German medical guidelines update VTE prophylaxis recommendations

The updated S3 guideline for the prevention of venous thromboembolism (VTE), version 4.1, has introduced significant changes regarding mechanical prophylaxis. Issued by the German Society of Internal Medicine and the German Society of Surgery, the guideline is valid until January 2031.

A key update is Recommendation 7.3, which has been assigned a Grade A recommendation with a 94 percent consensus. For patients with medium to high VTE risk who have contraindications to drug-based prophylaxis, physical measures—specifically intermittent pneumatic compression (IPC)—are now preferred. This change is based on evidence suggesting that IPC is more efficient than compression stockings.

The guideline specifies that physical measures should not replace indicated drug prophylaxis, though they may be used additionally. Specific applications for IPC include central nervous system procedures, elective spinal surgery, and treatment for immobile patients with acute ischemic stroke, where compression stockings are explicitly not recommended.