scholarly journals The Current Status of Venous Thromboembolism Prophylaxis Following Total Joint Arthroplasty

2021 ◽  
Vol 9 (6) ◽  
Author(s):  
Dustin Rinehart ◽  
Ivy Nguyen ◽  
Michael Huo
Keyword(s):  
Venous Thromboembolism ◽  
Oral Anticoagulants ◽  
Professional Associations ◽  
Current Data ◽  
Ease Of Use ◽  
Current Status ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
The Past ◽  
Increased Risk

Background: A variety of local and systemic factors contribute to the increased risk of venous thromboembolism (VTE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA). The optimal regimen(s) for VTE prophylaxis are not conclusively defined at the present. This review is focused on the most current data on the outcomes of using various VTE prophylaxis following TKAs and THAs in the United State (U.S.) Methods: A review of the literature over the past 5 years was undertaken. We in particular focused on the data comparing the efficacy and the safety of different agents. Results: The commonly used VTE prophylaxis agents in the U.S. include: low-molecular-weight heparin, the new oral anticoagulants (factor Xa inhibitors), warfarin, and aspirin. Aspirin in particular has gained popularity over the past few years. This is principally due to several factors: less bleeding, equal efficacy, and the ease of use. Most surgeons use a “multi-modal” protocol including early mobilization, mechanical prophylaxis, and chemoprophylaxis. Conclusion: There is no conclusive evidence with regard to what agent(s) are the most efficacious and the safest in VTE prophylaxis following TKAs and THAs. There is however general agreement between the major guidelines from the professional associations of orthopedic surgery, and from the non-orthopedic disciplines. It is important to risk-stratify each patient, and to apply the most appropriate VTE prophylaxis.

scholarly journals Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

2020 ◽  
Vol 38 (5) ◽  
pp. 496-520 ◽  
Author(s):  
Nigel S. Key ◽  
Alok A. Khorana ◽  
Nicole M. Kuderer ◽  
Kari Bohlke ◽  
Agnes Y.Y. Lee ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Medical Condition ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Signs And Symptoms ◽  
Cochrane Library ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Increased Risk

PURPOSE To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. METHODS PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommendations as needed. RESULTS The systematic review included 35 publications on VTE prophylaxis and treatment and 18 publications on VTE risk assessment. Two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in patients with cancer reported that edoxaban and rivaroxaban are effective but are linked with a higher risk of bleeding compared with low-molecular-weight heparin (LMWH) in patients with GI and potentially genitourinary cancers. Two additional RCTs reported on DOACs for thromboprophylaxis in ambulatory patients with cancer at increased risk of VTE. RECOMMENDATIONS Changes to previous recommendations: Clinicians may offer thromboprophylaxis with apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban and edoxaban have been added as options for VTE treatment; patients with brain metastases are now addressed in the VTE treatment section; and the recommendation regarding long-term postoperative LMWH has been expanded. Re-affirmed recommendations: Most hospitalized patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE. Additional information is available at www.asco.org/supportive-care-guidelines .

Effectiveness and Safety of Twice Daily Versus Thrice Daily Subcutaneous Unfractionated Heparin for Venous Thromboembolism Prophylaxis at a Tertiary Medical Center

2020 ◽  
pp. 089719002096121
Author(s):  
Meghan W. Sorgi ◽  
Erin Roach ◽  
Seth R. Bauer ◽  
Stephanie Bass ◽  
Michael Militello ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Propensity Scores ◽  
Medical Center ◽  
Matched Cohort ◽  
Thromboembolism Prophylaxis ◽  
Full Cohort ◽  
Vte Prophylaxis ◽  
Major Bleed ◽  
Increased Risk

Background: The direct comparison of twice daily (BID) and thrice daily (TID) dosing of subcutaneous low dose unfractionated heparin (LDUH) for venous thromboembolism (VTE) prophylaxis in a mixed inpatient population is not well-studied. Objective: This study evaluated the effectiveness and safety of BID compared to TID dosing of LDUH for prevention of VTE. Methods: Retrospective, single-center analysis of patients who received LDUH for VTE prophylaxis between July and September 2015. Outcomes were identified by ICD-9 codes. A matched cohort was created using propensity scores and multivariate analysis was conducted to identify independent risk factors for VTE. The primary outcome was incidence of symptomatic VTE. Results: In the full cohort, VTE occurred in 0.71% of patients who received LDUH BID compared to 0.77% of patients who received LDUH TID ( p = 0.85). There was no difference in major ( p = 0.85) and minor ( p = 0.52) bleeding between the BID and TID groups. For the matched cohort, VTE occurred in 1.4% of BID patients and 2.1% of TID patients ( p = 0.32). Major bleed occurred in 0.36% of BID patients and 0.52% of TID patients ( p = 0.7), while a minor bleed was seen in 3.4% of BID patients and 2.1% of TID patients ( p = 0.13). Personal history of VTE ( p = 0.002) and weight ( p = 0.035) were independently associated with increased risk of VTE. Conclusion: This study did not demonstrate a difference in effectiveness or safety between BID and TID dosing of LDUH for VTE prevention.

Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis

2020 ◽  
Author(s):  
Herbert Chen ◽  
Irene Lou
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Bleeding Complications ◽  
Thromboembolism Prophylaxis ◽  
Therapy Management ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Perioperative Anticoagulation

The management of perioperative anticoagulation, antiplatelet therapy, and perioperative venous thromboembolism (VTE) prophylaxis is essentially a balancing act between patient risk factors for thrombosis and surgical risk factors for bleeding. The purpose of this review is to assist surgeons with the identification of patients at increased risk for thromboembolism when antithrombotic therapy is interrupted, patients for whom bridging anticoagulation should be considered, patients who require perioperative VTE prophylaxis, and patients at increased risk for bleeding complications and to briefly review the literature and major guidelines regarding perioperative antithrombotic therapy management and perioperative VTE prophylaxis. Figures show approaches to the management of perioperative anticoagulation, antiplatelet therapy, and VTE prophylaxis.  This review contains 2 figures, 7 tables, and 61 references. Keywords: Venous thromboembolism, pulmonary embolism, anticoagulation, surgery, perioperative period, prophylaxis  

scholarly journals Minor Hematochezia Decreases Use of Venous Thromboembolism Prophylaxis in Patients with Inflammatory Bowel Disease

2019 ◽  
Vol 26 (9) ◽  
pp. 1394-1400 ◽  
Author(s):  
Adam S Faye ◽  
Kenneth W Hung ◽  
Kimberly Cheng ◽  
John W Blackett ◽  
Anna Sophia Mckenney ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Hospitalized Patients ◽  
High Yield ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Factors Associated ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Despite increased risk of venous thromboembolism (VTE) among hospitalized patients with inflammatory bowel disease (IBD), pharmacologic prophylaxis rates remain low. We sought to understand the reasons for this by assessing factors associated with VTE prophylaxis in patients with IBD and the safety of its use. Methods This was a retrospective cohort study conducted among patients hospitalized between January 2013 and August 2018. The primary outcome was VTE prophylaxis, and exposures of interest included acute and chronic bleeding. Medical records were parsed electronically for covariables, and logistic regression was used to assess factors associated with VTE prophylaxis. Results There were 22,499 patients studied, including 474 (2%) with IBD. Patients with IBD were less likely to be placed on VTE prophylaxis (79% with IBD, 87% without IBD), particularly if hematochezia was present (57% with hematochezia, 86% without hematochezia). Among patients with IBD, admission to a medical service and hematochezia (adjusted odds ratio 0.27; 95% CI, 0.16–0.46) were among the strongest independent predictors of decreased VTE prophylaxis use. Neither hematochezia nor VTE prophylaxis was associated with increased blood transfusion rates or with a clinically significant decline in hemoglobin level during hospitalization. Conclusion Hospitalized patients are less likely to be placed on VTE prophylaxis if they have IBD, and hematochezia may drive this. Hematochezia appeared to be minor and was unaffected by VTE prophylaxis. Education related to the safety of VTE prophylaxis in the setting of minor hematochezia may be a high-yield way to increase VTE prophylaxis rates in patients with IBD.

scholarly journals Recent advances in the treatment and prevention of venous thromboembolism in cancer patients: role of the direct oral anticoagulants and their unique challenges

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 974 ◽  
Author(s):  
Dominique Farge ◽  
Corinne Frere
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Patient Characteristics ◽  
Primary Prophylaxis ◽  
Disease Stage ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Increased Risk

Venous thromboembolism (VTE) is a common complication in patients with cancer and is associated with poor prognosis. Low-molecular-weight heparins (LMWHs) are the standard of care for the treatment of cancer-associated thrombosis. Primary VTE prophylaxis with LMWH is recommended after cancer surgery and in hospitalized patients with reduced mobility. However, owing to wide variations in VTE and bleeding risk, based on disease stage, anti-cancer treatments, and individual patient characteristics, routine primary prophylaxis is not recommended in ambulatory cancer patients undergoing chemotherapy. Efforts are under way to validate risk assessment models that will help identify those patients in whom the benefits of primary prophylaxis will outweigh the risks. In recent months, long-awaited dedicated clinical trials assessing the direct oral anticoagulants (DOACs) in patients with cancer have reported promising results. In comparison with the LMWHs, the DOACs were reported to be non-inferior to prevent VTE recurrence. However, there was an increased risk of bleeding, particularly in gastrointestinal cancers. Safe and optimal treatment with the DOACs in the patient with cancer will require vigilant patient selection based on patient characteristics, co-morbidities, and the potential for drug–drug interactions.

Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis

2020 ◽  
Author(s):  
Herbert Chen ◽  
Irene Lou
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Bleeding Complications ◽  
Thromboembolism Prophylaxis ◽  
Therapy Management ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Perioperative Anticoagulation

The management of perioperative anticoagulation, antiplatelet therapy, and perioperative venous thromboembolism (VTE) prophylaxis is essentially a balancing act between patient risk factors for thrombosis and surgical risk factors for bleeding. The purpose of this review is to assist surgeons with the identification of patients at increased risk for thromboembolism when antithrombotic therapy is interrupted, patients for whom bridging anticoagulation should be considered, patients who require perioperative VTE prophylaxis, and patients at increased risk for bleeding complications and to briefly review the literature and major guidelines regarding perioperative antithrombotic therapy management and perioperative VTE prophylaxis. Figures show approaches to the management of perioperative anticoagulation, antiplatelet therapy, and VTE prophylaxis.  This review contains 2 figures, 7 tables, and 61 references. Keywords: Venous thromboembolism, pulmonary embolism, anticoagulation, surgery, perioperative period, prophylaxis  

scholarly journals The Current Status of Direct Oral Anticoagulants in Cancer-Related Venous Thromboembolism Treatment

2020 ◽  
Vol 16 (2) ◽  
pp. 286-295
Author(s):  
К. V. Lobastov ◽  
I. V. Schastlivtsev
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Similar Efficacy ◽  
Current Status ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Discontinuation Of Treatment

This article is a review of epidemiology, pathogenesis and treatment of venous thromboembolism (VTE) in cancer patients. In accordance with actual guidelines, the duration of anticoagulant therapy of cancer-related venous thrombosis should be at least 6 months. The use of vitamin K antagonists (VKA) is associated with an increased risk of VTE recurrence and bleeding, so low molecular weight heparin (LMWH), in particular dalteparin, has been the "gold standard" until recently. Compared to VKA, prolonged use of LMWH can reduce the incidence of VTE recurrence without affecting the risk of bleeding or death. The main disadvantage of LMWH is low compliance, leading to premature discontinuation of treatment or switching to alternative anticoagulants. Direct oral anticoagulants (DOACs) have changed the situation. Compared to VKA, they demonstrated higher efficacy with a similar (or improved for individual DOACs) safety in patients with cancer-related VTE. Recently, the results of studies comparing the use of DOACs with dalteparin in cancer patients have been published: SELECT-D (rivaroxaban), HOKUSAI-VTE Cancer (edoxaban), ADAM VTE (apixaban), CARAVAGGIO (apixaban). Rivaroxaban showed higher efficacy than dalteparin with a similar risk of major bleeding, but an increased risk of clinically relevant non-major (CRNM) bleeding. Edoxaban had the same efficacy as dalteparin but increased risk of major but not CRNM bleeding. Apixaban showed similar efficacy and safety as dalteparin in the CARAVAGGIO study, but did not provide higher safety in the ADAM VTE study. It was noted that gastrointestinal and urogenital bleeding dominated in the structure of hemorrhagic complications of DOACs. The results of published trials are reflected in the current guidelines of the specialized societies. DOACs (particularly, rivaroxaban and edoxaban) are recommended for the VTE treatment in cancer patients.

scholarly journals The Efficacy and Safety of Rivaroxaban for Venous Thromboembolism Prophylaxis after Total Hip and Total Knee Arthroplasty

Thrombosis ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Robert D. Russell ◽  
William R. Hotchkiss ◽  
Justin R. Knight ◽  
Michael H. Huo
Keyword(s):  
Total Knee Arthroplasty ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Vte Prophylaxis ◽  
Total Hip ◽  
Increased Risk ◽  
Total Knee

Venous thromboembolism (VTE) is a common complication after total hip and total knee arthroplasty. Currently used methods of VTE prophylaxis after these procedures have important limitations, including parenteral administration, and unpredictable plasma levels requiring frequent monitoring and dose adjustment leading to decreased patient compliance with recommended guidelines. New oral anticoagulants have been demonstrated in clinical trials to be equally efficacious to enoxaparin and allow for fixed dosing without the need for monitoring. Rivaroxaban is one of the new oral anticoagulants and is a direct factor Xa inhibitor that has demonstrated superior efficacy to that of enoxaparin. However, the data also suggest that rivaroxaban has an increased risk of bleeding compared to enoxaparin. This paper reviews the available data on the efficacy and safety of rivaroxaban for VTE prophylaxis after total hip and total knee arthroplasty.

Improving the Quality of Inpatient Ulcerative Colitis Management: Promoting Evidence-Based Practice and Reducing Care Variation With an Inpatient Protocol

2019 ◽  
Vol 25 (11) ◽  
pp. 1822-1827 ◽  
Author(s):  
Sara M Lewin ◽  
Ryan A McConnell ◽  
Roshan Patel ◽  
Suzanne R Sharpton ◽  
Fernando Velayos ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Venous Thromboembolism ◽  
Oral Morphine ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Thromboembolism Prophylaxis ◽  
Disease Extent ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Evidence Based Care

Abstarct Background Hospitalization for ulcerative colitis is a high-risk period associated with increased risk of Clostridium difficile infection, thromboembolism, and opiate use. The study aim was to develop and implement a quality-improvement intervention for inpatient ulcerative colitis management that standardizes gastroenterology consultant recommendations and improves delivery of evidence-based care. Methods All adult patients hospitalized for ulcerative colitis between July 1, 2014, and December 31, 2017, who received intravenous corticosteroids were included. On July 1, 2016, the UCSF Inpatient Ulcerative Colitis Protocol was implemented, featuring standardized core recommendations and a daily checklist for gastroenterology consultant notes, a bundled IBD electronic order set, and an opiate awareness campaign. The composite primary outcome was adherence to all 3 evidence-based care metrics: C. difficile testing performed, pharmacologic venous thromboembolism (VTE) prophylaxis ordered, and opiates avoided. Results Ninety-three ulcerative colitis hospitalizations occurred, including 36 preintervention and 57 postintervention. Age, gender, disease duration, disease extent, and medication use were similar preintervention and postintervention. C. difficile testing was performed in 100% of hospitalizations. Venous thromboembolism prophylaxis was ordered on 84% of hospital days before intervention compared with 100% after intervention (P ≤ 0.001). Opiates were administered in 67% of preintervention hospitalizations, compared with 53% of postintervention hospitalizations (P = 0.18). The median daily dose of oral morphine equivalents decreased from 12.1 mg before intervention to 0.5 mg after intervention (P = 0.02). The composite outcome of adherence to all 3 metrics was higher after intervention (25% vs. 47%, P = 0.03). Conclusions Evidence-based inpatient ulcerative colitis management may be optimized with standardized algorithms that reinforce core principles, reduce care variation, and do not require IBD specialists to implement.

Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis

2020 ◽  
Author(s):  
Herbert Chen ◽  
Irene Lou
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Bleeding Complications ◽  
Thromboembolism Prophylaxis ◽  
Therapy Management ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Perioperative Anticoagulation

The management of perioperative anticoagulation, antiplatelet therapy, and perioperative venous thromboembolism (VTE) prophylaxis is essentially a balancing act between patient risk factors for thrombosis and surgical risk factors for bleeding. The purpose of this review is to assist surgeons with the identification of patients at increased risk for thromboembolism when antithrombotic therapy is interrupted, patients for whom bridging anticoagulation should be considered, patients who require perioperative VTE prophylaxis, and patients at increased risk for bleeding complications and to briefly review the literature and major guidelines regarding perioperative antithrombotic therapy management and perioperative VTE prophylaxis. Figures show approaches to the management of perioperative anticoagulation, antiplatelet therapy, and VTE prophylaxis.  This review contains 2 figures, 7 tables, and 61 references. Keywords: Venous thromboembolism, pulmonary embolism, anticoagulation, surgery, perioperative period, prophylaxis  

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