, Fan ZQ1, Yan LJ1, Wang JY1, Gu ZJ3., "Efficacy of intermittent pneumatic compression for venous thromboembolism prophylaxis in patients undergoing gynecologic surgery: A systematic review and meta-analysis.," Oncotarget. , vol. 8, no. 12, 2017. 
[28]  Haun CT1, Roberts MD1,2, Romero MA1, Osburn SC1, Healy JC2, Moore AN2,3, Mobley CB1, Roberson PA1, Kephart WC1, Mumford PW1, Goodlett MD2,4, Pascoe DD1, Martin JS5,6., "Concomitant external pneumatic compression treatment with consecutive days of high intensity interval training reduces markers of proteolysis.," Eur J Appl Physiol. , vol. 117, no. 2, 2017. 
[29]  Santa Maria PL1, Santa Maria C2, Eisenried A3, Velasquez N2,3, Kannard BT4, Ramani A4, Kahn DM5, Wheeler AJ6, Brock-Utne JG3., "A novel thermal compression device for perioperative warming: a randomized trial for feasibility and efficacy.," BMC Anesthesiol., vol. 17, no. 1, 2017. 
[30]  Álvares VRC1, Ramos CD, Pereira BJ, Pinto AL, Moysés RMA, Gualano B, Elias RM., "Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial.," Am J Nephrol. , vol. 45, no. 5, 2017. 
[31]  Marc Schnetzke,1 Benedict Swartman,1 Isabel Bonnen,1 Holger Keil,1 Svenja Schüler,2 Paul A. Grützner,1 and Jochen Frankecorresponding author1, "Vascular Impulse Technology versus elevation in the treatment of posttraumatic swelling of extremity fractures: study protocol for a randomized controlled trial," Trials., vol. 18, no. 73, 2017. 
[32]  Snyder MA1, Sympson AN2, Scheuerman CM2, Gregg JL2, Hussain LR2., "Efficacy in Deep Vein Thrombosis Prevention With Extended Mechanical Compression Device Therapy and Prophylactic Aspirin Following Total Knee Arthroplasty: A Randomized Control Trial.," J Arthroplasty. , vol. 32, no. 5, 2017. 
[33]  Snyder MA1, Sympson AN2, Scheuerman CM2, Gregg JL2, Hussain LR2., "Efficacy in Deep Vein Thrombosis Prevention With Extended Mechanical Compression Device Therapy and Prophylactic Aspirin Following Total Knee Arthroplasty: A Randomized Control Trial.," J Arthroplasty. , vol. 32, no. 5, 2017. 
[34]  Schmidt-Braekling T1, Pearle AD2, Mayman DJ2, Westrich GH2, Waldstein W3, Boettner F2., "Deep Venous Thrombosis Prophylaxis After Unicompartmental Knee Arthroplasty: A Prospective Study on the Safety of Aspirin. (2017)," J Arthroplasty, vol. 32, no. 3, 2017. 
[35]  Pavon JM1, Adam SS2, Razouki ZA3, McDuffie JR4, Lachiewicz PF5, Kosinski AS6, Beadles CA7, Ortel TL2, Nagi A3, Williams JW Jr4., "Effectiveness of Intermittent Pneumatic Compression Devices for Venous Thromboembolism Prophylaxis in High-Risk Surgical Patients: A Systematic Review.," J Arthroplasty. , vol. 31, no. 2, 2016. 
[36]  Nakanishi K1, Takahira N2,3,4, Sakamoto M4, Yamaoka-Tojo M4, Katagiri M5, Kitagawa J2., "Effects of intermittent pneumatic compression of the thigh on blood flow velocity in the femoral and popliteal veins: developing a new physical prophylaxis for deep vein thrombosis in patients with plaster-cast immobilization of the leg.," J Thromb Thrombolysis. , vol. 42, no. 4, 2016. 
[37]  Kuroda S1, Kikuchi S, Nishizaki M, Kagawa S, Hinotsu S, Fujiwara T., "A Phase II Clinical Trial of the Efficacy and Safety of Short-term (3 days) Enoxaparin for the Prevention of Venous Thromboembolism after Gastric Cancer Surgery.," Acta Med Okayama., vol. 70, no. 5, 2016. 
[38]  Braithwaite I1, De Ruyter B2, Semprini A3, Ebmeier S3, Kiddle G2, Willis N2, Carter J2, Weatherall M4, Beasley R1., "Cohort feasibility study of an intermittent pneumatic compression device within a below-knee cast for the prevention of venous thromboembolism.," BMJ Open. , vol. 6, no. 10, 2016. 
[39]  Okamoto LE1, Diedrich A1, Baudenbacher FJ1, Harder R1, Whitfield JS1, Iqbal F1, Gamboa A1, Shibao CA1, Black BK1, Raj SR1, Robertson D1, Biaggioni I2., "Efficacy of Servo-Controlled Splanchnic Venous Compression in the Treatment of Orthostatic Hypotension: A Randomized Comparison With Midodrine.," Hypertension. , vol. 68, no. 2, 2016. 
[40]  Leegwater NC1, Nolte PA2, de Korte N3, Heetveld MJ4, Kalisvaart KJ5, Schönhuth CP6, Pijnenburg B7, Burger BJ8, Ponsen KJ9, Bloemers FW10, Maier AB11, van Royen BJ6., "The efficacy of continuous-flow cryo and cyclic compression therapy after hip fracture surgery on postoperative pain: design of a prospective, open-label, parallel, multicenter, randomized controlled, clinical trial.," BMC Musculoskelet Disord. , vol. 8, no. 17, 2016. 
[41]  Hoffman MD, Badowski N, Chin J, Stuempfle KJ., "A Randomized Controlled Trial of Massage and Pneumatic Compression for Ultramarathon Recovery.," J Orthop Sports Phys Ther. , vol. 46, no. 5, 2016. 
[42]  Jonas P1, Charlois S1, Chevalerias M1, Delmas D2, Kerihuel JC3, Blanchemaison P4., "Efficacy of the Stendo Pulsating suit in patients with leg lymphedema: a pilot randomized study.," Eur J Dermatol. , vol. 26, no. 1, 2016. 
[43]  Northey JM1, Rattray B, Argus CK, Etxebarria N, Driller MW., "Vascular Occlusion and Sequential Compression for Recovery After Resistance Exercise.," J Strength Cond Res. , vol. 30, no. 2, 2016. 
[44]  Sadaghianloo N1, Dardik A2., "The efficacy of intermittent pneumatic compression in the prevention of lower extremity deep venous thrombosis.," J Vasc Surg Venous Lymphat Disord. , vol. 4, no. 2, 2016. 
[45]  Pawlaczyk K1, Gabriel M2, Urbanek T3, Dzieciuchowicz Ł4, Krasiński Z2, Gabriel Z2, Olejniczak-Nowakowska M5, Stanisić M2., "Effects of Intermittent Pneumatic Compression on Reduction of Postoperative Lower Extremity Edema and Normalization of Foot Microcirculation Flow in Patients Undergoing Arterial Revascularization.," Med Sci Monit., 2015. 
[46]  Jakub Taradaj,1 Joanna Rosińczuk,2 Robert Dymarek,2 Tomasz Halski,3 and Winfried Schneider4, "Comparison of efficacy of the intermittent pneumatic compression with a high- and low-pressure application in reducing the lower limbs phlebolymphedema. (2015)," Ther Clin Risk Manag. , vol. 11, 2015. 
[47]  Dennis M, Sandercock P, Graham C, Forbes J; CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration, Smith J., "The Clots in Legs Or sTockings after Stroke (CLOTS) 3 trial: a randomised controlled trial to determine whether or not intermittent pneumatic compression reduces the risk of post-stroke deep vein thrombosis and to estimate its cost-effectiveness.," Health Technol Assess. , vol. 19, no. 76, 2015. 
[48]  Uzkeser H1, Karatay S, Erdemci B, Koc M, Senel K., "Efficacy of manual lymphatic drainage and intermittent pneumatic compression pump use in the treatment of lymphedema after mastectomy: a randomized controlled trial.," Breast Cancer. , vol. 22, no. 3, 2015. 
[49] Martin JS1,2, Friedenreich ZD3, Borges AR3, Roberts MD1,2., "Preconditioning with peristaltic external pneumatic compression does not acutely improve repeated Wingate performance nor does it alter blood lactate concentrations during passive recovery compared with sham.," Appl Physiol Nutr Metab. , vol. 40, no. 11, 2015. 
[50]  Dennis M1, Graham C2, Smith J3, Forbes J4, Sandercock P1; CLOTS trial collaboration., "Which stroke patients gain most from intermittent pneumatic compression: further analyses of the CLOTS 3 trial.," Int J Stroke. , vol. 10, 2015. 
[51]  "Thromboembolism Prophylaxis in Hip Arthroplasty: Routine and High Risk Patients.," J Arthroplasty. , vol. 30, no. 12, 2015. 
[52]  Nagata C1,2, Tanabe H3, Takakura S1, Narui C3, Saito M1, Yanaihara N1, Okamoto A1., "Randomized controlled trial of enoxaparin versus intermittent pneumatic compression for venous thromboembolism prevention in Japanese surgical patients with gynecologic malignancy.," J Obstet Gynaecol Res. , vol. 41, no. 9, 2015. 
[53]  Martin JS1, Borges AR, Beck DT., "Peripheral conduit and resistance artery function are improved following a single, 1-h bout of peristaltic pulse external pneumatic compression.," Eur J Appl Physiol., vol. 115, no. 9, 2015. 
[54]  Domeij-Arverud E1, Labruto F1, Latifi A1, Nilsson G1, Edman G2, Ackermann PW1., "Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation: a prospective randomised trial of acute ruptures of the Achilles tendon.," Bone Joint J. , vol. 97, 2015. 
[55]  Kraeutler MJ1, Reynolds KA2, Long C2, McCarty EC2., "Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression.," J Shoulder Elbow Surg. , vol. 24, no. 6, 2015. 
[56]  Holländer SW1, Sifft A2, Hess S3, Klingen HJ4, Djalali P5, Birk D6., "Identifying the Bariatric Patient at Risk for Pulmonary Embolism: Prospective Clinical Trial Using Duplex Sonography and Blood Screening.," Obes Surg. , vol. 25, no. 11, 2015. 
[57]  Sands WA1, McNeal JR, Murray SR, Stone MH., "Dynamic Compression Enhances Pressure-to-Pain Threshold in Elite Athlete Recovery: Exploratory Study.," J Strength Cond Res. , vol. 29, no. 5, 2015. 
[58]  Cudré L, Perrenoud B., "[Prevention of venous thromboembolism risks. Efficacy of intermittent pneumatic compression boots].," Krankenpfl Soins Infirm. , vol. 107, no. 9, 2014. 
[59]  Zaleska M1, Olszewski WL, Durlik M., "The effectiveness of intermittent pneumatic compression in long-term therapy of lymphedema of lower limbs.," Lymphat Res Biol. , vol. 12, no. 2, 2014. 
[60]  Jawad H1, Bain DS2, Dawson H3, Crawford K3, Johnston A2, Tucker A4., "The effectiveness of a novel neuromuscular electrostimulation method versus intermittent pneumatic compression in enhancing lower limb blood flow.," J Vasc Surg Venous Lymphat Disord. , vol. 2, no. 2, 2014. 
[61]  Dodds MK1, Daly A2, Ryan K2, D'Souza L2., "Effectiveness of 'in-cast' pneumatic intermittent pedal compression for the pre-operative management of closed ankle fractures: a clinical audit.," Foot Ankle Surg. , vol. 20, no. 1, 2014. 
[62]  Ho KM1., "Benefit of intermittent pneumatic compression of lower limbs in reducing venous thromboembolism in hospitalised patients: interactions between risk and effectiveness.," Anaesth Intensive Care. , vol. 42, no. 1, 2014. 
[63]  CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration., "Effect of intermittent pneumatic compression on disability, living circumstances, quality of life, and hospital costs after stroke: secondary analyses from CLOTS 3, a randomised trial.," Lancet Neurol., vol. 13, no. 12, 2014. 
[64]  Koo KH1, Choi JS2, Ahn JH1, Kwon JH3, Cho KT4., "Comparison of clinical and physiological efficacies of different intermittent sequential pneumatic compression devices in preventing deep vein thrombosis: a prospective randomized study.," Clin Orthop Surg. , vol. 6, no. 4, 2014. 
[65]  Rohner-Spengler M1, Frotzler A2, Honigmann P1, Babst R1., "Effective Treatment of Posttraumatic and Postoperative Edema in Patients with Ankle and Hindfoot Fractures: A Randomized Controlled Trial Comparing Multilayer Compression Therapy and Intermittent Impulse Compression with the Standard Treatment with Ice.," J Bone Joint Surg Am. , vol. 96, no. 15, 2014. 
[66] Song KY1, Yoo HM, Kim EY, Kim JI, Yim HW, Jeon HM, Park CH., "Optimal prophylactic method of venous thromboembolism for gastrectomy in Korean patients: an interim analysis of prospective randomized trial.," Ann Surg Oncol. , vol. 21, no. 13, 2014. 
[67]  Williams KJ1, Moore HM1, Davies AH2., "Haemodynamic changes with the use of neuromuscular electrical stimulation compared to intermittent pneumatic compression.," Phlebology. , vol. 30, no. 5, 2015. 
[68]  Choi JS1, Han HS2, Choi YH3, Kwon JH4, Ahn HY5., "Comparison of Simultaneous and Alternate Bilateral Pneumatic Compression in Hemodynamic Effects and Thromboprophylaxis After Total Knee Arthroplasty.," Clin Appl Thromb Hemost. , vol. 21, no. 7, 2015. 
[69]  Reddick KL1, Smrtka MP1, Grotegut CA1, James AH2, Brancazio LR1, Swamy GK1., "The effects of intermittent pneumatic compression during cesarean delivery on fibrinolysis.," Am J Perinatol. , vol. 31, no. 9, 2014. 

Post-Market Clinical Evaluation Report for the effectiveness of Intermittent Pneumatic Compression (IPC) Devices
Clinical evaluation studies