Clinical Study of Neuromuscular Electrical Stimulation Combined with Intermittent Pneumatic Compression for Preventing Lower-Extremity Deep Vein Thrombosis in Patients with Stroke

Objective: To investigate the efficacy and safety of neuromuscular electrical stimulation (NMES) combined with intermittent pneumatic compression (IPC) for preventing lower-extremity deep vein thrombosis (DVT) in patients with acute stroke and lower-limb immobilization.
Methods: This was a single-center, prospective controlled study. Twenty consecutive patients with acute stroke were enrolled and allocated in a 1:1 ratio to a control group (IPC, n=10) or an intervention group (NMES+IPC, n=10). Lower-extremity venous ultrasonography was performed at enrollment to exclude pre-existing DVT; during follow-up, repeat ultrasonography was conducted at prespecified time points and/or when clinically indicated to ascertain incident DVT. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-dimer were measured at baseline and on day 7 of intervention. Days of bed rest and hospitalization and functional outcomes (Barthel Index and modified Rankin Scale [mRS]) were recorded.
Results: The incidence of DVT was 30.0% (3/10) in the control group and 10.0% (1/10) in the intervention group, with no statistically significant difference (Fisher’s exact test P=0.582; RR=0.33, 95% CI 0.04–2.69). D-dimer levels decreased over time in both groups: from 1067.8 [640.9, 1355.4] µg/L to 775.6 [526.9, 997.6] µg/L in the control group and from 745.3 [668.4, 875.3] µg/L to 464.4 [302.6, 581.2] µg/L in the intervention group; the between-group difference on day 7 was not significant (P=0.104). The gain in Barthel Index (discharge minus baseline) was 10.80±11.55 points in the control group and 26.20±6.86 points in the intervention group, with a between-group mean difference of 15.40 points (95% CI 6.33–24.47; P=0.003). The median mRS at discharge [IQR] was 3.0 [2.0, 3.8] in the control group and 1.5 [1.0, 2.8] in the intervention group (P=0.023); the proportions with good outcome (mRS 0–2) were 40.0% and 70.0%, respectively (P=0.370). No device-related serious adverse events were recorded during the study period.

Conclusion: In this pilot study, NMES combined with IPC showed a trend toward a lower incidence of DVT compared with IPC alone and was associated with better functional recovery outcomes. Given the small sample size, larger, multicenter randomized controlled trials are needed to confirm the true effect size and identify the populations most likely to benefit.