Low-Dose Aspirin Thromboprophylaxis Is Safe and Effective in Patients Undergoing Total Hip Arthroplasty with or without Outpatient Pneumatic Compression Devices

Venous thromboembolism (VTE) remains a serious complication following total hip arthroplasty (THA). Current guidelines recommend pharmacologic prophylaxis with or without intermittent pneumatic compression devices (IPCDs). At our institution, portable IPCDs were previously worn by THA patients at standard risk for VTE for 14 days. Routine prescription of portable outpatient IPCDs was discontinued due to concerns with their efficacy and safety. We sought to determine if discontinuation of portable outpatient IPCDs changed VTE rates after THA. A retrospective review of 1,825 consecutive THA cases was conducted identifying patients with VTE, periprosthetic fractures, dislocations, bleeding complications, infection, and death at 90 days postoperatively. Patients were divided into two cohorts. One cohort received outpatient IPCDs for a period of 14 days (control) while the other did not (no-IPCD). All patients received inpatient IPCDs and were maintained on 81-mg aspirin (ASA) twice daily for 28 days. A total of 748 IPCD patients and 1,077 no-IPCD patients were identified. There was no difference between the total VTE rate for the IPCD versus no-IPCD groups (0 vs. 0.19%, p = 0.24). There were also no differences in periprosthetic fractures (p = 0.09), dislocations (p = 0.22), bleeding complications (p = 0.79), or infection rates (p = 0.75). No deaths were observed. The use of a low-dose ASA thromboprophylaxis protocol was safe and effective for VTE prevention in standard-risk patients undergoing THA with or without portable IPCDs. Any marginal benefit of portable IPCD use was too small to demonstrate despite our relatively large sample size.

Deep vein thrombosis prevention with triad of soluble aspirin, pneumatic compression device and early mobilization in surgically managed proximal femur fracture: an observational study

<p><strong>Background: </strong>To evaluate the effectiveness of regime of thromboprophylaxis including soluble aspirin, pneumatic compression devices and early mobilization in prevention of deep vein thrombosis (DVT) with patients of proximal femoral fracture managed by internal fixation.<strong></strong></p><p><strong>Methods</strong>: The study was an observational study conducted at tertiary care hospital of Indian armed forces with sample size of n= 50, diagnosed case of fracture proximal femur and managed operatively with soluble aspirin and pneumatic compression devices and early mobilization. Patients were observed and evaluated periodically for 12 weeks post discharge with colour doppler assessment.</p><p><strong>Results</strong>: The findings at end of 2 Week, n=1 (2%, p&lt;0.003) had findings suggested of DVT and n=49 (98%) had no signs of DVT. Next periodic evaluation at 6 weeks and 12 weeks n=50 (100% p&lt;0.001) was devoid of any doppler findings suggestive of DVT.</p><p><strong>Conclusions</strong>: The observational prospective study demonstrated the triad of soluble aspirin, pneumatic compression and early mobilization were efficacious in prevention of DVT in surgically managed cases of fracture proximal femur.</p>

Thermal and moisture behavior of a multi-layered assembly in a pneumatic compression device

The objective of this research was to determine the effect of multiple layers of materials typical of those used in air pneumatic compression devices (which require air impermeable layers to function) on thermal and water vapor resistance. The experimental set-up included: (a) single layers of two next-to-skin knit fabrics in both relaxed and extended conditions, (b) two layers of silicone, and (c) a multi-layered assembly comprised of a next-to-skin fabric and two layers of silicone. Structural properties (thickness, mass) dominated thermal resistance of the multi-layered assembly, and the silicone layers rendered this assembly impermeable to water vapor as expected. Results confirmed the need for some form of 'ventilation' to facilitate water vapor transfer from a potential user’s skin to the environment. By creating 18 circular vents across the silicone layers (each vent 314 mm2), which formed ventilation of ∼2% of total surface area, the water vapor resistance of the multi-layered assembly dropped significantly from very high (but non-measurable) to below ∼300 m2 Pa/W, although ventilation did not improve the thermal resistance of the multi-layer arrangements. Results of this research will enable manufacturers of pneumatic compression devices to develop devices comprised of a multiple layer arrangements i.e. a knit fabric next-to-skin layer and silicone layers with optimized vents across the silicone layers, so that the user can continue the compression treatment with an acceptable microenvironment.

The Role of Intermittent Pneumatic Compression in the Treatment of Lower Extremity Chronic Wounds

Intermittent pneumatic compression devices (IPC) are often used as noninvasive adjuncts in patients with lymphedema, and more recently with venous stasis disease, to promote flow and reduce the adverse effects of interstitial edema associated with both disorders. We will be focusing on lower extremity wounds associated with venous and/or lymphatic disease, the combination often referred to as “lymphophlebitic” disease, and the treatment effect of IPC on this disease process and its sequelae. The function and purpose of pneumatic compression is closely examined along with a variety of pneumatic compression devices that currently exist in the market. A thorough review of the literature was conducted to evaluate the utility of intermittent pneumatic compression in the treatment of lower extremity venous stasis ulcers. Additionally, the author describes personal experience with the use of pneumatic compression on 10 patients with venous stasis ulcers at a single center. There is significant data supporting the use of IPC in patients with lymphophlebitic disease. Overall, ideal patient selection may be crucial. Previous data has shown that patients with high body mass index (>33 kg/m2) and poor functional status (walking less than 200m a day) are related to poor ulcer healing. Therefore, a study that looks primarily at this group (as our small quality assurance [QA] project did) may show increased benefit in this population. It is clear that IPC is of benefit to some patient cohorts with lymphophlebitic disease. This advanced therapy would help patients who have failure of their calf muscle pump and an inability to improve it through other means. However, it is only part of an algorithm that includes: direct wound bed management, moisture control, possible primary venous disease intervention, physical therapy, weight loss, and improved nutrition.

Discontinued Use of Outpatient Portable Intermittent Pneumatic Compression Devices May Be Safe for Venous Thromboembolism Prophylaxis in Primary Total Knee Arthroplasty Using Low-Dose Aspirin

Venous thromboembolism (VTE) is a rare, but serious complication following total knee arthroplasty (TKA). Current VTE guidelines recommend pharmacologic agents with or without intermittent pneumatic compression devices (IPCDs). At our institution, both 81-mg aspirin (ASA) twice a day (BID) and portable IPCDs were previously prescribed to TKA patients at standard risk for VTE, but the IPCDs were discontinued and patients were treated with ASA alone going forward. The aim of this study is to determine if discontinued use of outpatient IPCDs is safe and does not increase the rate of VTE or any other related complications in patients following TKA. A retrospective review of 2,219 consecutive TKA cases was conducted, identifying patients with VTE, bleeding complications, infection, and mortality within 90 days postoperatively. Patients were divided into two cohorts. Patients in cohort one received outpatient IPCDs for a period of 14 days (control), while those in cohort two did not (ASA alone). All study patients received inpatient IPCDs and were maintained on 81-mg ASA BID for 28 days. A posthoc power analysis was performed using a noninferiority margin of 0.25 (α = 0.05; power = 80%), which showed that our sample size was fully powered for noninferiority for our reported deep vein thrombosis (DVT) rates, but not for pulmonary embolism (PE) rates. A total of 867 controls and 1,352 patients treated with ASA alone were identified. Only two control patients were diagnosed with a PE (0.23%), while one patient in the ASA alone group had DVT (0.07%). There was no statistical difference between these rates (p = 0.33). Furthermore, no differences were found in bleeding complications (p = 0.12), infection (p = 0.97), or 90-day mortality rates (p = 0.42) between both groups. The discontinued use of outpatient portable IPCDs is noninferior to outpatient IPCD use for DVT prophylaxis. Our findings suggest that this protocol change may be safe and does not increase the rate of VTE in standard risk patients undergoing TKA while using 81-mg ASA BID.

Anticoagulation in COVID – 19: An Update

The novel coronavirus disease, 2019 (COVID – 19) evolved as an unprecedented pandemic. The severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2) infection has been associated with significantly deranged coagulation parameters and increased incidence of thrombotic events. Deranged coagulation parameters, such as D-dimers and fibrin degradation products, can indicate a poor prognosis, and their measurement will help stratify the patients according to the disease severity, need of intensive care unit admission, and prediction of the clinical course. Gaps in understanding the natural history of the disease cause difficulties in tailoring therapies and optimizing the management of patients. Lack of specific treatment further complicates this situation. While thrombotic events can cause significant morbidity and mortality in patients, a focused approach to the prevention and treatment of venous thromboembolism (VTE) can, to a great extent, decrease the disease burden caused by thrombotic diseases. Pharmacological prophylactic anticoagulants and mechanical therapies such as pneumatic compression devices can help prevent venous thromboembolism and other thrombotic events. Thrombotic events due to COVID-19, their prevention and management, are the focus of this paper, with the prospect of providing insights into this relatively unexplored area.

Deep Vein Thrombosis (DVT) Pasca Cedera Otak Traumatik Berat

Cedera otak traumatik(COT) adalah penyebab utama kematian dan disabilitas. Deep vein thrombosis (DVT) adalah salah satu risiko tinggi dari COT. Faktor risiko DVT lain yang umum ditemukan pada pasien COTadalah paralisis, imobilisasi, dan cedera ortopedi. Deep vein thrombosis diduga terkait gangguan koagulasi yang sering ditemukan pada COT, terutama pada COT berat. Deep vein thrombosis dapat menyebabkan pulmonary embolism (PE) yang merupakan salah satu penyebab kematian lambat terbanyak pada pasien trauma. Diagnosis DVT didapatkan melalui stratifikasi risiko, pemeriksaan fisik, dan pemeriksaan penunjang yang mencakup pemeriksaan d-dimer, ultrasonografi, dan penunjang lain seperti spiral computed tomography venography. Tata laksana DVT pada pasien COT mencakup pemberian antikoagulan intravena yang dilanjutkan oral jangka panjang,stoking kompresi, dan pemasangan vena cava filter (VCF). Pada pasien COT, adanya risiko perdarahan intrakranial umumnya menimbulkan keraguan pada klinisi terkait inisiasi profilaksis farmakologis dengan antikoagulan. Profilaksis nonfarmakologis mencakup penggunaan graduated compression stocking (GCS), alat kompresi pneumatik (pneumatic compression devices/PCD), A-V foot pump, dan vena cava filter (VCF). Beberapa studi terkini menyarankan pemasangan PCD pada semua pasien COT pada awal perawatan selama tidak ditemukan kontraindikasi. Pemeriksaan CT selanjutnya dilakukan setelah 24 jam. Penemuan hasil yang stabil pada CT, profilaksis farmakologis dapat dimulai dalam 24-48 jam setelah CT. Selama pemberian antikoagulan, CT serial dapat dilakukan untuk memantau progresi perdarahan.Deep Vein Thrombosis (DVT) after Severe Traumatic Brain InjuryAbstractTraumatic brain injury (TBI) is a risk factor for deep vein thrombosis (DVT). Beside the common risk factors of DVT among TBI patients, this is associated with coagulopathycommonly foundin TBI, especially in severe TBI.Diagnosis and treatment of DVT are also crucial to prevent mortality. Deep vein thrombosis could be diagnosed through risk stratification, physical examination, and d-dimer as well as ultrasonography examination. Treatment includes intravena anticoagulant continue with longterm oral, stocking compression and the use of vein cava filter (VCF). Deep vein thrombosis could cause pulmonary embolism (PE), a common cause of late mortality in trauma patients. Deep vein thrombosis could be prevented pharmacologically (with anticoagulant) and nonpharmacologically. However, in TBI patients, the risk of intracranial hemorrhage usually considered an initiation of pharmacological prophylaxis. Nonpharmacological prophylaxisincludes graduated compression stocking (GCS), pneumatic compression devices (PCD), A-V foot pump, and vena cava filter (VCF). Latest studes suggest the use of PCD for all TBI patients without contraindication since administration. Computed tomography should be performed within 24 hours and if the resultis stable, pharmacological prophylaxis should be initiated within 24-48 hours.