Development and validation of a risk calculator for post-discharge venous thromboembolism following hepatectomy for malignancy

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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ASO Author Reflections: Post-Discharge Venous Thromboembolism Incidence and Risk Factors

Annals of Surgical Oncology ◽

10.1245/s10434-018-6908-5 ◽

2018 ◽

Vol 25 (S3) ◽

pp. 745-746

Author(s):

Pablo E. Serrano

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Post Discharge

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Choice of End-points in Assessing the Efficacy of Post-discharge Prophylaxis for Venous Thromboembolism

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614252 ◽

1998 ◽

Vol 79 (01) ◽

pp. 234-234 ◽

Cited By ~ 2

Author(s):

Alfonso Iorio ◽

Giancarlo Agnelli ◽

Adriano Alatri

Keyword(s):

Venous Thromboembolism ◽

Post Discharge ◽

End Points

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Prophylaxis of Venous Thromboembolism after Hospital Discharge in Internal Medicine: Findings from the Observational FADOI-NoTEVole Study

Thrombosis and Haemostasis ◽

10.1055/s-0039-1697661 ◽

2019 ◽

Vol 119 (12) ◽

pp. 2043-2052

Author(s):

Alessandro Squizzato ◽

Giancarlo Agnelli ◽

Mauro Campanini ◽

Francesco Dentali ◽

Francesca Agnelli ◽

...

Keyword(s):

Internal Medicine ◽

Venous Thromboembolism ◽

Multivariable Analysis ◽

Inverse Correlation ◽

Venous Catheter ◽

Post Discharge ◽

Cancer History ◽

Thrombotic Risk ◽

Vte Prophylaxis ◽

History Of

Abstract Background and Aim Post-discharge prophylaxis for venous thromboembolism (VTE) is a challenging issue in patients hospitalised in Internal Medicine Units (IMUs). The aim of this study was to evaluate the frequency and the factors associated with post-discharge prophylaxis for VTE in IMUs. Methods Multi-centre, retrospective study including consecutive patients who were admitted for any cause and discharged from an IMU. Results Overall, 3,740 patients (mean age 74.1 ± 15.7 years) were included in the study at 38 IMUs in Italy. At discharge, the percentage of patients receiving pharmacological thromboprophylaxis was 16.0% (20.1% after excluding patients treated with anticoagulants for indications other than VTE prophylaxis). At multivariable analysis, history of ischaemic stroke, hypomobility ≥ 7 days, central venous catheter, ≥ 10 versus ≤ 5 days of hospital stay, use of corticosteroids, cancer, history of falls, availability of a caregiver, infections and age were significantly associated with thromboprophylaxis, while an inverse correlation was observed with concomitant anti-platelet drugs and platelet count < 70,000/mm3. Patients with a Padua Prediction Score ≥ 4 versus < 4 and with an IMPROVE bleeding score ≥ 7 versus < 7 more frequently received prophylaxis at discharge (31.2% vs. 10.6%, p < 0.0001, and 25.7% vs. 19.6%, p = 0.028, respectively). Conclusion In this study, one in five patients discharged from an Italian IMU received prophylaxis for VTE. The perceived thrombotic risk is significantly related to the use of prophylaxis.

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