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Ankle pump exercises plus anticoagulants reduce postoperative DVT riskAnkle Pump Exercises May Lower DVT Risk After Surgery

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Key Takeaway
Consider adding ankle pump exercises to anticoagulant therapy for postoperative DVT prevention, but evidence quality is low.

This meta-analysis evaluated the effect of ankle pump exercise combined with anticoagulant therapy versus anticoagulant therapy alone on the incidence of postoperative deep vein thrombosis (DVT) in surgical patients. The analysis included data from multiple randomized controlled trials.

The authors observed that the addition of ankle pump exercises was associated with a significantly reduced risk of postoperative DVT compared to anticoagulant therapy alone. In a subgroup analysis, active ankle pump exercises demonstrated a statistically significant and relatively consistent effect.

Key limitations noted by the authors include methodological shortcomings of the included studies, between-study heterogeneity, and potential publication bias. The overall quality of evidence was rated as low according to GRADE assessment.

Clinically, the addition of ankle pump exercises to routine anticoagulant therapy may further reduce the risk of postoperative lower-extremity DVT. However, these findings should be interpreted cautiously, and further high-quality randomized controlled trials are needed to confirm the benefit.

Researchers looked at data from over 2,000 patients who had surgery to see if adding specific movements could prevent deep vein thrombosis (DVT). DVT is a serious condition where blood clots form in the deep veins, often in the legs. The study compared patients receiving standard anticoagulant therapy alone against those who also performed ankle pump exercises.

The results showed that patients who did ankle pumps along with their medication had a significantly lower risk of developing blood clots. Specifically, active ankle pump exercises showed a consistent protective effect. This suggests that simple physical movements might be a helpful addition to standard medical treatments for preventing clots after surgery.

It is important to note that the quality of the evidence is currently low because the original studies had some flaws and differences. Because the data is not yet definitive, these findings should be viewed as an early indication rather than a proven rule. Patients should talk to their doctors about whether adding these exercises is right for their specific recovery plan.

What this means for you:
Adding ankle pump exercises to blood thinners may lower DVT risk after surgery, but more high-quality research is needed.

Common questions

What is deep vein thrombosis (DVT)?

Deep vein thrombosis, or DVT, is a condition where a blood clot forms in a deep vein, most commonly in the legs. It can occur after surgery when mobility is limited. This study looked at how adding ankle pump exercises to standard medication could help lower the risk of these clots forming during recovery.

How do ankle pumps help after surgery?

The study found that combining ankle pump exercises with anticoagulant therapy significantly reduced the risk of DVT compared to using medication alone. Active ankle pump exercises showed a consistent protective effect in the data, suggesting they may be a helpful addition to standard care for patients at risk of blood clots.

Is this finding certain enough to change treatment?

The evidence is currently considered low quality due to flaws in the original studies and differences between them. While the results show a link between ankle pumps and lower DVT risk, doctors should be cautious. More high-quality trials are needed before these findings can be fully confirmed as a standard practice.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
BackgroundPost-operative deep vein thrombosis (DVT) remains a common and potentially serious perioperative complication. Although anticoagulant therapy is the cornerstone of thromboprophylaxis, its effectiveness in alleviating postoperative lower-limb venous stasis is limited. Ankle pump exercises enhance venous return from the lower extremities and may provide a complementary antithrombotic effect when combined with anticoagulant therapy. However, the efficacy of ankle pump exercises as an adjunct to anticoagulation for preventing postoperative DVT has not been comprehensively evaluated. Therefore, this study aimed to assess the effectiveness of ankle pump exercises combined with anticoagulant therapy in preventing postoperative lower-extremity DVT.MethodsA systematic search was conducted in PubMed, EMBASE, Web of Science, the Cochrane Library, EBSCO-CINAHL, CNKI, VIP Database, and Wanfang Database from database inception to May 14, 2026. Randomized controlled trials (RCTs) comparing “ankle pump exercise combined with anticoagulant therapy” vs. “anticoagulant therapy alone” for the prevention of postoperative DVT were included. The primary outcome was the incidence of postoperative DVT. STATA 17.0 was used for meta-analysis. Subgroup analyses were performed according to the type of ankle pump exercise. Risk of bias was assessed using the Cochrane RoB 2 tool, and the quality of evidence was evaluated using the GRADE framework.ResultsA total of 16 RCTs involving 2,169 postoperative patients were included. Meta-analysis demonstrated that, compared with anticoagulant therapy alone, ankle pump exercise combined with anticoagulant therapy significantly reduced the risk of postoperative DVT (RR = 0.26, 95% CI: 0.16–0.45). Moderate heterogeneity was observed across studies (I2 = 60.9%). Subgroup analysis showed that active ankle pump exercise provided a statistically significant and relatively consistent effect (RR = 0.21, 95% CI: 0.14–0.34; I2 = 0.0%), whereas passive or device-assisted ankle pump exercise exhibited substantial heterogeneity. Sensitivity analyses suggested relative stability of the findings; however, funnel plot asymmetry and Egger's test suggested the potential presence of publication bias. According to the GRADE assessment, the overall quality of evidence was low.ConclusionsThe addition of ankle pump exercises to routine anticoagulant therapy may further reduce the risk of postoperative lower-extremity DVT, with active ankle pump exercises demonstrating a relatively more consistent protective effect. This combined approach may simultaneously address venous stasis and hypercoagulability and appears to be clinically feasible in postoperative settings. However, the overall certainty of the current evidence is limited by methodological shortcomings of the included studies, between-study heterogeneity, and potential publication bias. Therefore, the clinical benefits of this strategy should be interpreted cautiously, and further high-quality randomized controlled trials are required to confirm its effectiveness.
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