scholarly journals COVID-19 and Venous Thromboembolism Pharmacologic Thromboprophylaxis

2020 ◽  
Author(s):  
Cassandra Benge
Keyword(s):  
Venous Thromboembolism ◽  
Pharmacologic Thromboprophylaxis

scholarly journals Efficacy of pre-operative pharmacologic thromboprophylaxis on incidence of venous thromboembolism following major gynecologic and gynecologic oncology surgery: a systematic review and meta-analysis

2020 ◽  
pp. ijgc-2020-001991
Author(s):  
Steven Bisch ◽  
Rachelle Findley ◽  
Christina Ince ◽  
Maria Nardell ◽  
Gregg Nelson
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Gynecologic Oncology ◽  
Quality Data ◽  
Gynecologic Surgery ◽  
Cochrane Central Register ◽  
Pharmacologic Prophylaxis ◽  
Pharmacologic Thromboprophylaxis

IntroductionVenous thromboembolism remains a significant complication following major gynecologic surgery. Evidence is lacking on whether it is beneficial to give pharmacologic thromboprophylaxis pre-operatively. The aim of this meta-analysis was to assess the role of pre-operative pharmacologic thromboprophylaxis in preventing post-operative venous thromboembolism.MethodsPubMed, EMBASE, and the Cochrane Central Register of Clinical Trials were searched to find randomized controlled, cohort, and case–control trials comparing pre-operative pharmacologic thromboprophylaxis to no prophylaxis, mechanical prophylaxis, or only post-operative pharmacologic thromboprophylaxis for open and minimally invasive major gynecologic surgery (benign and malignant conditions). Two authors independently assessed abstracts, full-text articles, and methodological quality. Data were extracted and pooled using ORs for random effects meta-analysis. Heterogeneity was explored using forest plots, Q-statistic, and I2 statistics. Planned subgroup analysis of use of sequential compression devices, equivalent versus non-equivalent post-operative prophylaxis, cancer diagnosis, and methodological quality were performed.ResultsSome 503 unique studies were found, and 16 studies (28 806 patients) were included in the systematic review. Twelve studies (14 273 patients) were included in the meta-analysis. The OR for incidence of post-operative venous thromboembolism was 0.59 (95% CI 0.39, 0.89), favoring pre-operative pharmacologic thromboembolism prophylaxis compared with no pre-operative pharmacologic prophylaxis (Q=13.80, I2=20.30). In studies where post-operative care was equivalent between groups, the OR for venous thromboembolism was 0.56 (95% CI 0.22, 1.40). Pre-operative pharmacologic prophylaxis demonstrated greatest benefit when utilized with both intra-operative and post-operative sequential compression devices (OR 0.43, 95% CI 0.30, 0.64) compared with when no sequential compression devices were utilized (OR 1.27, 95% CI 0.63, 2.56). When looking at only studies determined to be of high quality, the results no longer reached significance (OR 0.73, 95% CI 0.36, 1.46).ConclusionsPre-operative pharmacologic thromboprophylaxis decreases the odds of venous thromboembolism in the peri-operative period for major gynecologic oncology surgery by approximately 40%. It remains unclear whether this benefit is present in benign and minor procedures. Adequately powered studies are needed.

scholarly journals Pharmacologic thromboprophylaxis in adult patients undergoing neurosurgical interventions for preventing venous thromboembolism

2020 ◽  
Vol 4 (12) ◽  
pp. 2798-2809
Author(s):  
Juan José Yepes-Nuñez ◽  
Anita Rajasekhar ◽  
Maryam Rahman ◽  
Philipp Dahm ◽  
David R. Anderson ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Neurosurgical Procedures ◽  
Assessment Development ◽  
Vein Thrombosis ◽  
Surrogate Outcomes ◽  
Symptomatic Pulmonary Embolism ◽  
Neurosurgical Patients ◽  
Pharmacologic Prophylaxis ◽  
Pharmacologic Thromboprophylaxis ◽  
The Impact

Abstract The impact of pharmacologic prophylaxis for venous thromboembolism in patients undergoing neurosurgical intervention remains uncertain. We reviewed the efficacy and safety of pharmacologic compared with nonpharmacologic thromboprophylaxis in neurosurgical patients. Three databases were searched through April 2018, including those for randomized controlled trials (RCTs) and for nonrandomized controlled studies (NRSs). Independent reviewers assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Seven RCTs and 3 NRSs proved eligible. No studies reported on symptomatic proximal and distal deep vein thrombosis (DVT). Two RCTs reported on screening-detected proximal and distal DVTs. We used the findings of these 2 RCTs as the closest surrogate outcomes to inform the proximal and distal DVT outcomes. These 2 RCTs suggest that pharmacologic thromboprophylaxis may decrease the risk of developing asymptomatic proximal DVT (relative risk [RR], 0.50; 95% confidence interval [CI], 0.30-0.84; low certainty). Findings were uncertain for mortality (RR, 1.27; 95% CI, 0.57-2.86; low certainty), symptomatic pulmonary embolism (PE) (RR, 0.84; 95% CI, 0.03-27.42; very low certainty), asymptomatic distal DVT (RR, 0.54; 95% CI, 0.27-1.08; very low certainty), and reoperation (RR, 0.43; 95% CI, 0.06-2.84; very low certainty) outcomes. NRSs also reported uncertain findings for whether pharmacologic prophylaxis affects mortality (RR, 0.72; 95% CI, 0.46-1.13; low certainty) and PE (RR, 0.18; 95% CI, 0.01-3.76). For risk of bleeding, findings were uncertain in both RCTs (RR, 1.57; 95% CI, 0.70-3.50; low certainty) and NRSs (RR, 1.45; 95% CI, 0.30-7.12; very low certainty). In patients undergoing neurosurgical procedures, low certainty of evidence suggests that pharmacologic thromboprophylaxis confers benefit for preventing asymptomatic (screening-detected) proximal DVT with very low certainty regarding its impact on patient-important outcomes.

Venous thromboembolism in patients with COVID-19 (SARS-CoV-2 infection) – a position paper of the German Society of Angiology (DGA)

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 259-263 ◽  
Author(s):  
Birgit Linnemann ◽  
Rupert Bauersachs ◽  
Mathias Grebe ◽  
Robert Klamroth ◽  
Oliver Müller ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Inflammatory Response ◽  
German Society ◽  
Position Paper ◽  
Adverse Outcomes ◽  
Current Evidence ◽  
Prothrombotic State ◽  
Embolism And Thrombosis ◽  
Pharmacologic Thromboprophylaxis

Summary: As observed in other infections with a systemic inflammatory response, severe COVID-19 is associated with hypercoagulability and a prothrombotic state. Currently, there is growing evidence that pulmonary embolism and thrombosis contribute to adverse outcomes and increased mortality in critically ill patients with COVID-19. The optimal thromboprophylactic regimen for patients with COVID-19 is not known. Whereas pharmacologic thromboprophylaxis is generally recommended for all hospitalized COVID-19 patients, adequate dosing of anticoagulants remains a controversial issue. Therefore, we summarize current evidence from the available literature and, on behalf of the German Society of Angiology (DGA), we aim to provide advice to establish an improved and more uniform strategy for thromboprophylaxis in patients with COVID-19.

Abstract 208: Pharmocologic Thromboprophylaxis Reduces the Odds of Venous Thromboembolism in Patients With Hemorrhagic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
A S Levy ◽  
Kristin Salottolo ◽  
William M Coplin ◽  
Richard Smith ◽  
Patricia Santos ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Hemorrhagic Stroke ◽  
Primary Diagnosis ◽  
Optimal Timing ◽  
Stepwise Logistic Regression ◽  
Filter Placement ◽  
Pharmacologic Thromboprophylaxis ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Continuous Use ◽  
Current Guidelines

Background: Current guidelines regarding the use and optimal timing of Pharmacologic Thromboprophylaxis (PTP) are unclear in patients with primary diagnosis of hemorrhagic stroke. We sought to determine the association between PTP and development of venous thromboembolism (VTE) in this population. Methods: We reviewed patients with non-traumatic/spontaneous subarachnoid hemorrhage and intracerebral hemorrhage admitted between 1/2010-12/2012 with hospital LOS ≥ 3 d (n=245). Multivariate stepwise logistic regression was used to analyze the association between PTP and development of VTE. PTP was analyzed in regards to: use of PTP (vs. not administered), early administration of PTP (vs. ≥ 72 h) and interruption of PTP (vs. continuous use). The following covariates were considered: primary diagnosis, age, gender, transfer status, pre-event warfarin use, overweight/obese (BMI ≥ 25), ambulation ≥ 100 feet, IVC filter placement, moderate/severe stroke (NIHSS ≥ 8), Glasgow Coma Score (GCS 3-8, 9-12, 13-15), hospital LOS and ICU LOS. Results: The overall incidence of VTE was11.4% (28/245). All but 4 patients (98.4%) received mechanical prophylaxis; however, only one-third of patients (n=81) received PTP, and was initiated early in a minority (9.9%, n=8). The incidence of VTE was not significantly different in patients who received PTP (7.3%, 5/69) compared to patients who did not receive PTP (13.1%, 23/176), before adjustment (OR: 0.52, p = 0.20). However, after adjustment for age, gender, pre-event warfarin use, ambulation, and ICU LOS, PTP was associated with significantly reduced odds of VTE (OR: 0.05 (0.01 - 0.31), p = 0.001). Age ≥ 65 (5.73 (1.17 - 28.19), p = 0.03) and prolonged ICU LOS (1.29 (1.16 - 1.44), p < 0.001) were associated with increased odds of VTE. Neither the timing nor the interruption of PTP was associated with development of VTE. Conclusions: This study demonstrated that the odds of developing VTE were 95% lower in patients receiving PTP. We recommend the use of PTP in addition to mechanical thromboprophylaxis in patients with stable hemorrhagic stroke. The exact timing of beginning such chemoprophylaxis needs better definition.

Evidence Base for the Management of Venous Thromboembolism in Pregnancy

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 173-180 ◽  
Author(s):  
Marc Rodger
Keyword(s):  
Venous Thromboembolism ◽  
Signs And Symptoms ◽  
Bleeding Risk ◽  
Evidence Base ◽  
Vein Thrombosis ◽  
Absolute Benefit ◽  
Diagnostic Approaches ◽  
Pharmacologic Thromboprophylaxis ◽  
Deep Vein ◽  
In Pregnancy

Abstract Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of maternal mortality during pregnancy. DVT and PE are commonly suspected due to many mimicking signs and symptoms that are normal in pregnancy. However, validated diagnostic approaches are lacking, and a fear of teratogenic/oncogenic exposure from imaging procedures affects the acceptability of diagnostic approaches used for VTE during pregnancy. DVT and PE treatment in pregnancy is also challenging due to this lack of validated diagnostic approaches, changes in maternal physiology, and the need for intact hemostasis at the time of delivery/epidural analgesia. Prevention requires an optimal balancing of absolute increased bleeding risk from pharmacologic thromboprophylaxis and the absolute benefit of reduced DVT and PE, which, while serious, are relatively uncommon.

Symptomatic Venous Thromboembolism and Major Bleeding After Renal Transplantation: Should We Use Pharmacologic Thromboprophylaxis?

2016 ◽  
Vol 48 (8) ◽  
pp. 2773-2778 ◽  
Author(s):  
D. Musso ◽  
G.I. Robaina ◽  
A.V. Figueroa Córdoba ◽  
G.D. Martini ◽  
R.A. Albertini ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Pharmacologic Thromboprophylaxis

scholarly journals A prospective study on the incidence of postoperative venous thromboembolism in Korean gastric cancer patients: An inquiry into the application of western guidelines to Asian cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15129-e15129
Author(s):  
Keun Wook Lee ◽  
Jin Won Kim ◽  
Eun Ju Chun ◽  
Sang Il Choi ◽  
Do Joong Park ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Stage Iv ◽  
Tumor Stage ◽  
Development Stage ◽  
Stage I ◽  
Pharmacologic Thromboprophylaxis ◽  
Gastric Cancer Patients ◽  
A Prospective Study

e15129 Background: Several Western guidelines recommend the routine use of pharmacologic thromboprophylaxis for cancer surgery patients to prevent venous thromboembolism (VTE). However, the necessity of routine pharmacologic perioperative thromboprophylaxis in Asian gastric cancer (GC) patients has not been clearly determined. Methods: To determine the necessity of routine perioperative pharmacologic thromboprophylaxis in Korean gastric cancer patients, the incidence of postoperative VTE was prospectively evaluated in gastric cancer patients receiving surgery. Among 610 GC patients who had received surgery, 375 patents prospectively underwent routine duplex Doppler ultrasonography (DUS) on days 5-12 following surgery to detect VTE and then VTE-related symptoms and signs were checked at 4 weeks after surgery (cohort A). The 235 patients that declined DUS were registered to cohort B and the occurrence of postoperative VTE was retrospectively analyzed. Results: In cohort A, symptomatic or asymptomatic VTE until 4 weeks after surgery was detected in 9 patients [2.4%; 95% confidence interval (CI); 0.9-3.9]. Tumor stage was a significant factor related to VTE development [stage I, 1.4%; stage II/III, 2.4%; stage IV, 9.7% (P = 0.008)]. In multivariate analysis, patients with stage IV had a higher postoperative VTE development [odds ratio, 8.18 (95% CI, 1.54-43.42)] than those with stage I. In cohort B, a low incidence of postoperative VTE was reaffirmed; only one postoperative VTE case (0.4%) was observed. Conclusions: The incidence of postoperative VTE in Korean GC patients was only 2.4%. Risk-stratified applications of perioperative pharmacologic thromboprophylaxis are thought to be more appropriate than the routine pharmacologic thromboprophylaxis in Korean GC patients receiving surgery.

scholarly journals Characterization of Venous Thromboembolism Risk in Medical Inpatients Using Different Clinical Risk Assessment Models

2016 ◽  
Vol 69 (6) ◽  
Author(s):  
Reza Rafizadeh ◽  
Ricky D Turgeon ◽  
Josh Batterink ◽  
Victoria Su ◽  
Anthony Lau
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Risk Stratification ◽  
Prediction Score ◽  
Study Cohort ◽  
Risk Assessment Models ◽  
Qualitative Risk Assessment ◽  
Medical Inpatients ◽  
Stratification Du Risque ◽  
Pharmacologic Thromboprophylaxis

<p><strong>ABSTRACT</strong></p><p><strong>Background:</strong> Symptomatic venous thromboembolism (VTE) occurs in about 1% of patients within 3 months after admission to a medical unit. Recent evidence for thromboprophylaxis in an unselected medical inpatient population has suggested only a modest net benefit. Consequently, guidelines recommend careful risk stratification to guide thromboprophylaxis.</p><p><strong>Objectives:</strong> To compare candidacy for thromboprophylaxis according to 4 risk stratification models: a regional preprinted order (PPO) set used in the study institution, the Padua Prediction Score, and the IMPROVE predictive and associative risk assessment models.</p><p><strong>Methods:</strong> A retrospective review of health records was undertaken for patients with no contraindication to pharmacologic thromboprophylaxis who were admitted to the internal medicine service of a teaching hospital between April and July 2013.</p><p><strong>Results:</strong> Of the 298 patients in the study cohort, 238 (80.0%) received pharmacologic thromboprophylaxis on admission, ordered according to the regional PPO. However, according to the Padua and the IMPROVE predictive risk assessment models, only 64 (21.5%) and 21 (7.0%) of the patients, respectively, were eligible for thromboprophylaxis at the time of admission. On the basis of risk factors identified during the subsequent hospital stay, 54 (18.1%) of the patients were eligible for thromboprophylaxis according to the IMPROVE associative model. Chance-corrected agreement between the PPO and the published risk assessment models was generally poor, with kappa coefficients of 0.109 for the PPO compared with the Padua Prediction Score and 0.013 for the PPO compared with the IMPROVE predictive model.</p><p><strong>Conclusions:</strong> These data suggest that quantitative models such as the Padua Prediction Score and the IMPROVE models identify more patients at low risk of venous thromboembolism than do in-hospital qualitative risk assessment models. Adoption of these guideline-based risk assessment models for predicting thromboembolic risk in medical inpatients could reduce the use of pharmacologic thromboprophylaxis from 80% to as low as 7%. Further external prognostic validation of risk assessment models and impact analysis studies may show improvements in safety and resource utilization.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte :</strong> La thromboembolie veineuse symptomatique se produit chez environ 1 % des patients dans les trois mois suivant leur admission à un service médical. Des données récentes portant sur la thromboprophylaxie chez une population non sélectionnée de patients hospitalisés ne suggéraient qu’un modeste avantage. Par conséquent, les lignes directrices recommandent une stratification du risque rigoureuse pour guider l’emploi d’une thromboprophylaxie.</p><p><strong>Objectifs :</strong> Comparer l’admissibilité à la thromboprophylaxie en fonction de quatre modèles de stratification du risque : un ensemble d’ordonnances préimprimées adopté dans une région et utilisé dans l’établissement à l’étude, le score prédictif de Padua et les modèles prédictifs et associatifs d’évaluation du risque issus de l’étude IMPROVE.</p><p><strong>Méthodes :</strong> Une analyse rétrospective des dossiers médicaux a été menée auprès des patients ne présentant pas de contre-indication à la thromboprophylaxie médicamenteuse qui ont été admis au service de médecine interne d’un hôpital universitaire entre avril et juillet 2013.</p><p><strong>Résultats :</strong> Parmi les 298 patients de l’étude de cohorte, 238 (80,0 %) ont reçu une thromboprophylaxie médicamenteuse au moment de l’admission, prescrite conformément à l’ensemble d’ordonnances préimprimées en usage dans la région. Or, respectivement selon les modèles prédictifs d’évaluation du risque Padua et IMPROVE, seuls 64 (21,5 %) et 21 (7,0 %) des patients étaient admissibles à la thromboprophylaxie au moment de l’admission. En fonction de facteurs de risques identifiés pendant le séjour subséquent à l’hôpital, 54 (18,1 %) des patients étaient admissibles à la thromboprophylaxie selon le modèle associatif IMPROVE. L’accord corrigé pour le hasard entre l’ensemble d’ordonnances préimprimées et les modèles d’évaluation du risque publiés était généralement faible, les coefficients de kappa étant de 0,109 pour l’ensemble d’ordonnances préimprimées comparé au score prédictif de Padua et de 0,013 pour l’ensemble d’ordonnances préimprimées comparé au modèle prédictif IMPROVE.</p><p><strong>Conclusions :</strong> Ces données suggèrent que les modèles quantitatifs comme le score prédictif de Padua et les modèles IMPROVE permettent de dépister plus de patients qui sont à faible risque de thromboembolie veineuse que ne le permettent les modèles qualitatifs d’évaluation du risque propres aux hôpitaux. L’adoption de ces modèles d’évaluation du risque mis de l’avant dans des lignes directrices pour prédire les risques d’événements thromboemboliques chez les patients médicaux hospitalisés pourrait réduire l’utilisation de la thromboprophylaxie médicamenteuse, qui pourrait passer de 80 % à aussi peu que 7 %. De plus amples validations externes quant à la valeur prédictive des modèles d’évaluation du risque et des études d’analyse d’impact pourraient montrer des améliorations à la sécurité et une réduction de l’utilisation des ressources.</p>

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