Venous thromboembolic pharmacological prophylaxis in severe traumatic acute subdural hematomas: Early prophylaxis is effective and safe

Venous thromboembolic disease is a major global cause of morbidity and mortality. An estimated 10 million episodes are diagnosed yearly; over half of these episodes are provoked by hospital admission/procedures and result in significant loss of disability adjusted life years. Temporary lower limb immobilisation after injury is a significant contributor to the overall burden of venous thromboembolism (VTE). Existing evidence suggests that pharmacological prophylaxis could reduce overall VTE event rates in these patients, but the proportional reduction of symptomatic events remains unclear. Recent studies have used different pharmacological agents, dosing regimens and outcome measures. Consequently, there is wide variation in thromboprophylaxis strategies, and international guidelines continue to offer conflicting advice for clinicians. In this review, we provide a summary of recent evidence assessing both the clinical and cost effectiveness of thromboprophylaxis in patients with temporary immobilisation after injury. We also examine the evidence supporting stratified thromboprophylaxis and the validity of widely used risk assessment methods.

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Timing of venous thromboembolic pharmacological prophylaxis in traumatic combined subdural and subarachnoid hemorrhage

The American Journal of Surgery ◽

10.1016/j.amjsurg.2021.11.021 ◽

2021 ◽

Author(s):

Dominik A. Jakob ◽

Meghan Lewis ◽

Elizabeth R. Benjamin ◽

Delbrynth Mitchao ◽

Aristomenis K. Exadaktylos ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Pharmacological Prophylaxis ◽

Venous Thromboembolic

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Combined assessment of thrombotic and haemorrhagic risk in acute medical patients

Thrombosis and Haemostasis ◽

10.1160/th14-12-1050 ◽

2016 ◽

Vol 115 (02) ◽

pp. 392-398 ◽

Cited By ~ 11

Author(s):

Francesco Orlandini ◽

Francesca Marchini ◽

Alessia Marinaro ◽

Rosanna Bonacci ◽

Paola Bonanni ◽

...

Keyword(s):

Internal Medicine ◽

Multivariate Analysis ◽

High Risk ◽

Bleeding Complications ◽

Thromboembolic Events ◽

Medical Patients ◽

Pharmacological Prophylaxis ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Supplementary Material

SummaryAcute medical patients have a high risk of venous thromboembolic events (VTE). Unfortunately, the fear of bleeding complications limits the use of antithrombotic prophylaxis in this setting. To stratify the VTE and haemorrhagic risk, two clinical scores (PADUA, IMPROVE) have recently been developed. However, it is not clear how many patients have a concomitant high VTE and haemorrhagic risk and what is the use of prophylaxis in this situation. To clarify these issues we performed a prospective cohort study enrolling consecutive patients admitted to internal medicine. Patients admitted to internal medicine (January to December 2013) were included. VTE and haemorrhagic risk were evaluated in all the included patients. Use and type of anti-thrombotic prophylaxis was recorded. A total of 1761 patients (mean age 77.6 years) were enrolled; 76.8 % (95 % CI 74.7–78.7) were at high VTE risk and 11.9 % (95 % CI 10.4–13.5) were at high haemorrhagic risk. Anti-thrombotic prophylaxis was used in 80.5 % of patients at high VTE risk and in 6.5 % at low VTE risk (p< 0.001), and in 16.6 % at high haemorrhagic risk and in 72.5 % at low haemorrhagic risk (p< 0.001). Prophylaxis was used in 20.4 % at both high VTE and haemorrhagic risk and in 88.9 % at high VTE risk but low haemor-rhagic risk. At multivariate-analysis, use of prophylaxis appeared highly influenced by the VTE risk (OR 68.2, 95 % CI 43.1 - 108.0). In conclusion, many patients admitted to internal medicine were at high risk of VTE. Since almost 90 % of them were at low haemorrhagic risk, pharmacological prophylaxis may be safely prescribed in most of these patients.Supplementary Material to this article is available online at www.thrombosis-online.com.

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Pharmacological prophylaxis versus none- pharmacological prophylaxis in prevention of clinical venous thromboembolic complications in morbid obese patients following bariatric surgery: a retrospective observational case-control study

10.21203/rs.3.rs-19824/v1 ◽

2020 ◽

Author(s):

Masoud Amini ◽

Nader Moein-vaziri ◽

Babak Hosseini ◽

Leila Vafa ◽

Neda Haghighat

Keyword(s):

Bariatric Surgery ◽

Laparoscopic Bariatric Surgery ◽

Obese Patients ◽

Pharmacological Prophylaxis ◽

Vte Prophylaxis ◽

Significant Difference ◽

Venous Thromboembolic ◽

Risk Patients ◽

Pharmacologic Prophylaxis ◽

Morbid Obese

Abstract Background: Venous thromboembolism (VTE) is a serious complication that may occur after bariatric surgery. This study aims to report the rate of clinically evident VTE using pharmacologic versus non-pharmacologic prophylaxis among morbid obese patients undergoing laparoscopic bariatric surgery who were at low risk for VTE.Methods: The laparoscopic research center database from 2017 to 2018 was queried to identify patients undergoing laparoscopic bariatric surgery. Retrospectively, each patient who met the inclusion and exclusion criteria was clinically evaluated for the presence of symptomatic VTE (DVT and PTE) during the postoperative period. VTE prophylaxis regimens were pharmacological prophylaxis or non-pharmacological prophylaxis. Results: We identified 794 patients who underwent bariatric surgery.110 patients excluded from the study based on the VTE risk factor. 371 (54.4%) patients had non-pharmacological, 313 (45.9%) patients had pharmacological prophylaxis. In the non-pharmacological group, the overall rates of DVT, and PTE were 1 (0.26%) and 1 (0.26%), respectively. In the pharmacological group, the overall rates of PTE and DVT were 2 (0.63%) and 0, respectively. Patients without pharmacological prophylaxis had no significant difference in DVT and PTE rate compared to the group which received pharmacological prophylaxis (P>0.5). Conclusions: Adequate VTE prophylaxis is achieved without pharmacological thromboprophylactic agents for lower-risk patients. Thus, an individualized prophylaxis regimen that balances efficacy and safety is suggested for each patient, based on various risk factors.

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Prevention of Readmission for Venous Thromboembolic Disease after Total Hip Arthroplasty

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70119-6 ◽

2007 ◽

Vol 2007 ◽

pp. 116-118

Author(s):

B.F. Morrey

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Thromboembolic Disease ◽

Venous Thromboembolic Disease ◽

Total Hip ◽

Venous Thromboembolic

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Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease

Seminars in Hematology ◽

10.1053/shem.2001.25184 ◽

2001 ◽

Vol 38 (2, Suppl 5) ◽

pp. 12-19 ◽

Cited By ~ 18

Author(s):

Joseph A. Caprini ◽

Juan I. Arcelus ◽

Jos[eacute] J. Reyna

Keyword(s):

Risk Stratification ◽

Thromboembolic Disease ◽

Venous Thromboembolic Disease ◽

Venous Thromboembolic ◽

Nonsurgical Patients

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Monitoring Heparin Therapy: Relationships between the Activated Partial Thromboplastin Time and Heparin Assays Based on Ex-Vivo Heparin Samples

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645678 ◽

1990 ◽

Vol 63 (01) ◽

pp. 016-023 ◽

Cited By ~ 41

Author(s):

A M H P van den Bessekaar ◽

J Meeuwisse-Braun ◽

R M Bertina

Keyword(s):

Partial Thromboplastin Time ◽

Plasma Sample ◽

Ex Vivo ◽

Correlation Coefficients ◽

Heparin Therapy ◽

Thromboembolic Disease ◽

Activated Partial Thromboplastin Time ◽

Venous Thromboembolic Disease ◽

Venous Thromboembolic

SummaryFive different APTT reagents, two amidolytic anti-ITa assays, one amidoiytic anti-Xa assay, and one coagulometric anti-Xa/ anti-IIa assay were used to assess the effect of heparin in patients treated for venous thromboembolic disease. Good correlations were observed between lug-transformed APYE> determined with the various reagents (correlation coefficients: 0.92-0.96).Nevertheless there were important differences in the slopes of the lines of relationship between the APTT reagents.Good correlations were observed between the anti-Xa and anti-IIa assay results (correlation coefficients: 0.92-0.97). However, the amidolytic anti-Xa activity was significantly higher (p <0.001) than the two amidolytic anti-IIa activities. Less good correlations were observed between the log-transformed APTTs and the anti-Xa or anti-IIa activities (correlation coefficients: 0.64-0.78). The correlations were improved by transforming the APTT into APTT-ratio, i.e. the ratio of the patient’s APTT to the same patient’s APTT after removal of heparin from the plasma sample by means of ECTEOLA-cellulose treatment. The correlation coefficients of log (AFTT-ratio) with anti-Xa or anti-IIa ranged from 0.76 to 0.87.For both APTT and amidolytic heparin assay, the response to in vitro heparin was different from the response to ex vivo heparin.Therefore, equivalent therapeutic ranges should be assessed by using ex vivo samples rather than in vitro heparin. Because of the response differences between the APTT reagents, it is not adequate to define a therapeutic range for heparin therapy without specification of the reagent.

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Post Discharge Clinically Overt Venous Thromboembolism in Orthopaedic Surgery Patients with Negative Venography -an Overview Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650681 ◽

1996 ◽

Vol 76 (06) ◽

pp. 0887-0892 ◽

Cited By ~ 32

Author(s):

Serena Ricotta ◽

Alfonso lorio ◽

Pasquale Parise ◽

Giuseppe G Nenci ◽

Giancarlo Agnelli

Keyword(s):

Venous Thromboembolism ◽

Orthopaedic Surgery ◽

Diagnostic Methods ◽

Future Research ◽

Post Discharge ◽

Pharmacological Prophylaxis ◽

Vein Thrombosis ◽

Overview Analysis ◽

Major Orthopaedic Surgery

SummaryA high incidence of post-discharge venous thromboembolism in orthopaedic surgery patients has been recently reported drawing further attention to the unresolved issue of the optimal duration of the pharmacological prophylaxis. We performed an overview analysis in order to evaluate the incidence of late occurring clinically overt venous thromboembolism in major orthopaedic surgery patients discharged from the hospital with a negative venography and without further pharmacological prophylaxis. We selected the studies published from January 1974 to December 1995 on the prophylaxis of venous thromboembolism after major orthopaedic surgery fulfilling the following criteria: 1) adoption of pharmacological prophylaxis, 2) performing of a bilateral venography before discharge, 3) interruption of pharmacological prophylaxis at discharge in patients with negative venography, and 4) post-discharge follow-up of the patients for at least four weeks. Out of 31 identified studies, 13 fulfilled the overview criteria. The total number of evaluated patients was 4120. An adequate venography was obtained in 3469 patients (84.1%). In the 2361 patients with negative venography (68.1%), 30 episodes of symptomatic venous thromboembolism after hospital discharge were reported with a resulting cumulative incidence of 1.27% (95% C.I. 0.82-1.72) and a weighted mean incidence of 1.52% (95% C.I. 1.05-1.95). Six cases of pulmonary embolism were reported. Our overview showed a low incidence of clinically overt venous thromboembolism at follow-up in major orthopaedic surgery patients discharged with negative venography. Extending pharmacological prophylaxis in these patients does not appear to be justified. Venous thrombi leading to hospital re-admission are likely to be present but asymptomatic at the time of discharge. Future research should be directed toward improving the accuracy of non invasive diagnostic methods in order to replace venography in the screening of asymptomatic post-operative deep vein thrombosis.

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