Venous thromboembolism (VTE) prophylaxis

2018 ◽  
pp. 121-126
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Surgical Patients ◽  
Related Factors ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Preventable Complication ◽  
Fatal Complications

Venous thromboembolism is a common but largely preventable complication following surgery. However, fatal complications can occur as a result of pulmonary embolism following deep vein thrombosis. A structured risk assessment should be performed preoperatively in all surgical patients and thromboprophylaxis measures should be tailored according to patient- and procedure-related factors. These measures include anticoagulation with low molecular weight heparin and the use of mechanical compression devices.

scholarly journals How I treat cancer-associated venous thromboembolism

Blood ◽  
2019 ◽  
Vol 133 (4) ◽  
pp. 291-298 ◽  
Author(s):  
Noémie Kraaijpoel ◽  
Marc Carrier
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Staging ◽  
Cancer Type ◽  
Related Factors ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Treatment Response Evaluation ◽  
Related Risk ◽  
Deep Vein ◽  
Underlying Risk

Abstract Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a common complication of cancer and is associated with significant morbidity and mortality. Several cancer-related risk factors contribute to the development of VTE including cancer type and stage, chemotherapy, surgery, and patient-related factors such as advanced age and immobilization. Patients with cancer frequently undergo diagnostic imaging scans for cancer staging and treatment response evaluation, which is increasing the underlying risk of VTE detection. The management of cancer-associated VTE is challenging. Over the years, important advances have been made and, recently, randomized controlled trials have been published helping clinicians’ management of this patient population. In this review, we will discuss common cancer-associated VTE scenarios and critically review available evidence to guide treatment decisions.

Thromboprophylaxis and haematomas

2018 ◽  
pp. 23-26
Author(s):  
Umraz Khan ◽  
Graeme Perks ◽  
Rhidian Morgan-Jones ◽  
Peter James ◽  
Colin Esler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Surgical Patients ◽  
Vein Thrombosis ◽  
Prosthetic Joint ◽  
Deep Vein ◽  
Haematoma Formation ◽  
Prolonged Surgery

This chapter discusses thromboprophylaxis and haematomas within periprosthetic joint infection. The issue of venous thromboembolism is important for all surgical patients and, as such, those undergoing arthroplasty must undergo a careful and accurate risk assessment. Prolonged surgery and delayed postoperative mobilization are risk factors and are common to most major joint arthroplasty. Use of prophylactic agents to prevent thrombosis must be balanced with the avoidance of haematoma formation as the latter contributes to a risk of prosthetic joint infection. Should deep vein thrombosis occur then swift methods of diagnosis and treatment must be in place.

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.

Abstract 11662: Obesity Does Not Increase Venous Thromboembolism in Hospitalized Medical Patients Upon Multivariate Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Gabriel V Fontaine ◽  
Emily Vigil ◽  
Paul Wohlt ◽  
David Collingridge ◽  
James F Lloyd ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Primary Outcome ◽  
Univariate Analysis ◽  
Obese Patients ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Therapeutic Anticoagulation ◽  
Comorbidity Index ◽  
Deep Vein

Introduction: Obesity increases the risk of venous thromboembolism (VTE) in hospitalized medical patients. Standard chemoprophylaxis in these patients may be suboptimal, potentially leading to increased VTE. The objective of this study was to compare the rate of VTE in obese (body mass index [BMI] ≤30 kg/m 2 ) medical patients receiving standard VTE prophylaxis with rates in non-obese patients (BMI 17-29.9 kg/m 2 ). Hypothesis: Obese patients will suffer from a higher incidence of VTE within 90 days of hospitalization. Methods: In a single-center retrospective cohort study, patients admitted to all medical units between November 2007 and November 2013 were evaluated for eligibility if they received an initial dose of VTE prophylaxis within 48 hours of admission. Appropriate prophylaxis was heparin 5000 units subcutaneously (SQ) every 8 to 12 hours or enoxaparin 30 mg SQ twice daily or 40 mg SQ once daily. Exclusion criteria included hypercoagulable states, therapeutic anticoagulation, and admission for trauma or surgery. The primary outcome was 90 day VTE defined as deep vein thrombosis or pulmonary embolism using ICD-9 codes. Secondary outcomes included in-hospital VTE, 30 day VTE, and 90 day mortality. Univariate and multivariate analyses were used in calculating p-values and odds ratios (OR) for the primary outcome. Results: There were 17,525 patients eligible for inclusion. The final cohort included 4,237 obese patients and 4,990 non-obese patients (median BMI 36 and 25 kg/m 2 , respectively). Obesity increased the risk of in-hospital VTE (5.6% vs. 4.4%; p=0.01), 30 day VTE (5.7% vs. 4.6%; p=0.013), and 90 day VTE (5.9% vs. 4.8%; p=0.028) on univariate analysis. However, using multiple logistic regression, obesity was not an independent predictor of 90 day VTE (OR 1.0; p=0.83). Variables which independently increased 90 day VTE were Charlson Comorbidity Index (OR 1.09; p=0.003), prior VTE (OR 36.35; p<0.001), congestive heart failure (OR 1.33; p=0.017), and surgery in 90 days following admission (OR 1.56; p=0.004). Mortality was lower at 90 days in obese patients (3.3% vs. 6.3% non-obese; p<0.001) Conclusions: The incidence of VTE at 90 days in hospitalized medical patients is significant, but it is uncertain if obesity independently contributes to this.

The diagnosis and treatment of venous thromboembolism

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 457-463 ◽  
Author(s):  
Philip Wells ◽  
David Anderson
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Pretest Probability ◽  
Low Molecular Weight ◽  
Major Hemorrhage ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Abstract Venous thromboembolism (VTE) is a common condition that can lead to complications such as postphlebitic syndrome, chronic pulmonary artery hypertension, and death. The approach to the diagnosis of has evolved over the years and an algorithm strategy combining pretest probability, D-dimer testing, and diagnostic imaging now allows for safe, convenient, and cost-effective investigation of patients. Patients with low pretest probability and a negative D-dimer can have VTE excluded without the need for imaging. The mainstay of treatment of VTE is anticoagulation, whereas interventions such as thrombolysis and inferior vena cava filters are reserved for special situations. Low-molecular-weight heparin has allowed for outpatient management of most patients with deep vein thrombosis at a considerable cost savings to the health care system. Patients with malignancy-associated VTE benefit from decreased recurrent rates if treated with long-term low-molecular-weight heparin. The development of new oral anticoagulants further simplifies treatment. The duration of anticoagulation is primarily influenced by underlying cause of the VTE (whether provoked or not) and consideration of the risk for major hemorrhage. Testing for genetic and acquired thrombophilia may provide insight as to the cause of a first idiopathic deep vein thrombosis, but the evidence linking most thrombophilias to an increased risk of recurrent thrombosis is limited.

Venous thromboembolism in patients with active cancer

2007 ◽  
Vol 98 (09) ◽  
pp. 656-661 ◽  
Author(s):  
Ali Seddighzadeh ◽  
Ranjith Shetty ◽  
Samuel Goldhaber
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Inferior Vena ◽  
The United States ◽  
Inferior Vena Caval ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein ◽  
Active Cancer

SummaryPatients with cancer have an increased risk of venous thromboembolism (VTE).To further define the demographics, comorbidities, and risk factors of VTE in these patients, we analyzed a prospective registry of 5,451 patients with ultrasound confirmed deep vein thrombosis (DVT) from 183 hospitals in the United States. Cancer was reported in 1,768 (39%), of whom 1,096 (62.0%) had active cancer. Of these, 599 (54.7%) were receiving chemotherapy, and 226 (20.6%) had metastases. Lung (18.5%), colorectal (11.8%), and breast cancer (9.0%) were among the most common cancer types. Cancer patients were younger (median age 66 years vs. 70 years; p<0.0001), were more likely to be male (50.4% vs. 44.5%; p=0.0005), and had a lower average body mass index (26.6 kg/m2 vs. 28.9 kg/m2; p<0.0001). Cancer patients less often received VTE prophylaxis prior to development of DVT compared to those with no cancer (308 of 1,096, 28.2% vs. 1,196 of 3,444, 34.6%; p<0.0001). For DVT therapy, low-molecular-weight heparin (LMWH) as monotherapy without warfarin (142 of 1,086, 13.1% vs. 300 of 3,429, 8.7%; p<0.0001) and inferior vena caval filters (234 of 1,086, 21.5% vs. 473 of 3,429, 13.8%; p<0.0001) were utilized more often in cancer patients than in DVT patients without cancer. Cancer patients with DVT and neurological disease were twice as likely to receive inferior vena caval filters than those with no cancer (odds ratio 2.17, p=0.005). In conclusion, cancer patients who develop DVT receive prophylaxis less often and more often receive filters than patients with no cancer who develop DVT. Future studies should focus on ways to improve implementation of prophylaxis in cancer patients and to further define the indications, efficacy, and safety of inferior vena caval filters in this population.

Outpatient Treatment of Pulmonary Embolism with Dalteparin

2000 ◽  
Vol 83 (02) ◽  
pp. 209-211 ◽  
Author(s):  
D. Anderson ◽  
B. Morrow ◽  
L. Gray ◽  
D. Touchie ◽  
P. S. Wells ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Outpatient Management ◽  
Medical Reason ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryPulmonary embolism is a common complication of deep vein thrombosis. It has been established that low molecular weight heparin may be used to treat deep vein thrombosis or pulmonary embolism and randomized studies have established that outpatient management of deep vein thrombosis with low molecular weight heparin is at least as effective as in-hospital management with unfractionated heparin.This was a prospective cohort study of eligible patients with pulmonary embolism managed as outpatients using dalteparin (200 U/kg s/c daily) for a minimum of five days and warfarin for 3 months. Outpatients included those managed exclusively out of hospital and those managed initially for 1-3 days as inpatients who then completed therapy o out of hospital. Reasons for admission included hemodynamic instability; hypoxia requiring oxygen therapy; admission for another medical reason; severe pain requiring parenteral analgesia or high risk of major bleeding. Patients were followed for three months for clinically apparent recurrent venous thromboembolism and bleeding.Between three teaching hospitals, a total of 158 patients with pulmonary embolism were identified. Fifty patients were managed as inpatients and 108 as outpatients. Of the outpatients, 27 were managed for an average of 2.5 days as inpatients and then completed dalteparin therapy as outpatients. The remaining 81 patients were managed exclusively as outpatients with dalteparin. For all outpatients the overall symptomatic recurrence rate of venous thromboembolism was 5.6% (6/108) with only 1.9% (2/108) major bleeds. There were a total of four deaths with none due to pulmonary embolism or major bleed.This prospective study suggests that outpatient management of pulmonary embolism is feasible and safe for the majority of patients.

scholarly journals Electronic prescribing systems as tools to improve patient care: a learning health systems approach to increase guideline concordant prescribing for venous thromboembolism prevention

2021 ◽  
Author(s):  
S. Gallier ◽  
A. Topham ◽  
P. Nightingale ◽  
M. Garrick ◽  
I. Woolhouse ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Systems Approach ◽  
Electronic Prescribing ◽  
Low Molecular Weight ◽  
Vte Prophylaxis ◽  
Face To Face ◽  
Guideline Compliance ◽  
Hospitalised Patients

AbstractBACKGROUNDVenous thromboembolism (VTE) causes significant mortality and morbidity in hospitalised patients. In England, reporting the percentage of patients with a completed VTE risk assessment is mandated, but this does not include whether that risk assessment resulted in appropriate prescribing. Full guideline compliance (an assessment and action) is rarely reported. Education, audit and feedback enhance guideline compliance but electronic prescribing systems(EPS) can mandate guideline-compliant actions. We hypothesised that EPS-based interventions would increase full VTE guideline compliance more than other interventions.METHODSAll admitted patients within University Hospitals Birmingham NHS Foundation Trust were included for analysis between 2011-2020. The proportion of patients who received a fully compliant risk assessment and action was assessed over time. Interventions included face-to-face feedback based on measured performance (an individual approach) and mandatory risk assessment and prescribing rules into an EPS (a systems approach).RESULTSData from all 235,005 admissions and all 5503 prescribers were included in the analysis. Face-to-face feedback improved full VTE guideline concordance from 70% to 77% (p=<0.001). Changes to the EPS to mandate assessment with prescribing rules increased full VTE compliance to 95% (p=<0.001). Further amendments to the EPS system to reduce erroneous VTE assessments slightly reduced full compliance to 92% (p<0.001), but this was then maintained including during changes to the low molecular weight heparin used for VTE prophylaxis.DISCUSSION/ CONCLUSIONAn EPS-systems approach was more effective in improving sustained guideline-compliant VTE prevention. Non-compliance was still not eradicated despite this mandated system and requires further research.FUNDINGHDR-UK Hub PIONEERSummary BoxWhat is already known?Hospitalised patients are at an increased risk of venous thromboembolism (VTE), which can lead to significant morbidity and mortality. Risk factors for VTE are well known, there are established screening criteria and there is an effective prophylactic therapy, using low molecular weight heparin where indicated. Since 2010, NHS England has mandated the reporting of the percentage of patients with a completed VTE risk assessment. However, it does not automatically follow that completing a risk assessment leads to the appropriate action (prescribing and administering VTE prophylaxis where indicated). Currently it is unclear what percentage of patients have a guideline compliant VTE risk assessment and an associated action, or how full guideline compliance can be improved.What does this paper add?First, this paper describes that a VTE risk assessment does not always lead to full VTE guideline compliance (an appropriate prescription and administration of heparin where indicated). This is currently not part of mandated reporting but potentially could lead to patient harm. Second, that Electronic Health Systems (EHS) can capture and interrogate guideline-associated risk assessments and prescribing, and be used to improve full guideline compliance, through a combination of individual feedback to prescribing outliers and mandated prescribing rules. These EPS-assisted systems are robust, and sustain guideline compliance through personnel and formulary changes.

scholarly journals Venous thromboembolism chemical prophylaxis after endoscopic trans-sphenoidal pituitary surgery

Pituitary ◽  
2021 ◽  
Author(s):  
Mueez Waqar ◽  
Annabel Chadwick ◽  
James Kersey ◽  
Daniel Horner ◽  
Tara Kearney ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Postoperative Bleeding ◽  
Pituitary Surgery ◽  
Outcome Data ◽  
Bleeding Events ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Safe Strategy ◽  
Postoperative Haematoma ◽  
Deep Vein

Abstract Purpose There is no compelling outcome data or clear guidance surrounding postoperative venous thromboembolism (VTE) prophylaxis using low molecular weight heparin (chemoprophylaxis) in patients undergoing pituitary surgery. Here we describe our experience of early chemoprophylaxis (post-operative day 1) following trans-sphenoidal pituitary surgery. Methods Single-centre review of a prospective surgical database and VTE records. Adults undergoing first time trans-sphenoidal pituitary surgery were included (2009–2018). VTE was defined as either deep vein thrombosis and/or pulmonary embolism within 3 months of surgery. Postoperative haematomas were those associated with a clinical deterioration together with radiological evidence. Results 651 Patients included with a median age of 55 years (range 16–86 years). Most (99%) patients underwent trans-sphenoidal surgery using a standard endoscopic single nostril or bi-nostril trans-sphenoidal technique. More than three quarters had pituitary adenomas (n = 520, 80%). Postoperative chemoprophylaxis to prevent VTE was administered in 478 patients (73%). Chemoprophylaxis was initiated at a median of 1 day post-procedure (range 1–5 days postoperatively; 92% on postoperative day 1). Tinzaparin was used in 465/478 patients (97%) and enoxaparin was used in 14/478 (3%). There were no cases of VTE, even in 78 ACTH-dependent Cushing’s disease patients. Six patients (1%) developed postoperative haematomas. Chemoprophylaxis was not associated with a significantly higher rate of postoperative haematoma formation (Fisher’s Exact, p = 0.99) or epistaxis (Fisher’s Exact, p > 0.99). Conclusions Chemoprophylaxis after trans-sphenoidal pituitary surgery on post-operative day 1 is a safe strategy to reduce the risk of VTE without significantly increasing the risk of postoperative bleeding events.

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