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

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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All I want for coagulation

Scottish Medical Journal ◽

10.1258/smj.2011.011154 ◽

2011 ◽

Vol 56 (4) ◽

pp. 183-187 ◽

Cited By ~ 1

Author(s):

K P Nunn ◽

M R Bridgett ◽

M R Walters ◽

I Walker

Keyword(s):

Deep Vein Thrombosis ◽

Cochrane Library ◽

Evidence Based ◽

Compression Stockings ◽

Vein Thrombosis ◽

Dvt Prophylaxis ◽

Clinical Encounters ◽

Santa Claus ◽

The Cochrane Library ◽

Deep Vein

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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Anticoagulation Treatment for Patients with Coronavirus disease 2019 (COVID-19) and its clinical effectiveness in 2020: A meta-analysis study

10.21203/rs.3.rs-551086/v1 ◽

2021 ◽

Author(s):

Jingyi Ge ◽

Yingmin Ma ◽

Zhipeng Wu ◽

Jiawei Jin ◽

Xiao Sun

Keyword(s):

Deep Vein Thrombosis ◽

Lower Risk ◽

Cochrane Library ◽

Vein Thrombosis ◽

Therapeutic Anticoagulation ◽

Significant Difference ◽

Current Outbreak ◽

Prophylactic Anticoagulation ◽

And Control ◽

Deep Vein

Abstract Objective To better inform efforts to treat and control the current outbreak with effective anticoagulant treatment strategies for coronavirus disease 2019 (Covid-19) patients. Methods We searched Cochrane Library, Pubmed, EMBASE, MEDLINE, SCIEXPANDED, Web of Science, Google Scholar, CNKI (Chinese Database), WanFang (Chinese Database), CBM (Chinese Database), VIP (Chinese Database) for studies published from November 1st 2019 to October 1, 2020, and we searched references of identified articles. Studies were reviewed for methodological quality. A random-effects model was used to pool results. Heterogeneity was assessed using I2. Publication bias was assessed using funnel plot. Results Fourteen studies involving 7,681 patients were included. We meta-analyzed the bleeding, deep vein thrombosis and pulmonary embolism risk between no anticoagulation and prophylactic anticoagulation, and found no significant difference. The same trend occurred in the comparison between with and without anticoagulation. However, when compared with no anticoagulation, both prophylactic anticoagulation (OR = 0.80, 95%CI: 0.69–0.93) and therapeutic anticoagulation (OR = 0.91, 95%CI: 0.80–1.05) had lower risk of mortality. Furthermore, the risk of overall bleeding among patients with therapeutic anticoagulation was 3.11 times (95% CI: 2.29–4.24) than that of patients with prophylactic anticoagulation, on the contrary, therapeutic anticoagulation had lower risk of deep vein thrombosis than prophylactic anticoagulation (OR = 0.34, 95%CI: 0.19–0.63). Conclusions Among Covid-19 patients, preventive and therapeutic anticoagulation were more beneficial than no anticoagulation for reducing mortality risk. The result will inform healthcare providers and public health policy makers in their efforts to treat and control the current outbreak.

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Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618821190 ◽

2019 ◽

Vol 25 ◽

pp. 107602961882119 ◽

Cited By ~ 5

Author(s):

Tao Tang ◽

Linyi Chen ◽

Jinhui Chen ◽

Tong Mei ◽

Yongming Lu

Keyword(s):

Clinical Trials ◽

Deep Vein Thrombosis ◽

Meta Analysis ◽

Cochrane Library ◽

Minor Bleeding ◽

Bleeding Events ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Significant Difference ◽

Deep Vein

Early catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) can reduce postthrombotic morbidity. Pharmacomechanical thrombolysis (PMT) is a new therapy that can be selected for the treatment of iliofemoral deep vein thrombosis (IFDVT). We performed a meta-analysis of clinical trials comparing PMT versus CDT for treatment of acute IFDVT. Literature on this topic published between January 1, 1990, and June 1, 2018, was identified using PubMed, Embase, Cochrane Library, and Web of Science. Six trials were included in the meta-analysis. Compared to CDT, PMT significantly reduced the Villalta score ( P = .007; I2 = 0%), thrombus score ( P = .01; I2 = 0%), the duration in the hospital ( P = .03; I2 = 64%), and thrombolysis time ( P < .00001, I2 = 0%). There was no significant difference in valvular incompetence events ( P = .21; I2 = 0%), minor bleeding events ( P = .59; I2 = 0%), stent events ( P = .09; I2 = 24%), and clot reduction grade I events ( P = .16; I2 = 43%) between PMT and CDT. Subgroup analysis was performed by dividing the clot reduction grade I events group into PMT plus CDT versus CDT group and significant differences were found ( P = .03, I2 = 0%) as well as for PMT alone versus CDT group ( P = .88, I2 = 37%). This meta-analysis shows that PMT reduces the severity of postthrombotic syndrome (PTS), thrombus score, duration in hospital, and thrombolysis time compared to CDT. More specifically, PMT plus CDT reduces clot reduction grade I events. No significant difference in valvular incompetence events, stent events, and minor bleeding events were found when PMT was compared to CDT.

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Do compression stockings or pharmacological prophylaxis prevent deep vein thrombosis in air travelers?

Evidence-Based Practice ◽

10.1097/ebp.0000000000000086 ◽

2018 ◽

Vol 21 (9) ◽

pp. 76

Author(s):

Amit Thatte ◽

Joseph Wiedemer

Keyword(s):

Deep Vein Thrombosis ◽

Compression Stockings ◽

Pharmacological Prophylaxis ◽

Vein Thrombosis ◽

Deep Vein

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Graduated Compression Stockings in the Prevention of Postoperative Deep Vein Thrombosis: A Comparative Study of Pressure Profiles and Patient Compliance

Phlebology The Journal of Venous Disease ◽

10.1177/026835559000500210 ◽

1990 ◽

Vol 5 (2) ◽

pp. 135-139 ◽

Cited By ~ 2

Author(s):

M. Williamson ◽

S. Thomas ◽

A. Edwards ◽

R. Johnson ◽

J. Riggs ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Patient Compliance ◽

Materials Testing ◽

Pressure Gradients ◽

Compression Stockings ◽

Vein Thrombosis ◽

Postoperative Deep Vein Thrombosis ◽

Pressure Profiles ◽

Significant Difference ◽

Deep Vein

Graded support stockings are widely used in the prophylaxis of postoperative deep vein thrombosis (DVT). For many years (following the results of early trials) one brand has dominated the market. We now describe an assessment of an alternative brand. Fifty patients undergoing major abdominal surgery were provided with graduated support stockings postoperatively for the prophylaxis of DVT. Two different makes of stockings were used, one on each leg; the leg randomly determined by an odd or even year of birth. Data was collected from each patient in order to determine patient compliance. Patients experienced no significant difference in comfort between the two makes, although, on balance, product ‘A’ was found to be more comfortable. No pressure sores were caused by either stocking type and there was no clinical evidence of DVT in any of the 50 patients. However, there were two cases of pulmonary embolus. Samples of both stockings were tested in a materials testing laboratory, to determine the pressure gradients which they could be expected to apply in normal use, and the results of these tests suggest that there are major differences in the performance of the products concerned.

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A Comparison of General Anesthesia and Regional Anesthesia as a Risk Factor for Deep Vein Thrombosis Following Hip Surgery: A Critical Review

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647346 ◽

1990 ◽

Vol 64 (04) ◽

pp. 497-500 ◽

Cited By ~ 86

Author(s):

Martin H Prins ◽

Jack Hirsh

Keyword(s):

Deep Vein Thrombosis ◽

General Anesthesia ◽

Regional Anesthesia ◽

Lower Incidence ◽

Hip Surgery ◽

Level Of Evidence ◽

Vein Thrombosis ◽

Postoperative Thrombosis ◽

High Level ◽

Deep Vein

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

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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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P6461The long-term clinical comparisons of symptomatic patients of pulmonary embolism with and those without deep vein thrombosis: from the COMMAND VTE Registry

European Heart Journal ◽

10.1093/eurheartj/ehz746.1053 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Murata ◽

Y Yamashita ◽

T Morimoto ◽

H Amano ◽

T Takase ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Acute Phase ◽

Clinical Presentation ◽

Vein Thrombosis ◽

Significant Difference ◽

Severe Clinical Presentation ◽

Recurrent Vte ◽

Deep Vein

Abstract Background Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), has significant morbidity and mortality. Acute PE, in particular, is fatal if we miss it, and symptomatic patients of PE sometimes have concomitant DVT. Purpose This study compared the risk of mortality in symptomatic patients of PE with and those without DVT in the long term. Methods The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. Patients with both PE and DVT (N=1334) were regarded as PE patients, and the current study population consisted of 1715 PE patients and 1312 DVT patients. Results There were 1203 symptomatic patients of PE, including 381 without and 822 with DVT. In our cohort, the mean age was 67.9±14.9 years, 63% was female, 44% had hypertension, 12% diabetes mellitus, 5% history of VTE. There were 20% of active cancer. Baseline characteristics were well matched except for dyslipidemia (18% vs. 23%, p=0.021) and atrial fibrillation (8% vs. 5%, p=0.045). Patients without DVT had a more severe clinical presentation compared to those with DVT, including hypoxemia, shock and arrest. Moreover, Initial parenteral anticoagulation therapy in the acute phase was administered less frequently in patients without DVT (89% vs. 96%, P=0.0001). Two groups received thrombolysis (20% vs. 26%, P=0.18) and mechanical supports (Ventilator 14% vs. 5%, p<0.001, PCPS 5% vs. 3%, p<0.001, respectively). During follow-up, 93 (8%) patients experienced recurrent VTE events and 98 (8%) major bleeding events, and 323 (27%) patients died. The most frequent cause of death was cancer (11%). There were a significant differences in the cumulative incidences of all-cause death between the groups (32% vs. 24%, P=0.006), whereas there was significant difference in VTE-related death (13% vs. 4%, p<0.001). Estimated freedom rates from death for patients of PE without and those with DVT were as follows: 88% vs 99% at 10-day, 86% vs 95% at 1-month, 75% vs 83% at 1-year, and 64% vs 71% at 5-year, respectively. Landmark analysis Conclusions In symptomatic patients of PE, there was a difference in mortality between groups, but no difference in recurrent VTE. Patients without DVT had a more severe clinical presentation compared to those with DVT, and many VTE-related deaths in the acute phase. The one-month mortality rate differed statistically between groups, but there was no significant difference in long-term survival beyond one month. Most of deaths were due to underlying diseases, mainly cancer, and less commonly due to VTE in the long term. Acknowledgement/Funding Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

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