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PubMed1995

Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve.

BACKGROUND: Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) has recently been demonstrated to provide significantly more blood flow to vital organs during cardiac arrest. To further enhance the effectiveness of this technique, we tested the hypothesis that intermittent impedance to inspiratory gas exchange during the decompression phase of ACD CPR enhances vital organ blood flow. METHODS AND RESULTS: ACD CPR was performed with a pneumatically driven automated compression-decompression device in a porcine model of ventricular fibrillation (VF). Nine pigs were randomized to receive ACD CPR alone, while 8 pigs received ACD CPR plus intermittent impedance to inspiratory gas exchange with a threshold valve set to 40 cm H2O. Results comparing 2 minutes of ACD CPR alone versus ACD CPR with the inspiratory impedance threshold valve (ITV) revealed significantly higher mean (+/- SEM) coronary perfusion pressures (diastolic aortic minus diastolic right atrial pressures) in the ITV (31.0 +/- 2.3 mm Hg) group versus with ACD CPR alone (21 +/- 3.6 mm Hg) (P < .05). Total left ventricular and cerebral blood flows, determined by radiolabeled microspheres, were 0.77 +/- 0.095 and 0.47 +/- 0.06 mL/min per gram, respectively, with ACD CPR plus the ITV versus 0.45 +/- 0.1 and 0.32 +/- 0.016 mL/min per gram, respectively, with ACD CPR alone (P < .05). Similar improvements in the ITV group were observed after 7 minutes of ACD CPR. After 16 minutes of VF and 13 minutes of ACD CPR, 6 of 8 pigs in the ITV group were successfully resuscitated with less than three successive 150-J shocks, whereas only 2 of 9 pigs with ACD CPR alone were resuscitated with equivalent energy levels (P < .02). With up to three additional and successive 200-J shocks, all pigs in the ITV group and 7 of 9 pigs with ACD CPR alone were resuscitated (P = .18). CONCLUSIONS: Intermittent impedance to inspiratory flow of respiratory gases during ACD CPR significantly improves coronary perfusion pressures and vital organ blood flow and lowers defibrillation energy requirements in a porcine model of VF.

Animals↗

PubMed2001

Prophylaxis of Venous Thrombosis.

Mechanical measures such as graduated compression stockings and intermittent compression boots are available for venous thrombosis prophylaxis, but compliance may be limited. Plantar venous pneumatic compression devices have attained widespread acceptance by both patients and nurses because of their comfort and compact size, but their track record for efficacy is poor. Inferior vena cava filters prevent pulmonary embolism, but do not halt the thrombotic process or prevent venous thrombosis. Pharmacologic prophylaxis traditionally has relied upon minidose unfractionated heparin; however, re-examination is warranted in the face of increasingly ill and complex patients. My opinion is that small, fixed doses of once-daily low molecular weight heparin will eventually replace minidose unfractionated heparin as the standard pharmacologic prophylaxis regimen for most surgical and medical patients. Prolongation of prophylaxis after hospital discharge should receive increased emphasis. Most patients being transferred to a skilled nursing facility should receive venous thromboembolism prophylaxis. Similarly, most patients undergoing total hip or knee replacement should receive prolonged preventive regimens, with at least 1 month of anticoagulation. Despite advances, certain aspects of venous thrombosis prophylaxis remain problematic. First, a surprisingly high number of hospitalized patients develop venous thrombosis because of failed (rather than omitted) prophylaxis. Second, many patients in intensive care have a combination of peripheral vascular disease and active bleeding (usually gastrointestinal) that precludes mechanical or pharmacologic prophylaxis. Third, neurosurgical patients undergoing craniotomy for brain tumors suffer a high rate of venous thrombosis and major pulmonary embolism despite the routine use of combined mechanical and pharmacologic prophylaxis. My opinion is that these three areas, in addition to the hospital culture of prophylaxis, should receive increased attention in an effort to prevent venous thromboembolism.

Journal Article↗

PubMed2002

Intermittent pneumatic compression for the treatment of lower extremity arterial disease: a systematic review.

This study aimed to identify the role of intermittent pneumatic compression in treating peripheral arterial disease and to investigate the types of treatment programs that are most effective. Data was sourced from English-language articles which were identified by a computer search using MEDLINE from 1966 to 2001, followed by extensive bibliography review. Studies were included if they contained pertinent material involving a compression device and arterial flow dynamics in lower limbs. A total of 26 English-language studies were identified that met the inclusion criteria. The diverse patient criteria and methods used in the studies provided an opportunity to examine the effectiveness of each, but made it difficult to compare one study with another. To assist in focusing on overall trends in improvement, patient type and treatment type disparities must be identified. In conclusion, it is evident that an intermittent pneumatic compression program appears promising and may be used in patients with severe peripheral arterial disease who are not candidates for revascularization using surgery or percutaneous angioplasty. It is now the goal to establish randomized, prospective, controlled trials to clarify the most beneficial regimen for treating such disease.

Arterial Occlusive Diseases↗

PubMed1999

Influence of lower limb pneumatic compression on pulmonary artery temperature: effect on cardiac output measurements.

OBJECTIVES: To characterize the decreases in pulmonary artery temperature that coincide with the inflation cycle of pneumatic calf compression stockings and to examine their effects on the thermodilution measurement of cardiac output. DESIGN: Three-part observational study. SETTING: University hospital surgical intensive care unit. PATIENTS: Postoperative patients with indwelling pulmonary artery catheters. INTERVENTION: Thermodilution cardiac output measurements with and without pneumatic calf compression. MEASUREMENTS AND MAIN RESULTS: Phase 1 (n = 18) examined the effects of pneumatic compression on pulmonary artery temperature. There was no effect on pulmonary artery temperature (device off, 37.468+/-0.008 degrees C; device on, 37.458+/-0.014 degrees C), but the difference between the maximum and minimum pulmonary artery temperatures was increased (off, 0.031+/-0.006 degrees C; on, 0.055+/-0.012 degrees C [p < .001]). Phase 2 (n = 12) found that the mean thermodilution cardiac output with 10 mL of cold (0-5 degrees C) injectate was unchanged by pneumatic compression (off, 7.00+/-2.28 L/min; on, 6.89+/-2.22 L/min). However, when the compression devices were operating, the variability between the individual measurements was increased, as reflected by larger coefficients of variation (off, 3.19+/-1.96; on, 8.72+/-6.56 [p < .02]). Similar results were obtained during phase 3 (n = 5), when cardiac output was measured with room temperature Injectate. CONCLUSIONS: Intermittent pneumatic calf compression increased lower limb venous return, causing acute but transient decreases in pulmonary artery blood temperature. This did not affect the accuracy of thermodilution cardiac output measurements that were made using 10 mL of either cold or room temperature injectate.

Bandages↗

PubMed2006

Bilateral peroneal nerve palsy caused by intermittent pneumatic compression.

A 63-year-old man developed bilateral peroneal nerve palsies after a craniotomy for a craniopharyngioma. It is believed that the primary etiology of the nerve palsies was intermittent pneumatic compression, which was used to prevent deep vein thrombosis and pulmonary embolism during the surgery. Physicians should take care to avoid compressing the fibula head when using pneumatic devices.

Bandages↗

PubMed1980

Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis.

The optimal stimulus which produced the maximum increase in blood velocity in the femoral vein during compression of the lower limb with a sequential compression device (six chambers) was determined using Doppler ultrasound in 10 normal limbs. Pressures of 35, 30, and 20 mm Hg at the ankle, calf, and thigh, respectively, applied sequentially for 12 seconds produced a 240% increase in the peak blood velocity. Higher pressures did not increase velocity any further. A nonsequential device (one chamber) inflated at 35 mm Hg for 12 seconds produced only a180% increase in blood velocity. The efficacy of the sequential device to prevent deep venous thrombosis then was tested and compared with a single chamber device and small-dose subcutaneous heparin in a randomized, controlled clinical trial using the 125I-fibrinogen test. The results suggest that the sequential compression device is as effective as heparin during the period when it is used (the first 24 hours after operation) and more effective than a nonsequential device in preventing deep venous thrombosis proximal to the calf.

Adult↗

PubMed1990

The venous pump of the human foot.

Pressures in the flexor digitorum muscle, posterior tibial and anterior tibial muscles and subcutaneous pressure in the lower leg were recorded in 18 volunteers with a non-infusion technique. The venous plexus of the sole of the foot was compressed by a pneumatic foot pump. Activation of this device creates oscillations of intramuscular and subcutaneous interstitial fluid hydrostatic pressure in the lower leg. The mechanism for this is explained by intermittent passive muscle stretch. The interstitial fluid pressure decreased following active muscle contractions during venous stasis of the limb, but not following activation of the pneumatic pump. Although the pneumatic foot pump may on theoretical grounds be useful in early treatment of postoperative and post-traumatic oedema of the leg, complementary studies are necessary to establish its effectiveness.

Adolescent↗

PubMed1999

High-pressure, rapid-inflation pneumatic compression improves venous hemodynamics in healthy volunteers and patients who are post-thrombotic.

PURPOSE: Deep vein thrombosis (DVT) is a preventable cause of morbidity and mortality in patients who are hospitalized. An important part of the mechanism of DVT prophylaxis with intermittent pneumatic compression (IPC) is reduced venous stasis with increased velocity of venous return. The conventional methods of IPC use low pressure and slow inflation of the air bladder on the leg to augment venous return. Recently, compression devices have been designed that produce high pressure and rapid inflation of air cuffs on the plantar plexus of the foot and the calf. The purpose of this study is to evaluate the venous velocity response to high-pressure, rapid-inflation compression devices versus standard, low-pressure, slow-inflation compression devices in healthy volunteers and patients with severe post-thrombotic venous disease. METHOD: Twenty-two lower extremities from healthy volunteers and 11 lower extremities from patients with class 4 to class 6 post-thrombotic chronic venous insufficiency were studied. With duplex ultrasound scanning (ATL-Ultramark 9, Advanced Tech Laboratory, Bothell, Wash), acute DVT was excluded before subject evaluation. Venous velocities were monitored after the application of each of five IPC devices, with all the patients in the supine position. Three high-pressure, rapid-compression devices and two standard, low-pressure, slow-inflation compression devices were applied in a random sequence. Maximal venous velocities were obtained at the common femoral vein and the popliteal vein for all the devices and were recorded as the mean peak velocity of three compression cycles and compared with baseline velocities. RESULTS: The baseline venous velocities were higher in the femoral veins than in the popliteal veins in both the volunteers and the post-thrombotic subjects. Standard and high-pressure, rapid-inflation compression significantly increased the popliteal and femoral vein velocities in healthy and post-thrombotic subjects. High-pressure, rapid-inflation compression produced significantly higher maximal venous velocities in the popliteal and femoral veins in both healthy volunteers and patients who were post-thrombotic as compared with standard compression. Compared with the healthy volunteers, the patients who were post-thrombotic had a significantly attenuated velocity response at both the popliteal and the femoral vein levels. CONCLUSION: High-pressure, rapid-inflation pneumatic compression increases popliteal and femoral vein velocity as compared with standard, low-pressure, slow-inflation pneumatic compression. Patients with post-thrombotic venous disease have a compromised hemodynamic response to all IPC devices. However, an increased velocity response to the high-pressure, rapid-inflation compression device is preserved. High-pressure, rapid-inflation pneumatic compression may offer additional protection from thrombotic complications on the basis of an improved hemodynamic response, both in healthy volunteers and in patients who were post-thrombotic.

Adult↗

PubMed2001

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery.

BACKGROUND: The pneumoperitoneum is the crucial element in laparoscopic surgery. Different clinical problems are associated with this procedure, which has led to various modifications of the technique. The aim of this guideline is to define the scientifically proven standards of the pneumoperitoneum. METHODS: Based on systematic literature searches (Medline, Embase, and Cochrane), an expert panel consensually formulated clinical recommendations, which were graded according to the strength of available literature evidence. RECOMMENDATIONS: Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5-7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.

Contraindications↗

PubMed1998

Optimizing standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve.

OBJECTIVES: This study was designed to assess whether intermittent impedance of inspiratory gas exchange improves the efficiency of standard cardiopulmonary resuscitation (CPR). BACKGROUND: Standard CPR relies on the natural elastic recoil of the chest to transiently decrease intrathoracic pressures and thereby promote venous blood return to the heart. To further enhance the negative intrathoracic pressures during the "relaxation" phase of CPR, we tested the hypothesis that intermittent impedance to inspiratory gases during standard CPR increases coronary perfusion pressures and vital organ perfusion. METHODS: CPR was performed with a pneumatically driven automated device in a porcine model of ventricular fibrillation. Eight pigs were randomized to initially receive standard CPR alone, while seven pigs initially received standard CPR plus intermittent impedance to inspiratory gas exchange with a threshold valve set to -40 cm H2O. The compression:ventilation ratio was 5:1 and the compression rate was 80/min. At 7-min intervals the impedance threshold valve (ITV) was either added or removed from the ventilation circuit such that during the 28 min of CPR, each animal received two 7-min periods of CPR with the ITV and two 7-min periods without the valve. RESULTS: Vital organ blood flow was significantly higher during CPR performed with the ITV than during CPR performed without the valve. Total left ventricular blood flow (mean+/-SEM) (mL/min/g) was 0.32+/-0.04 vs 0.23+/-0.03 without the ITV (p<0.05). Cerebral blood flow (mL/min/g) was 20% higher with the ITV (+ITV, 0.23+/-0.02; -ITV, 0.19+/-0.02; p<0.05). Each time the ITV was removed, there was a statistically significant decrease in the vital organ blood flow and coronary perfusion pressure. CONCLUSIONS: Intermittent impedance to inspiratory flow of respiratory gases during standard CPR significantly improves CPR efficiency during ventricular fibrillation. These studies underscore the importance of lowering intrathoracic pressures during the relaxation phase of CPR.

Animals↗

PubMed2001

Effects of lithotomy position and external compression on lower leg muscle compartment pressure.

BACKGROUND: Case reports have suggested that externally applied pressure from antithrombosis devices may contribute to the development of compartment syndromes during extended surgery in the lithotomy position. The purpose of this study was to assess the effects of a pneumatic compression device on directly measured intracompartment pressure in the lower leg with the leg positioned in the lithotomy position. METHODS: In 25 conscious, healthy men and women, the authors measured pressure within the tibialis anterior muscle compartment with the leg supine and in the lithotomy position with and without intermittent compression. Three different devices were used to keep the leg in the lithotomy position, supporting the leg either behind the knee, under the calf, or at the ankle. RESULTS: The lithotomy position with support behind the calf or knee increased intracompartment pressure to 16.5+/-3.4 versus 10.7+/-5.8 mmHg supine (mean +/- SD; P < 0.05). The addition of intermittent compression decreased pressure to 13.4+/-5.1 mmHg during lithotomy (P < 0.05) and to 9.1+/-7.0 mmHg in the supine position (P < 0.05). In contrast, the lithotomy position with support near the ankle decreased intracompartment pressure to 8.7+/-5.6 versus 13.3+/-5.1 mmHg supine (P < 0.05). The addition of intermittent compression decreased pressure to 6.5+/-5.4 mmHg during lithotomy (P < 0.05) and to 10.3+/-4.7 mmHg in the supine position (P < 0.05). CONCLUSIONS: These results show that the lithotomy position is associated with changes in intracompartment pressure that are dependent on the method of leg support used. Furthermore, they indicate that intermittent external compression can reduce intracompartment pressure in the lower leg. Therefore, increases in intracompartment pressure during surgery in the lithotomy position with the calf or knee supported may be one of the factors that contribute to the development of compartment syndrome. Further, use of intermittent external compression may significantly reduce this pressure increase.

Adult↗

PubMed2000

Rapid intermittent compression increases skin circulation in chronically ischemic legs with infra-popliteal arterial obstruction.

BACKGROUND: Intermittent pneumatic compression (IPC) has been shown, by duplex, to increase popliteal artery flow in normal legs and in legs with superficial femoral artery occlusion. The objective of this study was to see if IPC improves distal circulation in legs with severe infra-popliteal disease. PATIENTS AND METHODS: Sixteen chronically ischemic legs with arteriographically demonstrated crural or pedal disease were studied during compression with an ArtAssist compression-device. This device delivers rapid compression of the foot and calf. Cutaneous laser-Doppler flux was measured continuously at the dorsal aspect of the distal forefoot. The findings were compared to those in thirteen normal controls of similar age. RESULTS: In ischemic legs, the spontaneous changes in skin-flux are minimal: mean resting flux in sitting position was 0.87 +/- 0.46 AU (Arbitrary Units). Upon activation of the compression device the maximum flux increased to 4.55 +/- 1.35 AU. The difference was statistically significant (p < 0.001). This response was similar to that in normal controls. CONCLUSION: Arterial flow augmentation upon compression is associated with increased skin-flux. This response remains present in severe disease of the crural outflow-arteries. Further investigation to define the role of intermittent compression for management of chronic arterial disease is warranted.

Aged↗

PubMed1997

Intermittent pneumatic pedal compression and edema resolution after acute ankle fracture: a prospective, randomized study.

Thirty patients with an acute Weber B or C ankle fracture were enrolled after signing an informed consent. Fifteen patients were randomized to a control group where they received a posterior splint, ice, and elevation before surgery. Fifteen patients were randomized to a pneumatic pedal compression group where they received the same treatment plus a pneumatic pedal compression device which was used full-time before surgery. Baseline volumetric measurements of the injured foot were obtained, followed by measurements at 24-hour increments until surgery. On average, the patients in the pneumatic pedal compression group had an 88 mL decrease in volume in the first 24 hours versus a 33 mL increase in the control group (P < 0.03) and a 31 mL decrease in the first 48 hours of treatment versus a 32 mL increase for the control group (P < 0.05). The pneumatic pedal compression was well tolerated by the majority of patients (only one did not tolerate its use because of pain) and, we believe, serves as a useful adjunct in preoperative edema resolution after ankle fracture.

Ankle Injuries↗

PubMed2002

Prevention of thromboembolic disease after non-cemented hip arthroplasty. A multimodal approach.

Thromboembolism following total hip arthroplasty is a common complication that may result in significant morbidity and mortality. Despite this, optimal prophylactic regimen is controversial. We investigated the efficacy of a comprehensive approach encompassing the use of aspirin, intermittent compression devices ('foot pumps'), and early mobilization in a cohort of 200 consecutive patients after non-cemented total hip replacements. The surgical procedures were carried out under epidural anesthesia in most cases (91%). All patients were allowed full weight bearing and received ambulation training starting on the first post-operative day. Ankle-high pneumatic boots ('foot pumps') and aspirin (325 mg p.o./qd) were used immediately after surgery. The presence of deep vein thrombosis was determined with the routine use of venous duplex scans on post-operative day number 5 to 10 (mean 6.8). The duration of the follow-up was 3 months. No patients were lost to follow-up. Four distal DVT's (2%) were detected in three patients. None of the patients developed symptomatic pulmonary embolism during the follow-up period. There were no major wound complications. Venous thromboembolic disease after hip replacement surgery is largely associated with postoperative immobilization and venous stasis. It is the authors' opinion that a prevention strategy should include mechanical as well as pharmacological measures. The concomitant use of epidural anesthesia, "foot pumps", aspirin and early full weight bearing ambulation may be effective in further reducing the incidence of DVT after surgery.

Adult↗

PubMed1996

Blood-flow augmentation of intermittent pneumatic compression systems used for prevention of deep vein thrombosis prior to surgery.

PURPOSE: To compare, using Duplex ultrasonography, different intermittent pneumatic compression (IPC) systems to augment venous blood flow for deep venous thrombosis (DVT) prevention during and after surgery and during periods of immobility. METHODS: This cross-over study randomly assigned 26 young, healthy, adult subjects, without history of DVT, hypertension, diabetes, stroke. vascular or cardiac pathologies, to an order of knee-high, foam, single-pulse IPC device and thigh-high, vinyl, sequential-pulse pneumatic compression systems. Prior to making the flow measurement, the girth of the calf and thigh and length of the leg of each subject were determined. The right leg was used in this evaluation. RESULTS: The average flow augmentation, which is a direct measure of the amount of femoral vein blood flow velocity increase over the base, was 107%+/-49% with the knee-high system, and 77%+/-35% with the thigh-high IPC system (P<0.002). Augmentation was higher for 62% of the subjects with knee-high IPC, and for 23% of the subjects with the thigh-high system. Overall, the blood was actively moving through the vein during the decompression phase. On occasion, the velocity during the decompression phase would fall to zero for short intervals with both systems, indicating complete emptying of the vessel. Variation in limb anatomy did not significantly affect blood-flow augmentation with the knee-high IPC, but augmentation decreased with increase in girth with the thigh-high IPC. CONCLUSIONS: The study indicates that the knee-high, foam, single-pulse IPC device produces a significantly higher venous blood-flow augmentation than the thigh-high, vinyl, sequential-pulse system.

Adult↗

PubMed1999

Effectiveness of the A-V impulse hand pump.

Acute swelling of the hand is a common problem after trauma or surgery and is associated with both pain and loss of function. We describe a prospective study of 47 patients in which we assessed the effects of a pneumatic compression device (A-V impulse hand pump) on the swollen hand. The pump reduced swelling by increasing the velocity of venous return as demonstrated by Duplex scanning of the median cubital vein. Continuous use of the pump for 48 hours gave a reduction of 78.6% in swelling of the injured hand compared with the opposite, uninjured side. Even when used intermittently, with the pump on for 12 hours out of 24, a statistically significant effect was seen. There was a subjective reduction in pain and an objective improvement in function of the hand. Use of the pump resulted in a nearly normal hand by the time of discharge from hospital after, on average, 48 hours.

Adolescent↗

PubMed1998

Is intermittent pulsatile pressure a valuable adjunct in healing the complicated diabetic wound?

Diabetic neuropathic ulceration and subsequent lower extremity amputation are a significant cause of chronic disability. High-risk diabetic patients with infected foot wounds, poor lower extremity blood flow, and inadequately controlled blood glucose require prompt action by clinicians in order to successfully avoid more severe sequelae. Dysvascular patients who are poor candidates for arterial bypass surgery may benefit from adjunctive treatment with a pneumatic pedal compression device. The authors discuss the rationale behind this unique treatment modality and present a case report illustrating a successful outcome in a high-risk diabetic patient.

Adult↗

PubMed2005

Intermittent pneumatic foot compression can activate blood fibrinolysis without changes in blood coagulability and platelet activation.

BACKGROUND: Intermittent pneumatic foot compression (IPC) is a useful technique for prophylaxis of peri-operative venous thromboembolism. The aim of this study was to determine the effect of IPC on blood coagulation/fibrinolysis and platelet function using a blood viscometer (Sonoclot) and a platelet aggregation monitor (WBA analyzer(TM)), respectively. Using the same blood samples, serum levels of tissue-type plasminogen activator (t-PA), thrombomodulin (TM) and activated protein C (APC) were also measured. METHODS: The soles and legs of each subject (n = 8) were compressed for 3 s (130 mmHg) at a 0.3-Hz interval using an IPC device. Parameters were measured 2 min before and at the end of 60-min compression. RESULTS: Parameters of the Sonoclot time-to-peak were shortened and clot retraction rate was increased significantly by IPC, whereas the other parameters did not change. These results indicate that IPC can activate blood fibrinolysis but not coagulability. A parameter of the WBA analyzer PATI (platelet aggregatory threshold index) did not change, indicating that IPC cannot activate platelet function per se. The concentration of t-PA decreased slightly but significantly. A decrease in the concentration of t-PA can lead to activation of fibrinolysis. Other humoral parameters did not change, indicating that IPC has no effect on endothelial function. Although neither blood coagulability nor platelet function were affected by IPC, fibrinolytic activity increased slightly, probably by activation of t-PA function. CONCLUSION: IPC is useful for prophylaxis for thromboembolism by activation of blood fibrinolysis as well as inhibition of blood stasis.

Activated Protein C Resistance↗