scholarly journals Does preoperative pharmacologic prophylaxis reduce the rate of venous thromboembolism in pancreatectomy patients?

HPB ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1020-1024
Author(s):  
Zhi V. Fong ◽  
Naomi M. Sell ◽  
Carlos Fernandez-del Castillo ◽  
Gabriel del Carmen ◽  
Cristina R. Ferrone ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Pharmacologic Prophylaxis

scholarly journals Efficacy of pre-operative pharmacologic thromboprophylaxis on incidence of venous thromboembolism following major gynecologic and gynecologic oncology surgery: a systematic review and meta-analysis

2020 ◽  
pp. ijgc-2020-001991
Author(s):  
Steven Bisch ◽  
Rachelle Findley ◽  
Christina Ince ◽  
Maria Nardell ◽  
Gregg Nelson
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Gynecologic Oncology ◽  
Quality Data ◽  
Gynecologic Surgery ◽  
Cochrane Central Register ◽  
Pharmacologic Prophylaxis ◽  
Pharmacologic Thromboprophylaxis

IntroductionVenous thromboembolism remains a significant complication following major gynecologic surgery. Evidence is lacking on whether it is beneficial to give pharmacologic thromboprophylaxis pre-operatively. The aim of this meta-analysis was to assess the role of pre-operative pharmacologic thromboprophylaxis in preventing post-operative venous thromboembolism.MethodsPubMed, EMBASE, and the Cochrane Central Register of Clinical Trials were searched to find randomized controlled, cohort, and case–control trials comparing pre-operative pharmacologic thromboprophylaxis to no prophylaxis, mechanical prophylaxis, or only post-operative pharmacologic thromboprophylaxis for open and minimally invasive major gynecologic surgery (benign and malignant conditions). Two authors independently assessed abstracts, full-text articles, and methodological quality. Data were extracted and pooled using ORs for random effects meta-analysis. Heterogeneity was explored using forest plots, Q-statistic, and I2 statistics. Planned subgroup analysis of use of sequential compression devices, equivalent versus non-equivalent post-operative prophylaxis, cancer diagnosis, and methodological quality were performed.ResultsSome 503 unique studies were found, and 16 studies (28 806 patients) were included in the systematic review. Twelve studies (14 273 patients) were included in the meta-analysis. The OR for incidence of post-operative venous thromboembolism was 0.59 (95% CI 0.39, 0.89), favoring pre-operative pharmacologic thromboembolism prophylaxis compared with no pre-operative pharmacologic prophylaxis (Q=13.80, I2=20.30). In studies where post-operative care was equivalent between groups, the OR for venous thromboembolism was 0.56 (95% CI 0.22, 1.40). Pre-operative pharmacologic prophylaxis demonstrated greatest benefit when utilized with both intra-operative and post-operative sequential compression devices (OR 0.43, 95% CI 0.30, 0.64) compared with when no sequential compression devices were utilized (OR 1.27, 95% CI 0.63, 2.56). When looking at only studies determined to be of high quality, the results no longer reached significance (OR 0.73, 95% CI 0.36, 1.46).ConclusionsPre-operative pharmacologic thromboprophylaxis decreases the odds of venous thromboembolism in the peri-operative period for major gynecologic oncology surgery by approximately 40%. It remains unclear whether this benefit is present in benign and minor procedures. Adequately powered studies are needed.

scholarly journals Pharmacologic thromboprophylaxis in adult patients undergoing neurosurgical interventions for preventing venous thromboembolism

2020 ◽  
Vol 4 (12) ◽  
pp. 2798-2809
Author(s):  
Juan José Yepes-Nuñez ◽  
Anita Rajasekhar ◽  
Maryam Rahman ◽  
Philipp Dahm ◽  
David R. Anderson ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Neurosurgical Procedures ◽  
Assessment Development ◽  
Vein Thrombosis ◽  
Surrogate Outcomes ◽  
Symptomatic Pulmonary Embolism ◽  
Neurosurgical Patients ◽  
Pharmacologic Prophylaxis ◽  
Pharmacologic Thromboprophylaxis ◽  
The Impact

Abstract The impact of pharmacologic prophylaxis for venous thromboembolism in patients undergoing neurosurgical intervention remains uncertain. We reviewed the efficacy and safety of pharmacologic compared with nonpharmacologic thromboprophylaxis in neurosurgical patients. Three databases were searched through April 2018, including those for randomized controlled trials (RCTs) and for nonrandomized controlled studies (NRSs). Independent reviewers assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Seven RCTs and 3 NRSs proved eligible. No studies reported on symptomatic proximal and distal deep vein thrombosis (DVT). Two RCTs reported on screening-detected proximal and distal DVTs. We used the findings of these 2 RCTs as the closest surrogate outcomes to inform the proximal and distal DVT outcomes. These 2 RCTs suggest that pharmacologic thromboprophylaxis may decrease the risk of developing asymptomatic proximal DVT (relative risk [RR], 0.50; 95% confidence interval [CI], 0.30-0.84; low certainty). Findings were uncertain for mortality (RR, 1.27; 95% CI, 0.57-2.86; low certainty), symptomatic pulmonary embolism (PE) (RR, 0.84; 95% CI, 0.03-27.42; very low certainty), asymptomatic distal DVT (RR, 0.54; 95% CI, 0.27-1.08; very low certainty), and reoperation (RR, 0.43; 95% CI, 0.06-2.84; very low certainty) outcomes. NRSs also reported uncertain findings for whether pharmacologic prophylaxis affects mortality (RR, 0.72; 95% CI, 0.46-1.13; low certainty) and PE (RR, 0.18; 95% CI, 0.01-3.76). For risk of bleeding, findings were uncertain in both RCTs (RR, 1.57; 95% CI, 0.70-3.50; low certainty) and NRSs (RR, 1.45; 95% CI, 0.30-7.12; very low certainty). In patients undergoing neurosurgical procedures, low certainty of evidence suggests that pharmacologic thromboprophylaxis confers benefit for preventing asymptomatic (screening-detected) proximal DVT with very low certainty regarding its impact on patient-important outcomes.

Temporal trends in pharmacologic prophylaxis for venous thromboembolism after hip and knee replacement in older adults

2020 ◽  
Vol 25 (5) ◽  
pp. 450-459
Author(s):  
Darae Ko ◽  
Alok Kapoor ◽  
Adam J Rose ◽  
Amresh D Hanchate ◽  
Donald Miller ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Adverse Events ◽  
Knee Replacement ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Temporal Trends ◽  
Major Hemorrhage ◽  
Vte Prophylaxis ◽  
Physician Review ◽  
Pharmacologic Prophylaxis

Trends in prescription for venous thromboembolism (VTE) prophylaxis following total hip (THR) and knee replacement (TKR) since the approval of direct oral anticoagulants (DOACs) and the 2012 guideline endorsement of aspirin are unknown, as are the risks of adverse events. We examined practice patterns in the prescription of prophylaxis agents and the risk of adverse events during the in-hospital period (the ‘in-hospital sample’) and 90 days following discharge (the ‘discharge sample’) among adults aged ⩾ 65 undergoing THR and TKR in community hospitals in the Institute for Health Metrics database over a 30-month period during 2011 to 2013. Eligible medications included fondaparinux, DOACs, low molecular weight heparin (LMWH), other heparin products, warfarin, and aspirin. Outcomes were validated by physician review of source documents: VTE, major hemorrhage, cardiovascular events, and death. The in-hospital and the discharge samples included 10,503 and 5722 adults from 65 hospitals nationwide, respectively (mean age 73, 74 years; 61%, 63% women). Pharmacologic prophylaxis was near universal during the in-hospital period (93%) and at discharge (99%). DOAC use increased substantially and was the prophylaxis of choice for nearly a quarter (in-hospital) and a third (discharge) of the patients. Aspirin was the sole discharge prophylactic agent for 17% and 19% of patients undergoing THR and TKR, respectively. Warfarin remained the prophylaxis agent of choice for patients aged 80 years and older. The overall risk of adverse events was low, at less than 1% for both the in-hospital and discharge outcomes. The low number of adverse events precluded statistical comparison of prophylaxis regimens.

Venous Thromboembolism in Patients Receiving Extended Pharmacologic Prophylaxis After Robotic Surgery for Endometrial Cancer

2017 ◽  
Vol 27 (8) ◽  
pp. 1774-1782 ◽  
Author(s):  
Josephine S. Kim ◽  
Kathryn A. Mills ◽  
Julia Fehniger ◽  
Chuanhong Liao ◽  
Jean A. Hurteau ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Venous Thromboembolism ◽  
Robotic Surgery ◽  
Pharmacologic Prophylaxis

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.

Pharmacologic Prophylaxis for Venous Thromboembolism in Elective Spine Surgery

2017 ◽  
Vol 17 (10) ◽  
pp. S186 ◽  
Author(s):  
Ryan P. McLynn ◽  
Pablo Diaz-Collado ◽  
Taylor Ottesen ◽  
Jonathan Cui ◽  
Nathaniel T. Ondeck ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Spine Surgery ◽  
Pharmacologic Prophylaxis

The National Practice Patterns of Venous Thromboembolism Prophylaxis Post-Cardiothoracic Surgery

2016 ◽  
Vol 30 (4) ◽  
pp. 394-399 ◽  
Author(s):  
Sheena E. Mathew ◽  
Craig J. Beavers ◽  
Elizabeth McNeely
Keyword(s):  
Venous Thromboembolism ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The United States ◽  
Cardiothoracic Surgery ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Multicenter Survey ◽  
Pharmacologic Prophylaxis ◽  
Chemical Prophylaxis

Background: The rates of venous thromboembolism (VTE) post-cardiothoracic surgery are not well understood. The american college of chest physicians (CHEST) guidelines report weak recommendations for starting VTE prophylaxis post-cardiothoracic surgery. It is suspected that due to the increase in bleed risk, postsurgery initiation of pharmacologic VTE prophylaxis is limited. Objective: The study sought to investigate the use of VTE prevention in US hospitals performing cardiac surgery and the use of mechanical/chemical prophylaxis postoperatively. Methods: This is a multicenter survey distributed to cardiac hospitals in the United States. The survey was distributed through 3 separate listservs. Data were analyzed utilizing descriptive statistics. Results: The majority of the hospitals were academic and/or community and completed coronary artery bypass graft (CABG), valve replacement (mitral/aortic/tricuspid), and aortic repair. It was common for hospitals to start mechanical and pharmacologic prophylaxis post-cardiothoracic surgery on postoperative day (POD) 1 to 2. The anticoagulation most commonly used consisted of unfractionated heparin. Conclusions: The majority of the institutions are initiating therapy POD 1 to 2 with both mechanical and chemical prophylaxis. The full impact of early initiation of VTE prophylaxis is unknown, and more studies are needed to assess the true risks/benefits of these practices.

scholarly journals Improved Compliance With Venous Thromboembolism Pharmacologic Prophylaxis for Patients With Gynecologic Malignancies Hospitalized for Nonsurgical Indications Did Not Reduce Venous Thromboembolism Incidence

2015 ◽  
Vol 25 (1) ◽  
pp. 152-159 ◽  
Author(s):  
Lauren S. Prescott ◽  
Lisa M. Kidin ◽  
Rebecca L. Downs ◽  
David J. Cleveland ◽  
Ginger L. Wilson ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk Population ◽  
Gynecologic Malignancies ◽  
National Guidelines ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Discharge Outcomes ◽  
Pharmacologic Prophylaxis ◽  
Prophylactic Anticoagulation ◽  
Hospital Acquired

ObjectiveNational guidelines recommend prophylactic anticoagulation for all hospitalized patients with cancer to prevent hospital-acquired venous thromboembolism (VTE). However, adherence to these evidence-based recommended practice patterns remains low. We performed a quality improvement (QI) project to increase VTE pharmacologic prophylaxis rates among patients with gynecologic malignancies hospitalized for nonsurgical indications and evaluated the resulting effect on rates of development of VTE.Materials and MethodsIn June 2011, departmental VTE practice guidelines were implemented for patients with gynecologic malignancies who were hospitalized for nonsurgical indications. A standardized VTE prophylaxis module was added to the admission electronic order sets. Outcome measures included number of admissions receiving VTE pharmacologic prophylaxis within 24 hours of admission; and number of potentially preventable hospital-acquired VTEs diagnosed within 30 and 90 days of discharge. Outcomes were compared between a preguideline implementation cohort (n = 99), a postguideline implementation cohort (n = 127), and a sustainability cohort assessed 2 years after implementation (n = 109). Patients were excluded if upon admission they had a VTE, were considered low risk for VTE, or had a documented contraindication to pharmacologic prophylaxis.ResultsAdministration of pharmacologic prophylaxis within 24 hours of admission increased from 20.8% to 88.2% immediately following the implementation of guidelines, but declined to 71.8% in our sustainability cohort (P < 0.001). There was no difference in VTE incidence among the 3 cohorts [n = 2 (4.2%) vs n = 3 (3.9%) vs n = 3 (4.2%), respectively; P = 1.00].ConclusionsOur QI project improved pharmacologic VTE prophylaxis rates. A small decrease in prophylaxis during the subsequent 2 years suggests a need for continued surveillance to optimize QI initiatives. Despite increased adherence to guidelines, VTE rates did not decline in this high-risk population.

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