scholarly journals Venous thromboembolism chemical prophylaxis after endoscopic trans-sphenoidal pituitary surgery

Pituitary ◽  
2021 ◽  
Author(s):  
Mueez Waqar ◽  
Annabel Chadwick ◽  
James Kersey ◽  
Daniel Horner ◽  
Tara Kearney ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Postoperative Bleeding ◽  
Pituitary Surgery ◽  
Outcome Data ◽  
Bleeding Events ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Safe Strategy ◽  
Postoperative Haematoma ◽  
Deep Vein

Abstract Purpose There is no compelling outcome data or clear guidance surrounding postoperative venous thromboembolism (VTE) prophylaxis using low molecular weight heparin (chemoprophylaxis) in patients undergoing pituitary surgery. Here we describe our experience of early chemoprophylaxis (post-operative day 1) following trans-sphenoidal pituitary surgery. Methods Single-centre review of a prospective surgical database and VTE records. Adults undergoing first time trans-sphenoidal pituitary surgery were included (2009–2018). VTE was defined as either deep vein thrombosis and/or pulmonary embolism within 3 months of surgery. Postoperative haematomas were those associated with a clinical deterioration together with radiological evidence. Results 651 Patients included with a median age of 55 years (range 16–86 years). Most (99%) patients underwent trans-sphenoidal surgery using a standard endoscopic single nostril or bi-nostril trans-sphenoidal technique. More than three quarters had pituitary adenomas (n = 520, 80%). Postoperative chemoprophylaxis to prevent VTE was administered in 478 patients (73%). Chemoprophylaxis was initiated at a median of 1 day post-procedure (range 1–5 days postoperatively; 92% on postoperative day 1). Tinzaparin was used in 465/478 patients (97%) and enoxaparin was used in 14/478 (3%). There were no cases of VTE, even in 78 ACTH-dependent Cushing’s disease patients. Six patients (1%) developed postoperative haematomas. Chemoprophylaxis was not associated with a significantly higher rate of postoperative haematoma formation (Fisher’s Exact, p = 0.99) or epistaxis (Fisher’s Exact, p > 0.99). Conclusions Chemoprophylaxis after trans-sphenoidal pituitary surgery on post-operative day 1 is a safe strategy to reduce the risk of VTE without significantly increasing the risk of postoperative bleeding events.

Evaluation of an oral direct anti-Xa anticoagulant, apixaban, for the prevention of venous thromboembolism in patients with myeloma treated with IMiD* compounds: A pilot study (MYELAXAT).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8019-8019 ◽  
Author(s):  
Brigitte Pegourie ◽  
Gilles Pernod ◽  
Lionel Karlin ◽  
Lofti Benboubker ◽  
Frederique Orsini ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Pilot Study ◽  
Meta Analysis ◽  
Medical Patients ◽  
First Line ◽  
Bleeding Events ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Compression Ultrasound ◽  
Deep Vein

8019 Background: The risk of venous thromboembolism (VTE) is higher in myeloma patients recieving IMiD* compounds (IMiD*: registered). A VTE prophylaxis using low-molecular-weight heparin or aspirin is proposed. Apixaban is an oral direct anti-Xa. Several studies have shown the efficiency and safety of apixaban in VTE prophylaxis compared to enoxaparin. The objective of this prospective pilot study was to assess the risk of VTE and bleeding in patients with myeloma treated with IMiD* compounds, using apixaban in a preventive scheme. Methods: Myeloma patients requiring Melphalan-Prednisone-Thalidomide in first line, or Lenalidomide-Dexamethasone in relapse, asymptomatic regarding VTE at inclusion, were enrolled between 2014 - 2016. All patients recieved apixaban, 2.5 mg x 2/day for 6 months, and were monthly monitored. Venous (pulmonary embolism – PE, or symptomatic proximal or distal deep vein thrombosis - DVT, or all proximal asymptomatic events detected by systematic proximal bilateral compression ultrasound) or arterial thrombotic events, and bleeding events (ISTH 2005) were registered. Based on meta-analysis of Carrier regarding VTE recurrence, and results from the ADOPT study in medical conditions regarding hemorrhages, < 13 symptomatic VTE events, < 3 severe and < 14 clinically relevant non major (CRNM) bleeding were expected on the treatment period. Results: 104 patients were enrolled (mean age 69.8 +/- 7.8yrs), 11 in first line, 93 in relapse. No PE or arterial cardiovascular events were reported. Two venous thrombotic events were registered, i.e an asymptomatic proximal DVT (patient in relapse) and a symptomatic distal DVT, although apixaban was stopped 14 days before, due to Lenalidomide-induced thrombopenia. Only one major and 11 CRNM hemorrhages were reported. Conclusions: Referring to the incidence of thromboembolic events in Carrier’s meta-analysis, and to hemorrhagic events in medical patients recieving apixaban in primary VTE prophylaxis, apixaban used in a preventive scheme seems to be efficient and safe in preventing VTE in myeloma patients treated with IMiD* compounds. Clinical trial information: NCT02066454.

scholarly journals Treatment Patterns and Clinical Outcomes in Korean Cancer Patients With Venous Thromboembolism: A Retrospective Cohort Study

2021 ◽  
Vol 27 ◽  
pp. 107602962097957
Author(s):  
Soo-Mee Bang ◽  
Jin-Hyoung Kang ◽  
Min Hee Hong ◽  
Jin-Seok Ahn ◽  
So Yeon Oh ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Events ◽  
Factors Associated ◽  
Vein Thrombosis ◽  
Medical Chart Review ◽  
Deep Vein

This study assessed epidemiologic data and clinical outcomes, including venous thromboembolism (VTE) recurrence and bleeding events, in patients with cancer-associated VTE, and assessed factors associated with clinical outcomes. Data were extracted from retrospective medical-chart review of adult patients diagnosed with cancer-associated deep vein thrombosis or pulmonary embolism who received anticoagulation treatment for ≥3 months. Patients were classified by: low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs), and other anticoagulants. First VTE recurrence and bleeding events, and factors associated with their occurrence, were assessed during the initial 6 months of treatment. Overall, 623 patients (age: 63.7 ± 11.3 years, 49.3% male) were included (119, 132, and 372 patients in LMWH, DOACs and other anticoagulants groups, respectively). The cumulative 6-month incidence of VTE recurrence was 16.6% (total), 8.3% (LMWH), 16.7% (DOACs), and 20.7% (other); respective bleeding events were 22.5%, 11.0%, 12.3%, and 30.7%). VTE recurrence and bleeding rates differed only between LMWH and other anticoagulants (HR 2.4, 95% CI: 1.2-5.0 and 3.6, 1.9-6.8, respectively). These results highlight the importance of initial VTE treatment choice for preventing VTE recurrence and bleeding events. LMWH or DOACs for ≥3 months can be considered for effective VTE management in cancer patients.

Venous thromboembolism (VTE) prophylaxis

2018 ◽  
pp. 121-126
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Surgical Patients ◽  
Related Factors ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Preventable Complication ◽  
Fatal Complications

Venous thromboembolism is a common but largely preventable complication following surgery. However, fatal complications can occur as a result of pulmonary embolism following deep vein thrombosis. A structured risk assessment should be performed preoperatively in all surgical patients and thromboprophylaxis measures should be tailored according to patient- and procedure-related factors. These measures include anticoagulation with low molecular weight heparin and the use of mechanical compression devices.

Venous Thromboembolism in Abdominoplasty Patients: A Study of Incidence and Prophylaxis Recommendations

2007 ◽  
Vol 24 (2) ◽  
pp. 66-79 ◽  
Author(s):  
Samir Pancholi ◽  
Angelo Cuzalina
Keyword(s):  
Venous Thromboembolism ◽  
Cosmetic Surgery ◽  
Mechanical Prophylaxis ◽  
Specific Data ◽  
Cosmetic Procedure ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Pharmacologic Prophylaxis ◽  
Incidence Analysis ◽  
Deep Vein

Introduction: Pulmonary embolism (PE) and deep vein thrombosis (DVT) comprise venous thromboembolism (VTE). VTE is the most common preventable cause of death in postsurgical hospitalized patients. The literature consistently defines prophylaxis as being integral to avoiding VTE. No study, however, specifically addresses this with abdominoplasty, a high-VTE-risk cosmetic procedure. This study aims to fill this void by providing specific data on VTE incidence and, through comprehensive literature review, providing specific abdominoplasty prophylaxis recommendations. Methods: A retrospective review of 267 patients undergoing abdominoplasty between January 2000 and June 2006 at a fully accredited outpatient surgical facility was performed to assess symptomatic VTE incidence. Analysis reviewed VTE risk factors and current prophylaxis practice. A review of current cosmetic, plastic, and general surgery prophylaxis measures in the literature was performed and correlated with the authors' practice to develop abdominoplasty-specific VTE prophylaxis recommendations. Results: Four of 267 abdominoplasty patients (1.5%) developed VTE (all DVT). None of the 97 patients undergoing abdominoplasty alone developed DVT. Four of 170 abdominoplasty patients undergoing additional cosmetic procedures developed DVTs (23%). Of these, 3 had liposuction and 1 had simultaneous breast augmentation/mastopexy. All patients underwent general anesthesia, received mechanical prophylaxis, and were encouraged to ambulate the morning after surgery. Conclusions: VTE is a real and preventable issue in patient safety. Cosmetic surgery patients frequently are treated with inconsistent and less aggressive VTE prophylaxis than similar noncosmetic surgery patients owing to scant relevant data and/or concerns of problematic bleeding. The authors present abdominoplasty-specific DVT and PE rates of 1.5% and 0%, respectively, when mechanical prophylaxis is used. Although the results mirror those in the literature, the demand for optimal VTE prevention led the authors to increase their current prophylaxis regimen to a higher standard. They soundly use and present a VTE prophylaxis protocol for abdominoplasty patients that includes mechanical as well as pharmacologic prophylaxis.

Abstract 11662: Obesity Does Not Increase Venous Thromboembolism in Hospitalized Medical Patients Upon Multivariate Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Gabriel V Fontaine ◽  
Emily Vigil ◽  
Paul Wohlt ◽  
David Collingridge ◽  
James F Lloyd ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Primary Outcome ◽  
Univariate Analysis ◽  
Obese Patients ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Therapeutic Anticoagulation ◽  
Comorbidity Index ◽  
Deep Vein

Introduction: Obesity increases the risk of venous thromboembolism (VTE) in hospitalized medical patients. Standard chemoprophylaxis in these patients may be suboptimal, potentially leading to increased VTE. The objective of this study was to compare the rate of VTE in obese (body mass index [BMI] ≤30 kg/m 2 ) medical patients receiving standard VTE prophylaxis with rates in non-obese patients (BMI 17-29.9 kg/m 2 ). Hypothesis: Obese patients will suffer from a higher incidence of VTE within 90 days of hospitalization. Methods: In a single-center retrospective cohort study, patients admitted to all medical units between November 2007 and November 2013 were evaluated for eligibility if they received an initial dose of VTE prophylaxis within 48 hours of admission. Appropriate prophylaxis was heparin 5000 units subcutaneously (SQ) every 8 to 12 hours or enoxaparin 30 mg SQ twice daily or 40 mg SQ once daily. Exclusion criteria included hypercoagulable states, therapeutic anticoagulation, and admission for trauma or surgery. The primary outcome was 90 day VTE defined as deep vein thrombosis or pulmonary embolism using ICD-9 codes. Secondary outcomes included in-hospital VTE, 30 day VTE, and 90 day mortality. Univariate and multivariate analyses were used in calculating p-values and odds ratios (OR) for the primary outcome. Results: There were 17,525 patients eligible for inclusion. The final cohort included 4,237 obese patients and 4,990 non-obese patients (median BMI 36 and 25 kg/m 2 , respectively). Obesity increased the risk of in-hospital VTE (5.6% vs. 4.4%; p=0.01), 30 day VTE (5.7% vs. 4.6%; p=0.013), and 90 day VTE (5.9% vs. 4.8%; p=0.028) on univariate analysis. However, using multiple logistic regression, obesity was not an independent predictor of 90 day VTE (OR 1.0; p=0.83). Variables which independently increased 90 day VTE were Charlson Comorbidity Index (OR 1.09; p=0.003), prior VTE (OR 36.35; p<0.001), congestive heart failure (OR 1.33; p=0.017), and surgery in 90 days following admission (OR 1.56; p=0.004). Mortality was lower at 90 days in obese patients (3.3% vs. 6.3% non-obese; p<0.001) Conclusions: The incidence of VTE at 90 days in hospitalized medical patients is significant, but it is uncertain if obesity independently contributes to this.

Generic Versus Branded Enoxaparin in the Prevention of Venous Thromboembolism Following Major Abdominal Surgery

2011 ◽  
Vol 17 (6) ◽  
pp. 633-639 ◽  
Author(s):  
Marise Gomes ◽  
Eduardo Ramacciotti ◽  
Alexandre Cruz Henriques ◽  
Gilson Roberto Araujo ◽  
Luiz Arnaldo Szultan ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Abdominal Surgery ◽  
The United States ◽  
Major Abdominal Surgery ◽  
Low Molecular Weight Heparins ◽  
Bleeding Events ◽  
Once Daily ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
To Receive

Introduction: Several generic low-molecular-weight heparins (LMWHs) have recently become available worldwide, including the United States. Companies have filed for regulatory approval of generic versions in many countries, based only on compound biochemical characteristics or its immunogenicity. Methods: Prospective study to evaluate the comparative effect of 2 enoxaparins (Sanofi-Aventis branded enoxaparin [SAe] vs eurofarma-enoxaparin [Ee], a generic version) as prophylaxis for venous thromboembolism (VTE) following major abdominal surgery. A total of 200 patients were randomized in a 1:1 ratio either to receive 40 mg of SAe or Ee subcutaneously (sc) once daily (od) postoperatively for 7 to 10 days. Compressive ultrasound was performed on day 10 + 4. Results: No statistically significant differences between the 2 groups were detected. In all, 2 SAe patients presented deep vein thrombosis ([DVT] 2.1%), none of the Ee group. No major bleeding events occurred. Conclusions: This exploratory trial suggests that the generic LMWH is probably as safe and as effective as the branded enoxaparin (Lovenox, Brazil) in the prophylaxis of VTE in this population.

Venous thromboembolism in patients with active cancer

2007 ◽  
Vol 98 (09) ◽  
pp. 656-661 ◽  
Author(s):  
Ali Seddighzadeh ◽  
Ranjith Shetty ◽  
Samuel Goldhaber
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Inferior Vena ◽  
The United States ◽  
Inferior Vena Caval ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein ◽  
Active Cancer

SummaryPatients with cancer have an increased risk of venous thromboembolism (VTE).To further define the demographics, comorbidities, and risk factors of VTE in these patients, we analyzed a prospective registry of 5,451 patients with ultrasound confirmed deep vein thrombosis (DVT) from 183 hospitals in the United States. Cancer was reported in 1,768 (39%), of whom 1,096 (62.0%) had active cancer. Of these, 599 (54.7%) were receiving chemotherapy, and 226 (20.6%) had metastases. Lung (18.5%), colorectal (11.8%), and breast cancer (9.0%) were among the most common cancer types. Cancer patients were younger (median age 66 years vs. 70 years; p<0.0001), were more likely to be male (50.4% vs. 44.5%; p=0.0005), and had a lower average body mass index (26.6 kg/m2 vs. 28.9 kg/m2; p<0.0001). Cancer patients less often received VTE prophylaxis prior to development of DVT compared to those with no cancer (308 of 1,096, 28.2% vs. 1,196 of 3,444, 34.6%; p<0.0001). For DVT therapy, low-molecular-weight heparin (LMWH) as monotherapy without warfarin (142 of 1,086, 13.1% vs. 300 of 3,429, 8.7%; p<0.0001) and inferior vena caval filters (234 of 1,086, 21.5% vs. 473 of 3,429, 13.8%; p<0.0001) were utilized more often in cancer patients than in DVT patients without cancer. Cancer patients with DVT and neurological disease were twice as likely to receive inferior vena caval filters than those with no cancer (odds ratio 2.17, p=0.005). In conclusion, cancer patients who develop DVT receive prophylaxis less often and more often receive filters than patients with no cancer who develop DVT. Future studies should focus on ways to improve implementation of prophylaxis in cancer patients and to further define the indications, efficacy, and safety of inferior vena caval filters in this population.

Effectiveness and Safety of Twice- Versus Thrice-Daily Subcutaneous Heparin for Venous Thromboembolism Prophylaxis at a Large Academic Medical Center

2021 ◽  
pp. 106002802110413
Author(s):  
Eryne E. Wiethorn ◽  
Sarah Harrison ◽  
Erin R. Weeda ◽  
Carolyn Magee Bell
Keyword(s):  
Venous Thromboembolism ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Secondary Outcome ◽  
Bleeding Events ◽  
Thromboembolism Prophylaxis ◽  
Vein Thrombosis ◽  
Venous Thromboembolism Prophylaxis ◽  
Deep Vein

Background Dosing variation of subcutaneous unfractionated heparin (UFH) exist for venous thromboembolism prophylaxis (VTEP). Objective The purpose of this study was to compare the safety and effectiveness of thrice-daily (TID) versus twice-daily (BID) administration of UFH during a heparin shortage for VTEP. Methods A single-center retrospective analysis was conducted in patients with orders for BID subcutaneous UFH during a heparin shortage from September 1, 2019, to February 4, 2020. These patients were matched to patients with TID subcutaneous UFH orders from January 1, 2019, to May 31, 2019. The primary outcome was the incidence of deep-vein thrombosis or pulmonary embolism confirmed by imaging during hospitalization. The secondary outcome was the incidence of major or clinically relevant nonmajor bleeding events as defined by International Society on Thrombosis and Haemostasis (ISTH) definitions. Results A total of 277 patients with orders for BID UFH and meeting inclusion criteria were evaluated and matched to patients who received TID UFH. After the exclusion criteria were implemented, 510 patients remained in the TID group. The primary outcome occurred in 4% of patients in the BID group and 3% in the TID group ( P = 0.645). Major bleeding or clinically relevant nonmajor bleeding events occurred in 10% of patients in the BID group and 8% in the TID group ( P = 0.310). Conclusion and Relevance There was no difference in effectiveness or safety of TID versus BID subcutaneous UFH for VTEP. During a heparin shortage, transitioning patients to BID UFH for VTEP to conserve supply may be considered.

scholarly journals The incidence of post operative venous thromboembolism in patients undergoing varicose vein surgery recorded in Hospital Episode Statistics

2012 ◽  
Vol 94 (7) ◽  
pp. 481-483 ◽  
Author(s):  
PA Sutton ◽  
Y El-Duhwaib ◽  
J Dyer ◽  
AJ Guy
Keyword(s):  
Venous Thromboembolism ◽  
Varicose Vein ◽  
Hospital Episode Statistics ◽  
Varicose Vein Surgery ◽  
Hospital Episode ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Endovenous Laser Therapy ◽  
Deep Vein ◽  
Bilateral Treatment

INTRODUCTION The aim of this study was to establish the incidence of post-operative venous thromboembolism (VTE) following varicose vein treatment. METHODS Hospital Episode Statistics (HES) data were obtained for all patients undergoing varicose vein treatment between April 2006 and April 2007 to identify those reattending with either deep vein thrombosis or pulmonary embolism within 12 months. RESULTS The incidence of VTE was 0.51%, which was comparable with the incidence for those undergoing open surgery (0.54%), sclerotherapy (0.19%) and endovenous laser therapy (EVLT) (0.47%). The incidence of VTE in those undergoing combined EVLT and phlebectomy was 1.26% (p=0.01). In contrast to unilateral treatment (all modalities), where bilateral treatment was performed an increase in the incidence of VTE was seen in those undergoing redo (1.62%) and short saphenous system (1.16%) treatments.Overall, 1.02% of cases were performed under local anaesthesia with zero incidence of VTE in this cohort. CONCLUSIONS The overall incidence of VTE recorded in HES was 0.51% and appears to be highest in those undergoing bilateral redo or short saphenous system surgery as well as those undergoing a combination of EVLT and phlebectomy. The use of VTE prophylaxis, particularly in these groups, is recommended.

Rivaroxaban for the prevention of venous thromboembolism after radiofrequency ablation of saphenous veins concomitant with miniphlebectomy, sclerotherapy, or no treatment of varicose tributaries

2021 ◽  
pp. 026835552110173
Author(s):  
Elena Murzina ◽  
Kirill Lobastov ◽  
Leonid Laberko ◽  
Anton Dvornikov ◽  
Ivan Popov
Keyword(s):  
Venous Thromboembolism ◽  
Radiofrequency Ablation ◽  
Thromboembolism Prophylaxis ◽  
Once Daily ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Saphenous Veins ◽  
Symptomatic Pulmonary Embolism ◽  
Efficacy Outcome ◽  
Deep Vein

Objective To assess the efficacy and safety of once-daily 10 mg rivaroxaban for venous thromboembolism prophylaxis after ClosureFast radiofrequency ablation (RFA) of saphenous veins. Method The medical records of patients, who had a Caprini score of ≥3, underwent RFA, received prophylactic rivaroxaban for five days, and completed follow up at one month were reviewed for efficacy (a combination of endovenous heat-induced thrombosis [EHIT] grade of 2–4, any symptomatic or asymptomatic deep vein thrombosis [DVT], and symptomatic pulmonary embolism [PE]) and safety (a combination of major and clinically relevant non-major [CRNM] bleeding) outcomes. Results The results of RFA for 248 great saphenous and 24 small saphenous veins with the concomitant miniphlebectomy (63.8%) and sclerotherapy (16.5%) were analyzed. The primary efficacy outcome occurred in 5 of 218 (2.3%; 95%CI, 1.0–5.3%) patients: three EHITs and two symptomatic DVTs. The CRNM bleeding was reported in two patients (0.9%; 95% CI, 0.2–3.3%). No difference was observed in comparison with 79 similar patients who received 40 mg of subcutaneous enoxaparin during the same time period. Conclusion Once-daily 10 mg rivaroxaban is suitable for VTE prophylaxis after RFA of saphenous veins.

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