Incremental cost of venous thromboembolism in trauma patients with contraindications to prophylactic anticoagulation: a prospective economic study

Background: Patients admitted to hospital for surgery or acute medical illnesses have a high risk for venous thromboembolism (VTE). Today’s widespread use of low molecular weight heparins (LMWH) for VTE prophylaxis is supposed to have reduced VTE rates substantially. However, data concerning the overall effectiveness of LMWH prophylaxis is sparse. Patients and methods: We prospectively studied all patients with symptomatic and objectively confirmed VTE seen in our hospital over a three year period. Event rates in different wards were analysed and compared. VTE prophylaxis with Enoxaparin was given to all patients at risk during their hospital stay. Results: A total of 50 464 inpatients were treated during the study period. 461 examinations were carried out for symptoms suggestive of VTE and yielded 89 positive results in 85 patients. Seventy eight patients were found to have deep vein thrombosis, 7 had pulmonary embolism, and 4 had both deep venous thrombosis and pulmonary embolism. The overall in hospital VTE event rate was 0.17%. The rate decreased during the study period from 0.22 in year one to 0,16 in year two and 0.13 % in year three. It ranged highest in neurologic and trauma patients (0.32%) and lowest (0.08%) in gynecology-obstetrics. Conclusions: With a simple and strictly applied regimen of prophylaxis with LMWH the overall rate of symptomatic VTE was very low in our hospitalized patients. Beside LMWH prophylaxis, shortening hospital stays and substantial improvements in surgical and anasthesia techniques achieved during the last decades probably play an essential role in decreasing VTE rates.

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Familial thrombophilia associated with fibrinogen Paris V: Dusart syndrome

Blood ◽

10.1182/blood.v96.3.1191 ◽

2000 ◽

Vol 96 (3) ◽

pp. 1191-1193 ◽

Cited By ~ 15

Author(s):

Takashi Tarumi ◽

Danko Martincic ◽

Anne Thomas ◽

Robert Janco ◽

Mary Hudson ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Early Onset ◽

Family Members ◽

Initial Presentation ◽

Pulmonary Emboli ◽

Common Cause ◽

History Of ◽

Prophylactic Anticoagulation ◽

Fibrin Clots

Abstract We report on a family with a history of venous thromboembolism associated with fibrinogen Paris V (fibrinogen A-Arg554→Cys). Ten members experienced thrombotic events, including 4 with fatal pulmonary emboli. Pulmonary embolism was the presenting feature in 4. Those with the mutation and a history of thrombosis had somewhat higher fibrinogen concentrations than those with the mutation and no thrombosis (294 ± 70 mg/dL vs 217 ± 37 mg/dL, respectively). The Paris V mutation consistently caused a prolongation of the reptilase time, and fibrin clots containing the abnormal fibrinogen were more translucent than normal clots. Given the early onset of symptoms and the initial presentation with pulmonary embolism in some family members, it was justifiable to offer prophylactic anticoagulation with warfarin to carriers of the mutation. Fibrinogen Paris V has now been reported in 4 apparently unrelated families, indicating that it is a relatively common cause of dysfibrinogenemia-associated thrombosis.

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Venous Thromboembolism Anticoagulation Prophylaxis Timing in Patients Undergoing Craniotomy for Tumor

Neurosurgery Open ◽

10.1093/neuopn/okaa018 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Hanna Algattas ◽

Spencer E Talentino ◽

Bradley Eichar ◽

Abraham A Williams ◽

Joseph M Murphy ◽

...

Keyword(s):

Venous Thromboembolism ◽

Clinical Judgment ◽

Tumor Resection ◽

The Elderly ◽

Extent Of Resection ◽

Subtotal Resection ◽

Hemorrhagic Complication ◽

Increased Risk ◽

Hemorrhagic Complications ◽

Prophylactic Anticoagulation

ABSTRACT BACKGROUND Prophylactic anticoagulation helps prevent postoperative venous thromboembolism (VTE) and time to initiation postcraniotomy has relied on clinical judgment and practice patterns. OBJECTIVE To compare risks of postoperative VTE and hemorrhage among patients undergoing tumor resection with initiation of prophylactic anticoagulation on postoperative day 1 (POD1) vs POD2. METHODS Adult patients undergoing craniotomy for tumor between 2008 and 2018 were retrospectively reviewed. Outcomes were recorded from the Electronic medical record (EMR) including deep vein thrombosis (DVT), pulmonary embolism (PE), and hemorrhage. RESULTS Of a total of 1168 patients undergoing craniotomy, 225 initiated anticoagulation on POD1 and 389 initiated on POD2. Of the 171 glioblastoma (GBM) cases, 64 initiated on POD1 and 107 on POD2. There were 9 DVTs (1.5%), 1 PE (0.20%), overall VTE rate of 1.6%, and 7 hemorrhagic complications (1.10%), 4 being clinically significant. The GBM cohort contained 4 DVTs (2.3%) and 3 hemorrhagic complications (1.80%). There was no increased risk of VTE or hemorrhage with anticoagulation initiated on POD2 compared to POD1 in either cohort. Multivariate analysis in both cohorts did not reveal a significant association between DVT, PE, or hemorrhagic complications with age, body mass index, GBM pathology, or extent of resection. Interestingly, glioma patients older than 70 with subtotal resection had a higher likelihood of suffering intracranial hemorrhage when anticoagulation was started on POD1 (odds ratio 12.98). CONCLUSION Risk of VTE or hemorrhagic complication did not significantly differ with prophylactic anticoagulation started on POD1 vs POD2. Early anticoagulation may certainly be considered in high risk cases; however, 1 group where risk may outweigh benefit is the elderly glioma population receiving a subtotal resection.

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Post‐hospitalization venous thromboembolism in COVID‐19 patients: Evidence against routine post‐hospitalization prophylactic anticoagulation

International Journal of Laboratory Hematology ◽

10.1111/ijlh.13633 ◽

2021 ◽

Author(s):

Jing Yuan Tan ◽

Chuen Wen Tan ◽

Wan Hui Wong ◽

May Anne Cheong ◽

Lai Heng Lee ◽

...

Keyword(s):

Venous Thromboembolism ◽

Prophylactic Anticoagulation

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Determining the impact of culture on venous thromboembolism prevention in trauma patients: A Southwestern Surgical Congress Multicenter trial

The American Journal of Surgery ◽

10.1016/j.amjsurg.2018.11.005 ◽

2019 ◽

Vol 217 (6) ◽

pp. 1030-1036 ◽

Cited By ~ 5

Author(s):

Justin L. Regner ◽

Courtney N. Shaver ◽

Richard Frazee ◽

Steven E. Brooks ◽

Sharmila Dissanaike ◽

...

Keyword(s):

Venous Thromboembolism ◽

Multicenter Trial ◽

Trauma Patients ◽

Venous Thromboembolism Prevention ◽

The Impact

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Venous Thromboembolism in Trauma Patients

The American Surgeon ◽

10.1177/000313480707301121 ◽

2007 ◽

Vol 73 (11) ◽

pp. 1173-1180 ◽

Cited By ~ 13

Author(s):

Om P. Sharma ◽

Michael F. Oswanski ◽

Rusin J. Joseph ◽

Peter Tonui ◽

Libby Westrick Pa-C ◽

...

Keyword(s):

Risk Factor ◽

Venous Thromboembolism ◽

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Univariate Analysis ◽

Trauma Patients ◽

Vein Thrombosis ◽

Cord Injury ◽

Deep Vein

Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1–2 RFs), 3.4 per cent in moderate (3–5 RFs), and 7.7 per cent in high (≥6 RFs) VTE scores ( P = 0.172). Incidence was statistically different (3% vs 7.2%, P = 0.048) on reanalyzing patients in two risk categories, low-risk (1–4 RFs) and high-risk (≥5 RFs). Only 4 of 16 RFs had statistically higher incidence of DVT in patients with or without RFs: previous VTE (27.3% vs 5.6%, odds ratio (OR) 6.628, P = 0.024), spinal cord injury (22.6% vs 5%, OR 5.493, P = 0.001), pelvic fractures (11.4% vs 5.1%, OR 2.373, P = 0.042), and head injury with a greater than two Abbreviated Injury Score (10.5% vs 4.2%, OR 2.639, P = 0.014). On reanalyzing patients with ≥5 RFs vs <5RFs, obesity (14.3 vs 6.1%, P = 0.007), malignancy (5.6% vs 0.6%, P = 0.006), coagulopathy (10.8% vs 1.8%, P = 0.000), and previous VTE (3.2% vs 0%, P = 0.019) were significant on univariate analysis. Patients with DVT had 3.70 ± 1.75 RFs and a 9.61 ± 4.93 VTE score, whereas, patients without DVT had 2.66 ± 1.50 RFs and a 6.83 ± 3.91 VTE score ( P = 0.000). DVTs had a direct positive relationship with higher VTE scores, length of stay, and number of VDS (>1 r, P ≤ 0.001). Increasing age was a weak risk factor (0.03 r, P = 0.5). First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of ≥15 and 25 had higher DVTs compared with the ones with lower injury severity score levels ( P ≤ 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.

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High level of venous thromboembolism in critically ill trauma patients despite early and well-driven thromboprophylaxis protocol

Annals of Intensive Care ◽

10.1186/s13613-017-0315-0 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 25

Author(s):

S. R. Hamada ◽

C. Espina ◽

T. Guedj ◽

R. Buaron ◽

A. Harrois ◽

...

Keyword(s):

Venous Thromboembolism ◽

Critically Ill ◽

Trauma Patients ◽

High Level

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In Trauma Patients with a Contraindication to Immediate Prophylactic Anticoagulation, Early Placement of a Vena Cava Filter Did Not Reduce a Composite of Pulmonary Embolism or Death at 90 Days

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.19.01330 ◽

2020 ◽

Vol 102 (4) ◽

pp. 342

Author(s):

Meir Liebergall ◽

Khalil Nasrallah

Keyword(s):

Pulmonary Embolism ◽

Vena Cava ◽

Vena Cava Filter ◽

Trauma Patients ◽

Prophylactic Anticoagulation ◽

Early Placement

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Massive Transfusion Protocol and Subsequent Development of Venous Thromboembolism: Statewide Analysis

The American Surgeon ◽

10.1177/0003134820948905 ◽

2020 ◽

pp. 000313482094890

Author(s):

Eric H. Bradburn ◽

Kwok M. Ho ◽

Madison E. Morgan ◽

Lauren D’Andrea ◽

Tawnya M. Vernon ◽

...

Keyword(s):

Venous Thromboembolism ◽

Injury Severity ◽

Massive Transfusion ◽

Subsequent Development ◽

Multivariate Logistic Regression Model ◽

Trauma Patients ◽

Vte Prophylaxis ◽

Vein Thrombosis ◽

Hemorrhagic Event ◽

High Index Of Suspicion

Background Massive transfusion protocols (MTP) are a routine component of any major trauma center’s armamentarium in the management of exsanguinating hemorrhages. Little is known about the potential complications of those that survive a MTP. We sought to determine the incidence of venous thromboembolism (VTE) following MTP. We hypothesized that MTP would be associated with a higher risk of VTE when compared with a risk-adjusted control population without MTP. Methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2015 to 2018 for trauma patients who developed VTE and survived until discharge at accredited trauma centers in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in VTE development between MTP and non-MTP patients. A multivariate logistic regression model assessed the adjusted impact of MTP on VTE development. Results 176 010 patients survived until discharge, meeting inclusion criteria. Of those, 1667 developed a VTE (pulmonary embolism [PE]: 662 [0.4%]; deep vein thrombosis [DVT]: 1142 [0.6%]; PE and DVT: 137 [0.1%]). 1268 patients (0.7%) received MTP and, of this subset of patients, 171 (13.5%) developed a VTE during admission. In adjusted analysis, patients who had a MTP and survived until discharge had a higher odds of developing a VTE (adjusted odds ratio: 2.62; 95% CI: 2.13-3.24; P < .001). Discussion MTP is a harbinger for higher risk of VTE in those patients who survive. This may, in part, be related to the overcorrection of coagulation deficits encountered in the hemorrhagic event. A high index of suspicion for the development of VTE as well as aggressive VTE prophylaxis is warranted in those patients who survive MTP.

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