Prophylaxis of Perioperative Venous Thrombosis: Role of Venous Compression

2000 ◽  
Vol 15 (3-4) ◽  
pp. 138-142 ◽  
Author(s):  
J. Silleran-Chassany ◽  
D. Safran
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limb ◽  
Vitamin K Antagonists ◽  
Bleeding Complications ◽  
Duration Of Action ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Mechanical Methods

Aim: To review the role of compression treatments in the prevention of perioperative deep venous thrombosis. Method: A review of current literature in the field of prevention of deep venous thrombosis following general and orthopaedic surgery has been conducted. Synthesis: There is a considerable risk of deep venous thrombosis following surgical treatment in hospital. This is particularly high following joint replacement in the lower limb. This may lead to fatal pulmonary embolism or chronic venous insufficiency of the lower limb with leg ulceration and disability. Perioperative deep venous thrombosis may be prevented by a number of drugs. The most frequently used is heparin or the more modern low-molecular-weight heparins (LMWH). Vitamin K antagonists are also commonly used, but have a long duration of action. Dextrans and aspirin have an effect in preventing perioperative venous thrombosis, but this is much less than heparin. Mechanical methods of prevention have the advantage of preventing venous thrombosis without increased risk of bleeding complications. Conclusion: Heparin and LMWH continue to be the most frequently used means of preventing peri-operative deep venous thrombosis in France. There is reliable to evidence to show that mechanical methods of prevention including graduated elastic compression and intermittent pneumatic compression of the lower limb are also effective. These may be used in combination with heparin for increased protection or as an alternative to anticoagulant drugs where there is a risk of bleeding. They are also effective when used alone.

Subcutaneous Heparin in the Prevention of Venous Thrombosis After Elective Aortic Bifurcation Graft Surgery

1979 ◽  
Author(s):  
J.J.F. Belch ◽  
G.D.O. Lowe ◽  
J.G. Pollock ◽  
C.D. Forbes ◽  
C.R.M. Prentice
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Controlled Trial ◽  
Bleeding Complications ◽  
Aortic Bifurcation ◽  
Double Blind ◽  
Risk Of Bleeding ◽  
Subcutaneous Heparin ◽  
Calcium Heparin ◽  
Intravenous Sodium

In a randomised double-blind controlled trial 24 patients undergoing elective aortic bifurcation graft surgery received subcutaneous calcium heparin (2, 500 u preoperatively then 5,000 u 12 hourly or 7 days) and 25 control patients received saline injections. All patients received the routine dose of intravenous sodium heparin intraoperatively. The trial was terminated because of excess bleeding complications in patients on subcutaneous heparin (8 vs. 1, p<0.05). Deep venous thrombosis was diagnosed by 125I-fibrinogen scanning in 8 control patients and 3 patients on heparin (p>0.05). In this group of patients the risk of bleeding due to subcutaneous heparin appeared to outweigh the benefit of thrombotic prophylaxis.

Role of an age-adjusted D-dimer cutoff level in the diagnosis algorithm of lower limb deep venous thrombosis in outpatients

2020 ◽  
Vol 8 (5) ◽  
pp. 734-740 ◽  
Author(s):  
Xavier Jimenez-Guiu ◽  
Antonio Romera-Villegas ◽  
Malka Huici-Sanchez ◽  
Carlos Martinez-Rico ◽  
Ramon Vila-Coll
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limb ◽  
Diagnosis Algorithm ◽  
D Dimer

scholarly journals Increased risk of deep venous thrombosis in patients with poor ankle dorsiflexion after lower limb immobilization

2019 ◽  
Vol 2 (2) ◽  
pp. e038
Author(s):  
Susanna Aufwerber ◽  
Praxitelis Praxitelous ◽  
Gunnar Edman ◽  
Karin Grävare Silbernagel ◽  
Paul W. Ackermann
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limb ◽  
Ankle Dorsiflexion ◽  
Increased Risk ◽  
Limb Immobilization

scholarly journals Coincidence of Malignancy and Congenital Thrombophilia as the Cause of Deep Venous Thrombosis - Case Report and Review of the Literature

2014 ◽  
Vol 14 (2) ◽  
pp. 16-24
Author(s):  
Stanclakova L. ◽  
Stasko J. ◽  
Jedlnakova Z. ◽  
Sokol J. ◽  
Plamenova I. ◽  
...  
Keyword(s):  
Case Report ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Clinical Manifestation ◽  
Genetic Disorder ◽  
Factor V Leiden ◽  
Clinical Aspects ◽  
Increased Risk ◽  
Mechanical Methods ◽  
Fv Leiden

Abstract Introduction: Deep venous thrombosis (DVT, phlebothrombosis) is a very important clinical problem with its resultant fatal pulmonary embolism (PE) as one of the possible consequences. Factor V Leiden (FV Leiden) is a genetic disorder characterized by a poor anticoagulant response to activated protein C (APC) and an increased risk of venous thromboembolism (VTE). Homozygous carriers of the FV Leiden mutation are estimated to have an 80-fold increased lifetime relative risk of VTE. Most homozygous carriers present with VTE before 40 years of age, but some can live thrombosis-free until the sixth or seventh decade of life or even remain asymptomatic for life. Case-controlled studies of patients with cancer revealed a four-fold increase in thromboembolic occurrence in acute leukaemia, with the risk of thrombosis persisting even after remission of the disease. Case Report: The authors present a case report of the 61-year-old patient with leukaemic transformation of myelodysplastic syndrome (MDS) to acute myeloid leukaemia (AML) and development of DVT of the left leg (LL) as the first clinical manifestation of homozygous FV Leiden carrier. Due to his diagnosis it was not possible to indicate surgical treatment of DVT. After initial treatment with subcutaneous low molecular weight heparin (LMWH) and continuous intravenous application of unfractionated heparin (UFH) the deficiency of antithrombin III (AT III) potentiating the persistence of his hypercoagulable state developed. Treatment with the new oral anticoagulant - rivaroxaban, vasoprotective and antithrombotic drugs in the combination with mechanical methods of VTE prophylaxis led to a reduction in edema of left thigh and calf by 3.5 cm and 4 cm, respectively. Son of the patient experienced DVT at the age of 27 years, too. Conclusion: In this report, we describe a case of the patient with DVT during the leukaemic transformation of MDS to AML as a relatively late first clinical manifestation of homozygous FV Leiden mutation. At the same time the article deals with the clinical aspects of discussed thrombophilia in the relatives of the patient, as well as with the etiopathogenesis, pharmacologic treatment options and possible complications of DVT (PE, pulmonary hypertension and post-thrombotic syndrome).

scholarly journals Management of Cancer-Associated Thrombosis: Unmet Needs and Future Perspectives

TH Open ◽  
2021 ◽  
Vol 05 (03) ◽  
pp. e376-e386
Author(s):  
Anna Falanga ◽  
Grégoire Le Gal ◽  
Marc Carrier ◽  
Hikmat Abdel-Razeq ◽  
Cihan Ay ◽  
...  
Keyword(s):  
Unmet Needs ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Bleeding Complications ◽  
Term Therapy ◽  
Patients With Cancer ◽  
Risk Of Bleeding ◽  
Clinical Scenarios ◽  
Increased Risk ◽  
Cancer Associated Thrombosis

AbstractPatients with cancer are at a high risk of symptomatic venous thromboembolism (VTE), which is a common cause of morbidity and mortality in this patient population. Increased risk of recurrent VTE and bleeding complications are two major challenges associated with therapeutic anticoagulation in these patients. Long-term therapy with low-molecular-weight heparins (LMWHs) has been the standard of care for the treatment of cancer-associated VTE given its favorable risk–benefit ratio in comparison with vitamin K antagonists. Direct oral anticoagulants (DOACs), which offer the convenience of oral administration and have a rapid onset of action, have recently emerged as a new treatment option for patients with cancer-associated thrombosis (CT). Randomized clinical trial data with head-to-head comparisons between DOACs and LMWHs showed that overall, DOACs have a similar efficacy profile but a higher risk of bleeding was observed in some of these studies. This review aims to identify unmet needs in the treatment of CT. We discuss important considerations for clinicians tailoring anticoagulation (1) drug–drug interactions, (2) risk of bleeding (e.g., gastrointestinal bleeding), (3) thrombocytopenia, hematological malignancies, (4) metastatic or primary brain tumors, and (5) renal impairment. Additional research is warranted in several clinical scenarios to help clinicians on the best therapeutic approach.

Ten-year trends in iliofemoral deep vein thrombosis treatment and referral pathways

Vascular ◽  
2020 ◽  
pp. 170853812097524
Author(s):  
Sylvie Bowden ◽  
Brandon VanAsseldonk ◽  
Naomi Eisenberg ◽  
Sebastian Mafeld ◽  
Graham Roche-Nagle
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Best Management Practices ◽  
Lower Limb ◽  
Diagnostic Methods ◽  
Treatment Pathways ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein

Objectives Iliofemoral deep venous thrombosis is associated with an increased risk of developing post-thrombotic syndrome resulting in reduced quality of life. As there is debate about best management practices, this study aimed to examine the referral and treatment pathways for patients presenting with iliofemoral deep venous thrombosis over an 11-year period at our institution. Methods We conducted a retrospective review of patients diagnosed with lower limb deep vein thrombosis between 2010 and 2020. Ultrasound report findings were reviewed for the presence of iliofemoral deep venous thrombosis with acute, occlusive, or proximal clot. Multiple factors were extracted, including patient demographics, risk factors, diagnostic methods, interventions, referrals, and details of follow-up. The CaVenT and ATTRACT trials studied the benefit of thrombolysis in the early phase of iliofemoral deep venous thrombosis management as compared to anticoagulation alone. An analysis was conducted of patients requiring thrombolysis to determine whether these trials impacted physician practice patterns for thrombolysis. Data were organized and examined by year for trends in treatment and referral pathways. Results The review yielded 2792 patients assessed for lower limb deep venous thrombosis by ultrasound. Four hundred and sixty-seven (16.7%) patients were confirmed to have an occlusive iliofemoral deep venous thrombosis. The average age was 62.7 years (18–101 years). Half (50.4%) of the patients were male. The most common etiology for clot was malignancy-induced hypercoagulable state (39.0%). There was no difference in incidence of iliofemoral deep venous thrombosis diagnosed by ultrasound per year, with an average of 42.5 per year and a peak of 61. There was a trend towards increased rates of computed tomography imaging, ranging between 9.1% and 52.9%. The rate thrombolysis per year ranged between 1.8% and 8.9%, with a range of 4.3% ( n = 20) to 8.9% ( n = 5) in 2018. The use of pharmacomechanical thrombolysis increased, from 25% ( n = 1) in 2010–2012 to 87.5% ( n = 7) in 2018–2020. The rate of inferior vena cava filter insertion alone decreased from 18.2% in 2010 ( n = 4) to 5.9% ( n = 1) in 2020. The length of thrombolysis treatment also decreased, from 100% of patients ( n = 4) receiving treatment duration greater than 24 h in 2010–2012 to 0% ( n = 0) in 2018–2020. About 45% of patients receiving thrombolysis ( n = 9) had venous stenting. No difference in treatment outcomes were observed, with greater than 87.5% of patients reaching intermediate to full resolution of clot burden. No patients experienced intracranial hemorrhage. Conclusions The results of this analysis highlight the change in practice in our institution over time. The low rate of intervention likely reflects the current lack of consensus in published guidelines. It is important for future work to elicit the most appropriate management pathways for patients with iliofemoral deep venous thrombosis.

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