Electric Muscle Stimulation for Prevention of Venous Thromboembolism in Patients with Multiple Lower Extremity Trauma

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Abstract

Relevance. Patients with multiple lower extremity trauma are the group of a very high risk for the development of venous thromboembolism. Therefore, they need a set of measures to prevent this complication. The risk of developing hemorrhagic complications in the I–III periods of traumatic disease prevents many physicians from prescribing anticoagulants. In addition, the application of the external fixation apparatus makes the use of mechanical blood flow acceleration (elastic bandages, compression knitwear, intermittent pneumatic compression) impossible. The purpose of the study is to evaluate the effectiveness and safety of electric muscle stimulation (EMS) for venous thromboembolism prevention in the patients with multiple trauma and the use of external fixation for the lower limb fractures. Material and Methods. The analysis of treatment results of 31 patients with multiple lower limb trauma with the use of external fixation was carried. All the patients were men with average age of 29.3±5.1 years. The patients were divided into two groups by stratified randomization. The groups were comparable by sex, age, body weight, and injury severity. The patients of main group received EMS, in control group — the authors did not use the mentioned treatment. The EMS was carried out using a Veinoplus DVT according to the scheme: 60 min morning, afternoon and evening. Vascular ultrasonography of the lower extremities was performed for all patients before EMS and then every 7 days, as well as before each surgery. All patients underwent venous thromboembolism prevention with low molecular weight heparins, followed by switching to oral anticoagulants. Results. Side effects associated with the use of the EMS, as well as hemorrhagic complications were not detected. The velocity of blood flow in the popliteal vein in the patients, received EMS, was 9.7 ± 0.7 cm/s before the session and 17.0±1.1 cm/s during the session (p<0.001). According to the vascular ultrasound, no venous thromboembolism was detected in the patients underwent the EMS. Deep vein thrombosis was diagnosed in the control group in 2 (13.3%) patients, and pulmonary embolism in 1 (6.7%). Conclusion. The use of EMS showed the absence of side effects and the development of hemorrhagic complications. The effectiveness of the EMS in the patients with external fixation was achieved due to a statistically significant (p <0.001) increase in the volumetric blood flow through the deep lower limb veins. The further study of the EMS in patients with multiple trauma, the development of optimal schemes for its use, depending on the severity of the injuries, will minimize the likelihood of developing venous thromboembolism in this category of patients.

About the authors

K. N. Nikolaev

Main Military Clinical Hospital of the National Guard of the Russian Federation

Author for correspondence.
Email: sabef@yandex.ru

Konstantin N. Nikolaev — Cand. Sci. (Med.), Assistant Chief of Hospital for Scientific Research

Balashikha

Russian Federation

D. R. Ivchenko

Department of Medical Provision of the National Guard of the Russian Federation

Email: fake@neicon.ru

Dmitriy R. Ivchenko — Cand. Sci. (Med.), Chief Surgeon

Moscow

Russian Federation

A. V. Akimov

Main Military Clinical Hospital of the National Guard of the Russian Federation

Email: fake@neicon.ru

Andrey V. Akimov — Chief of Vascular Surgery Department

Balashikha

Russian Federation

E. A. Golubov

Main Military Clinical Hospital of the National Guard of the Russian Federation

Email: fake@neicon.ru

Evgeniy A. Golubov — Chief of Cardiovascular Surgery Department

Balashikha

Russian Federation

S. N. Dvortsevoy

Main Military Clinical Hospital of the National Guard of the Russian Federation

Email: fake@neicon.ru

Sergey N. Dvortsevoy — Cand. Sci. (Med.), Chief of Ultrasound Department

Balashikha

Russian Federation

S. V. Chevychelov

Main Military Clinical Hospital of the National Guard of the Russian Federation

Email: fake@neicon.ru

Sergey V. Chevychelov — Senior Physician of Ultrasound Department

Balashikha

Russian Federation

Yu. R. Alborov

Main Military Clinical Hospital of the National Guard of the Russian Federation

Email: fake@neicon.ru

Yuriy R. Alborov — Cardiovascular Surgeon

Balashikha

Russian Federation

E. A. Kukushkina

Main Military Clinical Hospital of the National Guard of the Russian Federation

Email: fake@neicon.ru

Elena A. Kukushkina — Cand. Sci. (Med.), Chief of CT and MRI Radiology Department

Balashikha

Russian Federation

V. N. Smol’yaninov

2-nd Military Clinical Hospital of the National Guard of the Russian Federation

Email: fake@neicon.ru

Vitaliy N. Smol’yaninov — Chief of General Surgery Department – Leading Surgeon

Pyatigorsk

Russian Federation

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