Meta-analysis of the effectiveness of ankle pump exercise combined with anticoagulant therapy for the prevention of post-operative lower extremity deep vein thrombosis.

BACKGROUND: Post-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.

METHODS: A 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.

RESULTS: A 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.

CONCLUSIONS: The 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.