Influence of Prescribed Blood Products on the Incidence of Deep Vein Thrombosis and Pulmonary Embolism in Surgical Patients

Deep vein thrombosis (DVT) and pulmonary embolisms (PEs) are common complications after surgical procedures. The influence of prescribed blood products on the occurrence of DVT and PE was evaluated in postsurgical patients in this retrospective case–control study. The records of 286 surgical patients were analyzed: DVT (n = 52), PE (n = 92), and a control group (n = 142). The amounts of prescribed blood, blood products, and vitamin K were reviewed, together with appropriate prescribing of low-molecular-weight heparins. The influence of prescribed blood products on the occurrence of DVT or PE was analyzed using multinomial logistic regression. We demonstrated a significant difference between the test and control groups ( P < .05) in relation to receiving packed red blood cells. Treatment with red blood cells was associated with an increased risk of PE but not DVT. Patients who developed PE after surgery were hospitalized for longer (median 10 days) than patients with DVT (median 6 days). There was no difference between the test and control groups concerning treatment with fresh frozen plasma. Inadequate thromboprophylaxis significantly increased the likelihood of DVT. There is a connection between receiving packed red blood cells and occurrence of postoperative PE in surgical patients. Thus, patients receiving red blood cells should be monitored more closely after surgery, as they are more likely to develop PE postoperatively.

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Clinical Application of Technetium-99m-Labeled Red Blood Cells Subcutaneous Radionuclide Venography and Abdominal/Pelvic Hybrid SPECT/CT Imaging in Patients with Suspicion of Proximal Deep Vein Thrombosis

Journal of Nuclear Medicine & Radiation Therapy ◽

10.4172/2155-9619.1000295 ◽

2016 ◽

Vol 7 (5) ◽

Author(s):

Liu CT ◽

Chu HL ◽

Tsai IH ◽

Chang YL

Keyword(s):

Deep Vein Thrombosis ◽

Red Blood Cells ◽

Clinical Application ◽

Blood Cells ◽

Ct Imaging ◽

Proximal Deep Vein Thrombosis ◽

Technetium 99M ◽

Vein Thrombosis ◽

Deep Vein ◽

Radionuclide Venography

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Concomitant Use of Diosmin/Hesperidin and Oral Rivaroxaban Increases Deep Vein Recanalization and Reduces the Incidence of Post-Thrombotic Syndrome in Patients with Proximal Deep Vein Thrombosis

Blood ◽

10.1182/blood-2018-99-110084 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 986-986

Author(s):

Kirill Lobastov ◽

Iliya Schastlivtsev ◽

Victor Barinov

Keyword(s):

Deep Vein Thrombosis ◽

Clinical Severity ◽

Proximal Deep Vein Thrombosis ◽

Control Groups ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

And Control ◽

Deep Vein ◽

The Impact

Abstract Aim: To assess the impact of long-term Diosmin/Hesperidin use in the treatment of proximal deep vein thrombosis (DVT). Methods: This study was a pilot randomized open-label study with blinded outcome assessor - enrolled patients with their first episodes of popliteal-femoral DVT confirmed by duplex ultrasound (DUS). All participants were randomized into two groups: 1.) control that received a standard treatment with oral Rivaroxaban, and 2.) experimental that required additional treatment with Diosmin/Hesperidin 450/50 mg twice a day. Both drugs were used for six months. Patients were followed-up for the whole treatment period with series DUS every two months in order to evaluate the degree of recanalization by popliteal (PV), superficial femoral (SFV), and common femoral (CFV) veins' compressibility. Thrombi extension was assessed by modified Marder score. At the end of the follow-up period, patients were assessed with Villalta and venous clinical severity scores. Post-thrombotic syndrome (PTS) was diagnosed in those who had ≥5 Villalta score. Results: Sixty patients were randomized to the control and experimental groups (n=30 in each group). There were 40 men and 20 women with mean age of 56.3±13.4. Clinically unprovoked DVT was recognized in 65% of cases and left side localization in 45%. The median of Marder baseline scores were 15.0±4.8 and 11.1±4.3 in the experimental and control groups, respectively (p=0.002). After six months of treatment, the Marder score decreased to 0.8±1.6 and 2.8±3.5 in the main control groups, respectively (p=0.006). The generalized linear model repeated measures found a greater reduction in the Marder score (р <0.0001) and increased speed of recanalization on SFV (р <0.0001) with a non-significant tendency in the CFV (p=0.130) and PV (p=0.204) in the experimental group compared to the control one. Full recanalization of the PV at six months was observed in 24 patients (80%), who had received Diosmin/Hesperidin, and only in 17 persons (57%) of the control group (p=0.047). The median of Villalta score in the group treated with Diosmin/Hesperidin was significantly lower compared to the control one (2.9±2.7 versus 5.8±3.0 [p <0.0001]). The same difference was found for VCSS score (2.3±1.9 versus 4.9±1.9 [p <0001]). According to the Villalta score, PTS was recognized in six patients (20%) and 17 patients (57%) in the experimental and control groups, respectively (p=0.004). Conclusion: Long-term treatment with Diosmin/Hesperidin can increase the speed of deep vein recanalization and reduce the incidence of PTS diagnosed at six months in patients with proximal DVT treated with oral rivaroxaban. Disclosures Lobastov: Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Schastlivtsev:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Barinov:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau.

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Diagnosis of deep vein thrombosis with in vivo 99mTc-labeled red blood cells

European Journal of Nuclear Medicine ◽

10.1007/bf00257065 ◽

1981 ◽

Vol 6 (1) ◽

pp. 5-9 ◽

Cited By ~ 5

Author(s):

V. Kempi ◽

W. van der Linden

Keyword(s):

Deep Vein Thrombosis ◽

Red Blood Cells ◽

Blood Cells ◽

Vein Thrombosis ◽

Deep Vein

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THE DIAGNOSTIC VALUE OF ANGIOSCINTIGRAPHY WITH 99mTc-LABELLED RED BLOOD CELLS FOR DETECTION OF DEEP VEIN THROMBOSIS

Nuclear Medicine Communications ◽

10.1097/00006231-200803030-00007 ◽

1982 ◽

Vol 3 (3) ◽

pp. 172-181

Author(s):

J. Fogh

Keyword(s):

Deep Vein Thrombosis ◽

Red Blood Cells ◽

Blood Cells ◽

Diagnostic Value ◽

Vein Thrombosis ◽

Deep Vein

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(More than) doubling down: Effective fibrinolysis at a reduced rt-PA dose for catheter-directed thrombolysis combined with histotripsy

PLoS ONE ◽

10.1371/journal.pone.0261567 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0261567

Author(s):

Samuel A. Hendley ◽

Aarushi Bhargava ◽

Christy K. Holland ◽

Geoffrey D. Wool ◽

Osman Ahmed ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Thrombolytic Therapy ◽

Red Blood Cells ◽

Blood Cells ◽

Vein Thrombosis ◽

Clinical Dose ◽

Infusion Catheter ◽

Catheter Directed Thrombolysis ◽

The Common ◽

Deep Vein

Deep vein thrombosis is a major source of morbidity and mortality worldwide. For acute proximal deep vein thrombosis, catheter-directed thrombolytic therapy is an accepted method for vessel recanalization. Thrombolytic therapy is not without risk, including the potential for hemorrhagic bleeding that increases with lytic dose. Histotripsy is a focused ultrasound therapy that generates bubble clouds spontaneously in tissue at depth. The mechanical activity of histotripsy increases the efficacy of thrombolytic therapy at doses consistent with current pharmacomechanical treatments for venous thrombosis. The objective of this study was to determine the influence of lytic dose on histotripsy-enhanced fibrinolysis. Human whole blood clots formed in vitro were exposed to histotripsy and a thrombolytic agent (recombinant tissue plasminogen activator, rt-PA) in a venous flow model perfused with plasma. Lytic was administered into the clot via an infusion catheter at concentrations ranging from 0 (control) to 4.54 μg/mL (a common clinical dose for catheter-directed thrombolysis). Following treatment, perfusate samples were assayed for markers of fibrinolysis, hemolysis, and intact red blood cells and platelets. Fibrinolysis was equivalent between the common clinical dose of rt-PA (4.54 μg/mL) and rt-PA at a reduction to one-twentieth of the common clinical dose (0.23 μg/mL) when combined with histotripsy. Minimal changes were observed in hemolysis for treatment arms with or without histotripsy, potentially due to clot damage from insertion of the infusion catheter. Likewise, histotripsy did not increase the concentration of red blood cells or platelets in the perfusate following treatment compared to rt-PA alone. At the highest lytic dose, a refined histotripsy exposure scheme was implemented to cover larger areas of the clot. The updated exposure scheme improved clot mass loss and fibrinolysis relative to administration of lytic alone. Overall, the data collected in this study indicate the rt-PA dose can be reduced by more than a factor of ten and still promote fibrinolysis when combined with histotripsy.

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99mTc labeled red blood cells versus ?-phlebography in diagnosis of deep vein thrombosis

European Journal of Nuclear Medicine ◽

10.1007/bf00251654 ◽

1982 ◽

Vol 7 (2) ◽

Author(s):

G. Jacolot ◽

P. Legendre ◽

L. Millour ◽

J.F. Morin ◽

P.P. Morin

Keyword(s):

Deep Vein Thrombosis ◽

Red Blood Cells ◽

Blood Cells ◽

Vein Thrombosis ◽

Deep Vein

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Systematic Underestimation of Treatment Effects as a Result of Diagnostic Test Inaccuracy: Implications for the Interpretation and Design of Thromboprophylaxis Trials

Thrombosis and Haemostasis ◽

10.1055/s-0038-1653746 ◽

1995 ◽

Vol 73 (02) ◽

pp. 167-171 ◽

Cited By ~ 40

Author(s):

Anthony Rodgers ◽

Stephen MacMahon

Keyword(s):

Deep Vein Thrombosis ◽

Diagnostic Test ◽

Diagnostic Tests ◽

Treatment Effects ◽

Screening Tests ◽

Randomised Trials ◽

Control Groups ◽

Vein Thrombosis ◽

And Control ◽

Deep Vein

SummaryMany clinical trials that have assessed strategies for the prevention of deep vein thrombosis have employed diagnostic tests that are less accurate than venography. The correct interpretation of these trials has been the subject of considerable debate. This paper attempts to quantify the likely effects of the use of inaccurate diagnostic tests (in particular fibrinogen scanning) on the validity and precision of estimates of treatment effects. It is shown that, if there is no difference in the rate of misclassification of deep vein thrombosis between study and control groups, then treatment effects will tend to be systematically underestimated in trials that only use inaccurate diagnostic tests. However, for trials in which there are no false positive diagnoses, such as those employing venography, the estimate of relative treatment effects will be unbiased. This phenomenon is demonstrated empirically by data from randomised trials of antiplatelet therapy. The implications of these findings are two-fold. First, so long as the accuracy of the test is the same in study and control groups, positive trial results cannot be ascribed to diagnostic test inaccuracy. Second, unbiased estimates of relative treatment effects can be obtained by using cheap, practicable and non-invasive screening tests that are supplemented by venographic assessment of positive test results. This would facilitate the conduct of much larger randomised trials than has generally been possible when mandatory venography was used; if future trials randomised some thousands of patients and employed confirmatory venography then they would provide both unbiased and precise estimates of relative treatment effects.

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Deep Vein Thrombosis Prophylaxis: Audit of Practice in General Surgical Patients in a Teaching Hospital

Phlebology The Journal of Venous Disease ◽

10.1177/026835550001500206 ◽

2000 ◽

Vol 15 (2) ◽

pp. 71-74 ◽

Cited By ~ 4

Author(s):

O. Agu ◽

A. Handa ◽

G Hamilton ◽

D. M. Baker

Keyword(s):

Deep Vein Thrombosis ◽

High Risk ◽

Teaching Hospital ◽

Surgical Patients ◽

Thrombosis Prophylaxis ◽

High Risk Patients ◽

Vein Thrombosis ◽

Dvt Prophylaxis ◽

Risk Patients ◽

Deep Vein

Objective: To audit the prescription and implementation of deep vein thrombosis (DVT) prophylaxis in general surgical patients in a teaching hospital. Methods: All inpatients on three general surgical wards were audited for adequacy of prescription and implementation prophylaxis (audit A). A repeat audit 3 months later (audit B) closed the loop. The groups were compared using the chi-square test. Results: In audit A 50 patients participated. Prophylaxis was correctly prescribed in 36 (72%) and implemented in 30 (60%) patients. Eighteen patients at moderate or high risk (45%) received inadequate prophylaxis. Emergency admission, pre-operative stay and inadequate risk assignment were associated with poor implementation of protocol. In audit B 51 patients participated. Prescription was appropriate in 45 (88%) and implementation in 40 (78%) patients (p< 0.05). Eleven patients at moderate or high risk received inadequate prophylaxis. Seven of 11 high-risk patients in audit A (64%) received adequate prophylaxis, in contrast to all high-risk patients in audit B. The decision not to administer prophylaxis was deemed appropriate in 5 of 15 (30%) in audit A compared with 6 of 10 (60%) in audit B. Conclusion: Increased awareness, adequate risk assessment, updating of protocols and consistent reminders to staff and patients may improve implementation of DVT prophylaxis.

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