Contraindications to Intermittent Pneumatic Compression: Between Lines of Recommendations

Abstract

When exploring the contraindications for intermittent sequential pneumatic compression (ISPC), doctors should follow the manufacturer's recommendations for a specific pneumatic compression device model, while manufacturers tend to defer clinical decision-making to the doctor. Contraindications can be determined through expert assessments, leading to discrepancies in sources, or based on empirical experience. Conditions like diabetes, severe diabetic neuropathy with sensory loss, or microangiopathy posing a risk of skin necrosis are not contraindications or limitations for prescribing ISPC. In cases of severe limb ischemia, ISPC may provide relief for patients unsuitable for revascularization or amputation. ISPC is the sole form of compression therapy prescribed for severe peripheral arterial occlusion. ISPC can be used in infectious diseases if the condition is managed by pharmacotherapy. Recommendations have allowed prescribing ISPC for lower limb in COVID-19 patients. Further research is needed to explore the possibility of using ISPC for specific infections. Current recommendations state that ISPC can be used in patients with metastatic cancer. Additional research is necessary to specify a safe procedural methodology. There have been no documented cases of pulmonary embolism when ISPC was applied to patients with deep vein thrombosis. Dangerous complications of acute deep vein thrombosis occur less frequently during ISPC than when using heparin. ISPC is not recommended for patients with severe cases of stage IV NYHA heart failure. More contraindications are becoming limitations. The formulation should specify the conditions under which the described condition becomes a contraindication. Attention should be devoted to studying the systemic effects of ISPC. Trust in manufacturer recommendations should be fundamental, while further research on ISPC safety and monitoring new data regarding contraindications is necessary.