High Incidence of Deep Vein Thrombosis in the Perioperative Period of Neurosurgical Patients

Deep vein thrombosis (DVT) is a prevalent vascular disease characterized by pelvic and limb deep vein thrombophlebitis, and it has a high incidence in traumatic patients. Contrary to older studies, recent research has reported that recanalization in DVT is not a slow process. The present study aimed at the comparative examination of DVT recanalization with Doppler ultrasound in different intervals following treatment with heparin or enoxaparin. This prospective study was conducted on all traumatic patients hospitalized in Imam Reza Hospital of Kermanshah, Iran, with the clinical and sonographic diagnosis of DVT in limb veins. Doppler ultrasound was performed two weeks, one month, and three months following treatment in order to examine recanalization. Data were analyzed using statistical tests in SPSS16 at the significance level of <0.05. Based on Doppler ultrasound, a significant difference was found between the degree of recanalization in patients aged <45 years and those aged >45 years, between male and female patients, and between different DVT locations (P<0.05). After three months of treatment with heparin and enoxaparin, the degree of recanalization was increased in DVT. Moreover, it was found that Doppler ultrasound is a useful tool for the diagnosis of recanalization in patients with DVT.

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Investigation of Time-Course Changes in the Incidence of Deep Vein Thrombosis during the Perioperative Period of Cancer of the Digestive System: A Prospective Study from Our Institution

The Journal of Japanese College of Angiology ◽

10.7133/jca.13-00025 ◽

2013 ◽

Vol 53 (September) ◽

pp. 143-149

Author(s):

Atsuo Kojima ◽

Kiwako Yoshida ◽

Osamu Kurita ◽

Takahiro Manabe ◽

Koji Hino ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Prospective Study ◽

Time Course ◽

Digestive System ◽

Perioperative Period ◽

Vein Thrombosis ◽

System A ◽

Course Changes ◽

A Prospective Study ◽

Deep Vein

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Abnormal Blood Yield Stress as an Aetiological Factor in Postoperative Deep Venous Thrombosis

10.1055/s-0039-1689540 ◽

1975 ◽

Author(s):

W. V. Humphreys ◽

A. Walker ◽

D. Charlesworth

Keyword(s):

Deep Vein Thrombosis ◽

Yield Stress ◽

Malignant Disease ◽

Aetiological Factor ◽

Venous Stasis ◽

Vein Thrombosis ◽

High Incidence ◽

Deep Vein ◽

Postoperative Deep Venous Thrombosis ◽

Low Shear

An elevated blood viscosity could lead to increased venous stasis and a higher incidence of post-operative deep vein thrombosis. Immediately preoperatively we have measured, using a Contraves low shear 2 viscometer, blood yield stress and viscosity at high and low shear rate in 28 general surgical patients. These patients were then screened by the standard I125 fibrinogen technique to detect the development of deep vein thrombosis post-operatively.13 patients developed a deep vein thrombosis. These patients had a significantly higher blood yield stress, corrected to a standard haemoerit of 45%, than the others (P < 0.01 students t). All other viscosity parameters were normal in these patients. Patients with malignant disease had a very high incidence of thrombosis (90%: 30%) and significantly higher yield stress values (mean 0.26 dynes/cm2: mean 0.194 dynes/cm2, P < 0.0005 students t) compared to patients with benign disease.We conclude that a high blood yield stress could be an important aetiological factor in thrombosis and the high values obtained in patients with malignant disease could partly explain the high incidence in these patients.

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An analysis of deep vein thrombosis in 1277 consecutive neurosurgical patients undergoing routine weekly ultrasonography

Journal of Neurosurgery ◽

10.3171/2012.11.jns121243 ◽

2013 ◽

Vol 118 (3) ◽

pp. 505-509 ◽

Cited By ~ 27

Author(s):

Akil P. Patel ◽

Michael T. Koltz ◽

Charles A. Sansur ◽

Mangla Gulati ◽

D. Kojo Hamilton

Keyword(s):

Deep Vein Thrombosis ◽

Mortality Rate ◽

Physical Examination ◽

Tertiary Care ◽

Significant Risk ◽

Vein Thrombosis ◽

Increased Risk ◽

Neurosurgical Patients ◽

Deep Vein ◽

Neurosurgical Intervention

Object Patients requiring neurosurgical intervention are known to be at increased risk for deep vein thrombosis (DVT) and attendant morbidity and mortality. Pulmonary embolism (PE) is the most catastrophic sequela of DVT and is the direct cause of death in 16% of all in-hospital mortalities. Protocols for DVT screening and early detection, as well as treatment paradigms to prevent PE in the acute postoperative period, are needed in neurosurgery. The authors analyzed the effectiveness of weekly lower-extremity venous duplex ultrasonography (LEVDU) in patients requiring surgical intervention for cranial or spinal pathology for detection of DVT and prevention of PE. Methods Data obtained in 1277 consecutive patients admitted to a major tertiary care center requiring neurosurgical intervention were retrospectively reviewed. All patients underwent admission (within 1 week of neurosurgical intervention) LEVDU as well as weekly LEVDU surveillance if the initial study was normal. Additional LEVDU was ordered in any patient in whom DVT was suspected on daily clinical physical examination or in patients in whom chest CT angiography confirmed a pulmonary embolus. An electronic database was created and statistical analyses performed. Results The overall incidence of acute DVT was 2.8% (36 patients). Of these cases of DVT, a statistically significant greater number (86%) were discovered on admission (within 1–7 days after admission) screening LEVDU (p < 0.05), whereas fewer were documented 8–14 days after admission (2.8%) or after 14 days (11.2%) postadmission. Additionally, for acute DVT detection in the present population, there were no underlying statistically significant risk factors regarding baseline physical examination, age, ambulatory status, or type of surgery. The overall incidence of acute symptomatic PE was 0.3% and the mortality rate was 0%. Conclusions Performed within 1 week of admission in patients who will undergo neurosurgical intervention, LEVDU is effective in screening for acute DVT and initiating treatment to prevent PE, thereby decreasing the overall mortality rate. Routine LEVDU beyond this time point may not be needed to detect DVT and prevent PE unless a change in the patient's physical examination status is detected.

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Deep vein thrombosis and pulmonary emboli in neurosurgical patients: a review

Journal of Neurosurgery ◽

10.3171/jns.1984.61.6.1055 ◽

1984 ◽

Vol 61 (6) ◽

pp. 1055-1062 ◽

Cited By ~ 68

Author(s):

Karl W. Swann ◽

Peter McL. Black

Keyword(s):

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Anticoagulation Therapy ◽

Screening Tests ◽

Limb Weakness ◽

Prophylactic Measure ◽

Vein Thrombosis ◽

Prophylactic Measures ◽

Neurosurgical Patients ◽

Deep Vein

✓ This review examines the incidence, natural history, diagnosis, prophylaxis, and management of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurosurgical patients. Recent studies estimate the incidence of postoperative DVT detected by fibrinogen scanning in neurosurgical patients to be 29% to 43%. Specific factors that enhance the risk of venous thromboembolism include previous DVT, surgery, immobilization, advanced age, obesity, limb weakness, heart failure, and lower extremity trauma. Clinical diagnosis of venous thromboembolism is unreliable but can be augmented by noninvasive screening tests such as iodine-125-fibrinogen scanning, Doppler ultrasonography, and impedance plethysmography. As prophylactic measures, mini-dose heparin and external pneumatic compression of the legs have decreased the incidence of DVT in clinical studies of neurosurgical patients. However, no prophylactic measure has been convincingly shown to prevent PE in neurosurgical patients. Thrombi involving the popliteal, deep femoral, and iliac veins appear most likely to cause significant PE. Anticoagulation therapy constitutes standard management of DVT and PE; however, in neurosurgical patients the potential for precipitating intracranial or intraspinal hemorrhage may necessitate vena caval interruption. This appears to be an effective alternative to anticoagulation.

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Analysis of Perioperative Risk Factors for Deep Vein Thrombosis in Patients With Femoral and Pelvic Fractures

10.21203/rs.3.rs-74152/v1 ◽

2020 ◽

Author(s):

Linqin Wu ◽

Bo Cheng

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Blood Transfusion ◽

Perioperative Period ◽

Pelvic Fractures ◽

C Reactive Protein ◽

Vein Thrombosis ◽

Reactive Protein ◽

Independent Risk Factors ◽

Deep Vein

Abstract Objective: Clinical characteristics, anticoagulant protocols and risk factors of deep Vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors.Methods: This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included. The Clinical data including general conditions,trauma, surgery,anticoagulant protocols and laboratory indexes were collected.According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group.Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT.Results: The incidence of DVT was 40.25%, PE was 1.93%, and preoperative DVT was 26.71%,which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%).The average time of DVT formation was 6.55±0.47 days after trauma and 6.67±0.48 days after surgery. Chronic obstructive pulmonary disease(COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT.The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7d, operative time > 2h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture.Conclusions: At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.

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Prevention of deep vein thrombosis in potential neurosurgical patients. A randomized trial comparing graduated compression stockings alone or graduated compression stockings plus intermittent pneumatic compression with control

Archives of Internal Medicine ◽

10.1001/archinte.149.3.679 ◽

1989 ◽

Vol 149 (3) ◽

pp. 679-681 ◽

Cited By ~ 18

Author(s):

A. G. Turpie

Keyword(s):

Deep Vein Thrombosis ◽

Randomized Trial ◽

Intermittent Pneumatic Compression ◽

Compression Stockings ◽

Vein Thrombosis ◽

Neurosurgical Patients ◽

Graduated Compression Stockings ◽

Deep Vein

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An Assessment Of Subcutaneous Ancrod In Prevention Of Deep Vein Thrombosis After Surgery For Hip Replacement

Thrombosis and Haemostasis ◽

10.1055/s-0038-1652230 ◽

1981 ◽

Vol 46 (01) ◽

pp. 093-093

Author(s):

J Belch ◽

D Meek ◽

G Lowe ◽

M Drummond ◽

A Campbell ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Hip Replacement ◽

Controlled Trial ◽

Placebo Patient ◽

Post Mortem ◽

Double Blind ◽

Subcutaneous Injections ◽

Vein Thrombosis ◽

High Incidence ◽

Deep Vein

There is a high incidence of deep vein thrombosis (DVT) and pulmonary embolism (PTE) amongst patients undergoing surgery for hip replacement. We have assessed the use of ancrod (Arvin), a de- fibrinating enzyme in the prophylaxis of DVT.In a randomised double-blind controlled trial 35 patients received daily subcutaneous injections of ancrod after operation for hip replacement and 38 patients received saline injections. DVT was detected by bilateral ascending venography (68 patients) or post-mortem (1 patient) 7-19 days after surgery. The frequency of major femoral DVT (> 5 cm long) was significantly reduced from 18 thrombi in the limbs of the placebo group to 5 in the ancrod group ( p<0.05). Major bilateral femoral DVT were similarly reduced from 7 to 1 patients by treatment with ancrod.The overall frequency of all thrombi, including calf DVT, was however not significantly different between the groups. 5 patients had evidence of PTE (3 placebo, 2 ancrod). 6 patients within the ancrod group had evidence of increased wound bleeding, compared with one placebo patient, but in only one patient was this considered severe enough to require cessation of ancrod injections. As the majority of PTE perhaps arise from large femoral thrombi it would seem that ancrod prophylaxis, by reducing thrombus size, could aid the reduction of PTE in this group of patients.

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