DVT Prevention - NICE Guidance

NICE guidance (MTG19) supports the geko™ device to reduce thromboembolism risk for patients when other mechanical and pharmacological methods of prophylaxis are impractical or contraindicated.


The geko™ device can prevent Venous Thromboembolism (VTE)

The geko™ device has been reviewed by The National Institute for Health and Clinical Excellence (NICE) medical technology evaluation program (MTEP) as anti-stasis/VTE prophylaxis solution to specific groups of patients who cannot be served by existing modalities

The recommendations are:

1. The case for adopting the geko™ device is supported for use in people who have a high risk of venous thromboembolism and for whom other mechanical and pharmacological methods of prophylaxis are impractical or contraindicated.

2. The case is supported because of the plausibility that the geko™ device may reduce the high risk of venous thromboembolism in patients who cannot use other forms of prophylaxis, and the low risk of the device causing harm.


Comparison of NMES with existing technologies 




VTE related Literature 


The benefits of using geko™

The chart below compares the ease of use of geko™ devices with other devices currently in use that are intended to perform a similar role taken from a recent Device Comparison Study - principal investigators Dr. Arthur Tucker and Dr. Annelie Maass, The Ernest Cooke Vascular & Microvascular Unit, St. Bartholomew's Hospital.


geko comparison



Current VTE prophylaxis

Disadvantages of pharmacological prophylaxis:

  • active bleeding
  • allergic reactions
  • risk of VTE can persist for weeks or months after hospital discharge
  • drug interactions with several substances, eg antibiotics, food
  • the level of clinical supervision required
  • heparin induced thrombocytopenia 


Disadvantages of mechanical prophylaxis (Intermittent Pneumatic Compression and Graduated Elastic Compression Stockings):

  • discomfort/pain
  • uncomfortable to wear
  • range of sizes required
  • weight
  • external power source required, restricting patient's mobility (IPC)
  • trip hazard (IPC)
  • poor compliance
  • expense
  • time and expertise required for fitting


Professor T. Briggs Medical Director, Royal National Orthopaedic Hospital - March 2010

"I am excited by the potential of this novel device to prevent significant adverse events in a high risk, high volume population".

According to the National Joint Registry over 150,000 lower limb arthroplasty procedures were carried out throughout the UK in 2008. Thromboembolic phenomena are a significant and common risk following these operations. DVT prophylaxis is by medical therapy and by prevention of blood stasis.

We are keen to examine the effect of the neuromuscular stimulator to lower the risk of post-operative DVT both directly and indirectly via increased ambulation.


David Warwick, MD BM FRCS FRCS(Orth) Reader in Orthopaedic Surgery
Wessex Nuffield Hospital, Southampton, SO53 2DW - April 2010

"The geko™ device offers the potential for effective, affordable and convenient thromboprophylaxis".

Venous thromboembolism is an important, and largely preventable, problem in orthopaedic surgery. Mechanical methods are intuitively attractive as they can reduce the risk without introducing the alternative risk of bleeding that is associated with chemical methods. Existing mechanical methods rely on sequential or impulse compression. These devices are relatively cumbersome and expensive. Electrical stimulation showed encouraging results very many years ago and the technology warrants a revisit. The geko™device offers the potential for effective, affordable and convenient thromboprophylaxis.


Professor Ajay Kakkar , Director of  the Thrombosis Research Institute, London - December 2009

"This technology has the potential to provide a paradigm shift in thrombosis prevention".