The use of prophylaxis in patients undergoing diagnostic tests for                suspected venous thromboembolism

Objectives The purpose of this study was to describe the use of pharmacological and mechanical prophylaxis and clinical outcomes of patients undergoing diagnostic tests for suspected venous thromboembolism (VTE). Methods The medical records of 660 consecutive inpatients referred for suspected VTE at an academic medical centre were retrospectively reviewed. Results Acute VTE was diagnosed in 138 (21%) of the 660 patients; the incidence of deep vein thrombosis and pulmonary embolism was 18–25%, respectively. Only 61% of eligible patients received pharmacological prophylaxis and 43% of patients received mechanical prophylaxis. The incidence of VTE was higher in patients who did not receive pharmacological prophylaxis (30%) compared with patients who did (16%, P value <0.001). Conclusions Preventive measures for VTE, including both pharmacological and mechanical prophylaxis, were underutilized in hospitalized patients undergoing diagnostic tests for suspected VTE.

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Reliable Rapid Blood Test for the Exclusion of Venous Thromboembolism in Symptomatic Outpatients

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650513 ◽

1996 ◽

Vol 76 (01) ◽

pp. 009-011 ◽

Cited By ~ 62

Author(s):

Franktien Turkstra ◽

Edwin J R van Beek ◽

Jan W ten Cate ◽

Harry R Buller

Keyword(s):

Venous Thromboembolism ◽

Negative Predictive Value ◽

Whole Blood ◽

Predictive Value ◽

Academic Medical Centre ◽

Vein Thrombosis ◽

Academic Medical ◽

Sensitivity Specificity ◽

Deep Vein ◽

D Dimer

SummaryIn this study we assessed the reliability of a rapid bed-side whole blood D-dimer assay prospectively in patients with clinically suspected venous thromboembolism, referred to the Academic Medical Centre, Amsterdam. In consecutive outpatients with clinically suspected deep vein thrombosis or pulmonary embolism we measured the sensitivity, specificity and negative predictive value of the assay compared to the outcome of standard diagnostic tests and 3-month follow-up. A total of 234 patients were included; the prevalence of venous thromboembolism was 29%. A sensitivity, specificity and negative predictive value of 100% (95% Cl: 95% -100%), 58% (95% Cl: 50% - 65%) and 100% (95% Cl: 96% -100%), respectively, were obtained. The exclusion rate was 41% of all referred patients. Conclusion: The SimpliRED whole blood D-dimer assay appears to be a simple and reliable method for the exclusion of venous thromboembolism in symptomatic outpatients.

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Venous Thromboembolism in Abdominoplasty Patients: A Study of Incidence and Prophylaxis Recommendations

The American Journal of Cosmetic Surgery ◽

10.1177/074880680702400203 ◽

2007 ◽

Vol 24 (2) ◽

pp. 66-79 ◽

Cited By ~ 3

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.

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Clinical Outcome of Orthopaedic Patients with Negative Lower Limb Venography at Discharge

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649878 ◽

1995 ◽

Vol 74 (04) ◽

pp. 1042-1044 ◽

Cited By ~ 13

Author(s):

Giancarlo Agnelli ◽

Valeria Ranucci ◽

Franca Veschi ◽

Emanuele Rinonapoli ◽

Luciano Lupattelli ◽

...

Keyword(s):

Venous Thromboembolism ◽

Hospital Stay ◽

Hospital Discharge ◽

Family Doctor ◽

Hip Surgery ◽

Thromboembolic Events ◽

Pharmacological Prophylaxis ◽

Vein Thrombosis ◽

Orthopaedic Patients ◽

Deep Vein

SummaryPharmacological prophylaxis for postoperative venous thromboembolism is generally restricted to the hospital stay. A high incidence of deep vein thrombosis (DVT) and pulmonary embolism presenting after hospital discharge has been reported and thus it has been claimed that pharmacological prophylaxis should be continued after discharge. The aim of this study was to perform a prospective survey to assess the prevalence of clinically overt thromboembolic events in hip surgery patients discharged with a negative venography without further pharmacological prophylaxis. We followed-up 213 patients with negative venography at discharge (105 elective hip replacement and 108 hip fracture patients). 186 patients (87.3%) were re-examined as outpatients one to two months after discharge. Five patients reported symptoms of DVT but the diagnosis was not confirmed by objective testing. The remaining 27 patients (12.7%) were followed up through their family doctor or by telephone call; in these patients the follow-up period ranged from 60 days to 2 years. Twenty-two patients (10.3%) were still alive and reported no signs or symptoms of venous thromboembolism. Three patients (1.4%) died for reasons not correlated with venous thromboembolism. Two patients could not be traced due to geographical inaccessibility; they were still alive after 1 year according to the records of their health care district. The results of our study suggest that in hip surgery patients with negative venography the prevalence of clinically overt thromboembolic events after hospital discharge ranges from 0 to 2.2% (95% C. I.). It is conceivable that the majority of late presenting postoperative DVT actually develop during the hospital stay and become symptomatic after hospital discharge.

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Post Discharge Clinically Overt Venous Thromboembolism in Orthopaedic Surgery Patients with Negative Venography -an Overview Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650681 ◽

1996 ◽

Vol 76 (06) ◽

pp. 0887-0892 ◽

Cited By ~ 32

Author(s):

Serena Ricotta ◽

Alfonso lorio ◽

Pasquale Parise ◽

Giuseppe G Nenci ◽

Giancarlo Agnelli

Keyword(s):

Venous Thromboembolism ◽

Orthopaedic Surgery ◽

Diagnostic Methods ◽

Future Research ◽

Post Discharge ◽

Pharmacological Prophylaxis ◽

Vein Thrombosis ◽

Overview Analysis ◽

Major Orthopaedic Surgery

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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Faculty Opinions recommendation of Traumatic brain injury is associated with the development of deep vein thrombosis independent of pharmacological prophylaxis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1162162.622633 ◽

2009 ◽

Author(s):

Donald Marion

Keyword(s):

Traumatic Brain Injury ◽

Deep Vein Thrombosis ◽

Brain Injury ◽

Pharmacological Prophylaxis ◽

Vein Thrombosis ◽

Deep Vein

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Assessment of Deep Vein Thrombosis or Pulmonary Embolism by the Combined Use of Clinical Model and Noninvasive Diagnostic Tests

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-2000-13219 ◽

2000 ◽

Vol 26 (06) ◽

pp. 643-656 ◽

Cited By ~ 59

Author(s):

Philip S. Wells ◽

David R. Anderson ◽

Jeffrey Ginsberg

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Diagnostic Tests ◽

Clinical Model ◽

Vein Thrombosis ◽

Combined Use ◽

Deep Vein

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Treatment Patterns and Clinical Outcomes in Korean Cancer Patients With Venous Thromboembolism: A Retrospective Cohort Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620979575 ◽

2021 ◽

Vol 27 ◽

pp. 107602962097957

Author(s):

Soo-Mee Bang ◽

Jin-Hyoung Kang ◽

Min Hee Hong ◽

Jin-Seok Ahn ◽

So Yeon Oh ◽

...

Keyword(s):

Venous Thromboembolism ◽

Cancer Patients ◽

Clinical Outcomes ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Bleeding Events ◽

Factors Associated ◽

Vein Thrombosis ◽

Medical Chart Review ◽

Deep Vein

This study assessed epidemiologic data and clinical outcomes, including venous thromboembolism (VTE) recurrence and bleeding events, in patients with cancer-associated VTE, and assessed factors associated with clinical outcomes. Data were extracted from retrospective medical-chart review of adult patients diagnosed with cancer-associated deep vein thrombosis or pulmonary embolism who received anticoagulation treatment for ≥3 months. Patients were classified by: low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs), and other anticoagulants. First VTE recurrence and bleeding events, and factors associated with their occurrence, were assessed during the initial 6 months of treatment. Overall, 623 patients (age: 63.7 ± 11.3 years, 49.3% male) were included (119, 132, and 372 patients in LMWH, DOACs and other anticoagulants groups, respectively). The cumulative 6-month incidence of VTE recurrence was 16.6% (total), 8.3% (LMWH), 16.7% (DOACs), and 20.7% (other); respective bleeding events were 22.5%, 11.0%, 12.3%, and 30.7%). VTE recurrence and bleeding rates differed only between LMWH and other anticoagulants (HR 2.4, 95% CI: 1.2-5.0 and 3.6, 1.9-6.8, respectively). These results highlight the importance of initial VTE treatment choice for preventing VTE recurrence and bleeding events. LMWH or DOACs for ≥3 months can be considered for effective VTE management in cancer patients.

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Incidence of venous thromboembolism among patients receiving neoadjuvant chemotherapy for advanced epithelial ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000980 ◽

2020 ◽

Vol 30 (4) ◽

pp. 491-497 ◽

Cited By ~ 3

Author(s):

Julia Rose Salinaro ◽

Kourtnie McQuillen ◽

Megan Stemple ◽

Robert Boccaccio ◽

Jessie Ehrisman ◽

...

Keyword(s):

Ovarian Cancer ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Adjuvant Chemotherapy ◽

Neoadjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Primary Outcome ◽

Vein Thrombosis ◽

Deep Vein

ObjectivesNeoadjuvant chemotherapy may be considered for women with epithelial ovarian cancer who have poor performance status or a disease burden not amenable to primary cytoreductive surgery. Overlap exists between indications for neoadjuvant chemotherapy and known risk factors for venous thromboembolism, including impaired mobility, increasing age, and advanced malignancy. The objective of this study was to determine the rate of venous thromboembolism among women receiving neoadjuvant chemotherapy for epithelial ovarian cancer.MethodsA multi-institutional, observational study of patients receiving neoadjuvant chemotherapy for primary epithelial ovarian, fallopian tube, or peritoneal cancer was conducted. Primary outcome was rate of venous thromboembolism during neoadjuvant chemotherapy. Secondary outcomes included rates of venous thromboembolism at other stages of treatment (diagnosis, following interval debulking surgery, during adjuvant chemotherapy, or during treatment for recurrence) and associations between occurrence of venous thromboembolism during neoadjuvant chemotherapy, subject characteristics, and interval debulking outcomes. Venous thromboembolism was defined as deep vein thrombosis in the upper or lower extremities or in association with peripherally inserted central catheters or ports, pulmonary embolism, or concurrent deep vein thrombosis and pulmonary embolism. Both symptomatic and asymptomatic venous thromboembolism were reported.ResultsA total of 230 patients receiving neoadjuvant chemotherapy were included; 63 (27%) patients overall experienced a venous thromboembolism. The primary outcome of venous thromboembolism during neoadjuvant chemotherapy occurred in 16 (7.7%) patients. Of the remaining venous thromboembolism events, 22 were at diagnosis (9.6%), six post-operatively (3%), five during adjuvant chemotherapy (3%), and 14 during treatment for recurrence (12%). Patients experiencing a venous thromboembolism during neoadjuvant chemotherapy had a longer mean time to interval debulking and were less likely to undergo optimal cytoreduction (50% vs 80.2%, p=0.02).ConclusionsPatients with advanced ovarian cancer are at high risk for venous thromboembolism while receiving neoadjuvant chemotherapy. Consideration of thromboprophylaxis may be warranted.

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Atrial fibrillation associated with increased risk of venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th14-05-0405 ◽

2015 ◽

Vol 113 (01) ◽

pp. 185-192 ◽

Cited By ~ 23

Author(s):

Chun-Cheng Wang ◽

Cheng-Li Lin ◽

Guei-Jane Wang ◽

Chiz-Tzung Chang ◽

Fung-Chang Sung ◽

...

Keyword(s):

Atrial Fibrillation ◽

Venous Thromboembolism ◽

Incidence Rates ◽

Vein Thrombosis ◽

Kaplan Meier ◽

Increased Risk ◽

Long Term Follow Up ◽

Deep Vein

SummaryWhether atrial fibrillation (AF) is associated with an increased risk of venous thromboembolism (VTE) remains controversial. From Longitudinal Health Insurance Database 2000 (LHID2000), we identified 11,458 patients newly diagnosed with AF. The comparison group comprised 45,637 patients without AF. Both cohorts were followed up to measure the incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Univariable and multivariable competing-risks regression model and Kaplan-Meier analyses with the use of Aelon-Johansen estimator were used to measure the differences of cumulative incidences of DVT and PE, respectively. The overall incidence rates (per 1,000 person-years) of DVT and PE between the AF group and non-AF groups were 2.69 vs 1.12 (crude hazard ratio [HR] = 1.92; 95 % confidence interval [CI] = 1.54-2.39), 1.55 vs 0.46 (crude HR = 2.68; 95 % CI = 1.97-3.64), respectively. The baseline demographics indicated that the members of the AF group demonstrated a significantly older age and higher proportions of comorbidities than non-AF group. After adjusting for age, sex, and comorbidities, the risks of DVT and PE remained significantly elevated in the AF group compared with the non-AF group (adjusted HR = 1.74; 95 %CI = 1.36-2.24, adjusted HR = 2.18; 95 %CI = 1.51-3.15, respectively). The Kaplan-Meier curve with the use of Aelon-Johansen estimator indicated that the cumulative incidences of DVT and PE were both more significantly elevated in the AF group than in the non-AF group after a long-term follow-up period (p<0.01). In conclusion, the presence of AF is associated with increased risk of VTE after a long-term follow-up period.

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