All I want for coagulation

Evidence-based medicine underpins modern practice of medicine. This paper describes a fictional consultation between Santa Claus and a doctor regarding deep vein thrombosis (DVT) prophylaxis, giving a review of the evidence for DVT prophylaxis in travellers while exposing the difficulty in applying evidence to atypical clinical encounters. Medline and the Cochrane Library were searched, and guidelines reviewed. Keywords used were DVT, thromboembolism, deep vein thrombosis and air travel-related venous thromboembolism. All relevant studies found, have been included in this review, with additional studies identified from the references in these articles. In conclusion, compression stockings, with or without a one-off dose of either aspirin or heparin, are the most evidence-based approaches for prophylaxis in someone with established risk factors for DVT prior to a long-haul flight. Simple exercises should also be encouraged.

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Combination Prophylaxis versus Pharmacologic Prophylaxis Alone for Preventing Deep Vein Thrombosis in Hip Surgery

Hip International ◽

10.5301/hipint.5000384 ◽

2016 ◽

Vol 26 (6) ◽

pp. 561-566

Author(s):

Feng-Fei Lin ◽

Chao-Hui Lin ◽

Bin Chen ◽

Ke Zheng

Keyword(s):

Deep Vein Thrombosis ◽

Hip Surgery ◽

Cochrane Library ◽

Comparative Efficacy ◽

Compression Stockings ◽

Pharmacological Prophylaxis ◽

Vein Thrombosis ◽

Significant Difference ◽

Pharmacologic Prophylaxis ◽

Deep Vein

Purpose To evaluate the comparative efficacy and safety of combination pharmacologic and graduated compression stockings (GCS) prophylaxis versus pharmacological prophylaxis alone for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in hip surgery. Methods Relevant publications indexed in PubMed, Cochrane Library, Embase, Web of Science, Wanfang Data, CNKI and Sinomed (CBM) were identified. Appropriate articles identified from the reference lists of the above searches were also reviewed. Results Significant differences in the rate of distal DVT were observed between combination prophylaxis and pharmacological groups. When data from Fredin 1989 was excluded no significant difference in the rate of distal DVT was seen between groups. No significant difference in the rate of proximal DVT or PE was observed between combination and pharmacologic prophylaxis groups. Conclusions A combination of pharmacological prophylaxis and GCS can decrease distal DVT in the lower extremity when compare to pharmacological prophylaxis alone, but it is not useful in decreasing proximal DVT and PE. If we use currently recommended pharmacologic prophylaxis it is not necessary to combine this with GCS.

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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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A local increase in red blood cell aggregation can trigger deep vein thrombosis: evidence based on quantitative cellular ultrasound imaging

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2010.04164.x ◽

2011 ◽

Vol 9 (3) ◽

pp. 481-488 ◽

Cited By ~ 51

Author(s):

F. T. H. YU ◽

J. K. ARMSTRONG ◽

J. TRIPETTE ◽

H. J. MEISELMAN ◽

G. CLOUTIER

Keyword(s):

Deep Vein Thrombosis ◽

Blood Cell ◽

Ultrasound Imaging ◽

Red Blood Cell ◽

Cell Aggregation ◽

Evidence Based ◽

Vein Thrombosis ◽

Local Increase ◽

Red Blood Cell Aggregation ◽

Deep Vein

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Do graduated compression stockings help to prevent deep vein thrombosis and pulmonary embolism?

Cochrane Clinical Answers ◽

10.1002/cca.2381 ◽

2019 ◽

Author(s):

Jane Burch ◽

Sera Tort

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Compression Stockings ◽

Vein Thrombosis ◽

Graduated Compression Stockings ◽

Deep Vein

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SP7.1.2 DVT and Abdominoplasty: A Holistic 8-point protocol-based approach to prevent DVT

British Journal of Surgery ◽

10.1093/bjs/znab361.139 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Reyan Saghir ◽

Noman Saghir ◽

Renee Okhiria ◽

Manu Sidhu ◽

Terrell Okhiria ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Incidence Rate ◽

Lower Incidence ◽

Holistic Approach ◽

Incidence Rates ◽

Thromboembolic Events ◽

Compression Stockings ◽

Specific Approach ◽

Vein Thrombosis ◽

Deep Vein

Abstract Aim Plastic surgery as a speciality is afflicted with one of the highest incidence rates of thromboembolic events, with abdominoplasty procedures known to assimilate the greatest rates of Deep Vein Thrombosis (DVT). Methods A total of 1078 abdominoplasty patients were enrolled onto an 8-point prophylaxis protocol with an inclusive holistic approach over a 7- year period. A 4-week smoking, HRT and COC cessation period was imposed on all patients and a maximum BMI score of 40 was required of all preoperative patients. Participants were administered with compression stockings, flowtrons and enoxaparin. Individuals with a DVT history were also required to be 1-year treatment free prior to surgery. Furthermore, the protocol necessitated post-operative deambulation of fit patients within 4 hours. Results Between 2008 and 2013, no incidence of DVT was recorded in all 1078 abdominoplasty surgery patients, indicating the potential for this protocol to lead to a significantly lower incidence than any previously published methodology. Due to the zero-incidence rate of DVT, different hypotheses of DVT proportions were tested to find out the rates that could be statistically consistent with our sample, thereby providing conservative incidence rate estimates. Conclusion This 8-point DVT prophylaxis protocol is the first non-criteria based inclusive protocol aimed at preventing abdominoplasty-associated DVT. As a result, not a single incident of DVT was recorded over the seven-year period of this study. We therefore believe that a holistic and procedure-specific approach to prophylaxis can drastically reduce the occurrence of DVT in abdominoplasty surgery.

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