Objective:

To assess the effectiveness of ankle pump exercises combined with anticoagulant therapy in preventing postoperative lower-extremity DVT.

Approach:

• Study Design: Systematic search and meta-analysis of randomized controlled trials (RCTs) comparing ankle pump exercise combined with anticoagulant therapy vs. anticoagulant therapy alone.
• Data Sources: PubMed, EMBASE, Web of Science, Cochrane Library, EBSCO-CINAHL, CNKI, VIP Database, and Wanfang Database.
• Outcome Measures: Primary outcome was the incidence of postoperative DVT.
• Statistical Analysis: Meta-analysis performed using STATA 17.0; risk of bias assessed with Cochrane RoB 2 tool; evidence quality evaluated using GRADE framework.

Key Findings:

• 16 RCTs involving 2,169 postoperative patients were included.
• Ankle pump exercise combined with anticoagulant therapy significantly reduced the risk of postoperative DVT (RR = 0.26, 95% CI: 0.16–0.45).
• Active ankle pump exercise showed a consistent effect (RR = 0.21, 95% CI: 0.14–0.34; I2 = 0.0%).
• Substantial heterogeneity was observed in passive or device-assisted ankle pump exercise (I2 = X%).
• Overall quality of evidence was assessed as low.

Interpretation:

The addition of ankle pump exercises to anticoagulant therapy may reduce the risk of postoperative lower-extremity DVT, particularly with active exercises.

Limitations:

• Methodological shortcomings of included studies, including small sample sizes and lack of blinding.
• Between-study heterogeneity.
• Potential publication bias indicated by funnel plot asymmetry and Egger's test.

Conclusion:

Further high-quality RCTs are required to confirm the effectiveness of combining ankle pump exercises with anticoagulant therapy for DVT prevention.