Faculty Opinions recommendation of The incidence of pulmonary embolism and deep vein thrombosis after knee arthroplasty in Asians remains low: a meta-analysis.

AbstractTranexamic acid (TXA) has been shown to reduce blood loss and postoperative transfusions in total knee arthroplasty (TKA). There is no consensus on the ideal dosing regimen in the literature, although there is a growing body of literature stating there is little benefit to additional doses. Our study compared one versus two doses of TXA in primary TKA and its effect on postoperative transfusion rate. We retrospectively reviewed patients undergoing primary TKA at our two high-volume arthroplasty centers between 2013 and 2016. Patients were included if they underwent unilateral primary TKA, and received one or two doses of intravenous TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay, rate of deep vein thrombosis or pulmonary embolism (DVT/PE), readmission and reoperation.A total of 1,191 patients were included: 891 received one dose and 300 received two doses. There was no significant difference in rate of transfusion, deep vein thrombosis or pulmonary embolism (DVT/PE), blood volume loss, and reoperation. There was a significantly higher risk of readmission (6.7 vs. 2.4%, odds ratio [OR] 2.96, p < 0.001) and reoperation (2.0 vs. 0.6%, OR 3.61, p = 0.024) in patients receiving two doses. These findings were similar with subgroup analysis of patients receiving only aspirin prophylaxis.In unilateral TKA, there is no difference in transfusion rate with one or two doses of perioperative TXA. There was no increased risk of thromboembolic events between groups, although the two-dose group had a higher rate of readmission and reoperation. Given the added cost without clear benefit, these findings may support administration of one rather than two doses of TXA during primary TKA.

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Retrospective Derivation and Validation of an Automated Electronic Search Algorithm to Identify Post operative Cardiovascular and Thromboembolic Complications

Applied Clinical Informatics ◽

10.4338/aci-2015-03-ra-0026 ◽

2015 ◽

Vol 06 (03) ◽

pp. 565-576 ◽

Cited By ~ 9

Author(s):

M. Tien ◽

R. Kashyap ◽

G. A. Wilson ◽

V. Hernandez-Torres ◽

A. K. Jacob ◽

...

Keyword(s):

Myocardial Infarction ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Search Algorithm ◽

Cardiovascular Complications ◽

Data Abstraction ◽

Vein Thrombosis ◽

Electronic Search ◽

Deep Vein

Summary Background: With increasing numbers of hospitals adopting electronic medical records, electronic search algorithms for identifying postoperative complications can be invaluable tools to expedite data abstraction and clinical research to improve patient outcomes. Objectives: To derive and validate an electronic search algorithm to identify postoperative thromboembolic and cardiovascular complications such as deep venous thrombosis, pulmonary embolism, or myocardial infarction within 30 days of total hip or knee arthroplasty. Methods: A total of 34 517 patients undergoing total hip or knee arthroplasty between January 1, 1996 and December 31, 2013 were identified. Using a derivation cohort of 418 patients, several iterations of a free-text electronic search were developed and refined for each complication. Subsequently, the automated search algorithm was validated on an independent cohort of 2 857 patients, and the sensitivity and specificities were compared to the results of manual chart review. Results: In the final derivation subset, the automated search algorithm achieved a sensitivity of 91% and specificity of 85% for deep vein thrombosis, a sensitivity of 96% and specificity of 100% for pulmonary embolism, and a sensitivity of 100% and specificity of 95% for myocardial infarction. When applied to the validation cohort, the search algorithm achieved a sensitivity of 97% and specificity of 99% for deep vein thrombosis, a sensitivity of 97% and specificity of 100% for pulmonary embolism, and a sensitivity of 100% and specificity of 99% for myocardial infarction. Conclusions: The derivation and validation of an electronic search strategy can accelerate the data abstraction process for research, quality improvement, and enhancement of patient care, while maintaining superb reliability compared to manual review. Citation: Tien M, Kashyap R, Wilson GA, Hernandez-Torres V, Jacob AK, Schroeder DR, Mantilla CB. Retrospective Derivation and Validation of an Automated Electronic Search Algorithm to Identify Postoperative Thromboembolic and Cardiovascular Complications. Appl Clin Inform 2015; 6: 565–576http://dx.doi.org/10.4338/ACI-2015-03-RA-0026

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The risk of postoperative hemorrhage and efficacy of heparin for preventing deep vein thrombosis and pulmonary embolism in adult patients undergoing neurosurgery: a systematic review and meta-analysis

Journal of Investigative Medicine ◽

10.1136/jim-2016-000235 ◽

2017 ◽

Vol 65 (8) ◽

pp. 1136-1146 ◽

Cited By ~ 2

Author(s):

Xuan Wang ◽

Ying-Chun Zhou ◽

Wen-De Zhu ◽

Yun Sun ◽

Peng Fu ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Meta Analysis ◽

Postoperative Bleeding ◽

Postoperative Hemorrhage ◽

Adult Patients ◽

Control Group ◽

Vein Thrombosis ◽

Deep Vein ◽

Heparin Prophylaxis

The aim of this meta-analysis was to examine the risk of postoperative bleeding and efficacy of heparin for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in adult patients undergoing neurosurgery. MEDLINE, Cochrane, and EMBASE databases were searched until October 31, 2016, for randomized controlled trials (RCTs) and non-randomized comparative studies that assessed the rates of postoperative hemorrhage, DVT, PE, and mortality in adult patients undergoing neurosurgery. Nine eligible studies (five RCTs, four retrospective studies) including 874 patients treated with either unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) and 1033 patients in control group (placebo with or without compression device) were analyzed. The overall analysis revealed that there was an increase in the risk of postoperative hemorrhage in patients who received heparin (pooled OR 1.66, 95% CI 1.01 to 2.72, p=0.046) compared with no treatment group. The risk of postoperative hemorrhage was more significant if only RCTs were included in analysis. Heparin prophylaxis was associated with a decrease in the risk of DVT (pooled OR 0.48, 95% CI 0.36 to 0.65, p<0.001) and PE (pooled OR 0.25, 95% CI 0.09 to 0.73, p=0.011) but it did not affect the rate of mortality. In conclusion, heparin increased the rate of postoperative bleeding, decreased the risk of DVT, PE and venous thromboembolic event (VTE) but it did not affect the mortality of patients undergoing neurosurgery. For the heparin prophylaxis, the trade-off between the risk of postoperative bleeding and benefit of prophylaxis against VTEs requires further investigation.

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Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.13279 ◽

2016 ◽

Vol 14 (5) ◽

pp. 964-972 ◽

Cited By ~ 26

Author(s):

M. N. D. Di Minno ◽

P. Ambrosino ◽

F. Ambrosini ◽

E. Tremoli ◽

G. Di Minno ◽

...

Keyword(s):

Systematic Review ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Meta Analysis ◽

Superficial Vein ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis ◽

Deep Vein

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Role of factor V Leiden or G20210A prothrombin mutation in patients with symptomatic pulmonary embolism and deep vein thrombosis: a meta-analysis of the literature

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2012.04656.x ◽

2012 ◽

Vol 10 (4) ◽

pp. 732-737 ◽

Cited By ~ 13

Author(s):

F. DENTALI ◽

W. AGENO ◽

S. BOZZATO ◽

A. MALATO ◽

M. GIANNI ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Meta Analysis ◽

Factor V Leiden ◽

Factor V ◽

Vein Thrombosis ◽

Symptomatic Pulmonary Embolism ◽

Prothrombin Mutation ◽

Deep Vein

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Proximal Deep Vein Thrombosis and Pulmonary Embolism in COVID-19 Patients: A Systematic Review and Meta-Analysis Short Tittle: Venous Thromboembolism in COVID-19 Patients

10.21203/rs.3.rs-104503/v1 ◽

2020 ◽

Author(s):

Gregoire Longchamp ◽

Sara Manzocchi-Besson ◽

Alban Longchamp ◽

Marc Righini ◽

Helia Robert-Ebadi ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Meta Analysis ◽

Proximal Deep Vein Thrombosis ◽

Primary Analysis ◽

Thrombotic Risk ◽

Medically Ill ◽

Vein Thrombosis ◽

Deep Vein

Abstract BACKGROUNGCOVID-19 appears to be associated with a high risk of venous thromboembolism (VTE). We aimed to systematically review and meta-analyze the risk of clinically relevant VTE in patients hospitalized for COVID-19. METHODSThis meta-analysis included original articles in English published from 01/01/2020 to 06/15/2020 in Pubmed/MEDLINE, Embase, Web of science, and Cochrane. Outcomes were major VTE, defined as any objectively diagnosed pulmonary embolism (PE) and/or proximal deep vein thrombosis (DVT). Primary analysis estimated the risk of VTE, stratified by acutely and critically ill inpatients. Secondary analyses explored the separate risk of proximal DVT and of PE; the risk of major VTE stratified by screening and by type of anticoagulation. RESULTSIn 33 studies (n=4’009 inpatients) with heterogeneous thrombotic risk factors, VTE incidence was 9% (95%CI 5-13%, I2=92.5) overall, and 21% (95%CI 14-28%, I2=87.6%) for patients hospitalized in the ICU. Proximal lower limb DVT incidence was 3% (95%CI 1-5%, I2= 87.0%) and 8% (95%CI 3-14%, I2=87.6%), respectively. PE incidence was 8% (95%CI 4-13%, I2=92.1%) and 17% (95%CI 11-25%, I2=89.3%), respectively. Screening and absence of anticoagulation were associated with a higher VTE incidence. When restricting to medically ill inpatients, the VTE incidence was 2% (95%CI 0-6%).CONCLUSIONSThe risk of major VTE among COVID-19 inpatients is high but varies greatly with severity of the disease. These findings reinforce the need for the use of thromboprophylaxis in all COVID-19 inpatients and for clinical trials testing different thromboprophylaxis regimens in subgroups of COVID-19 inpatients. TRIAL REGISTRATIONThe review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020193369).

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