Deep Venous Thrombosis Prophylaxis In Patients Research Articles

Prophylaxis of venous thromboembolism in knee replacement surgery

Venous thromboembolism (VTE) is still a frequent and sometimes severe complication after knee replacement surgery. Both pharmacological and non-pharmacological measures have been widely used to decrease VTE risk. Non pharmacological treatment include measures directed to decrease the effects of blood stasis, intermittent pneumatic compression device (IPCD) and graduated compression stockings, and mechanical devices. Pharmacological prophylaxis of venous thromboembolism (VTE) is associated with a more significant decrease in the incidence of deep venous thrombosis (DVT) and related complications after knee arthroplasty however anticoagulation may increase the risk of postoperative bleeding and related complications, in particular the need for re-intervention. Aim of present review was to suggest practical approach to DVT prophylaxis in patients undergoing knee arthroplasty

PROPHYLAXIS OF VENOUS THROMBOEMBOLISM IN KNEE REPLACEMENT SURGERY

Venous thromboembolism (VTE) is still a frequent and sometimes severe complication after knee replacement surgery. Both pharmacological and non-pharmacological measures have been widely used to decrease VTE risk. Non pharmacological treatment include measures directed to decrease the effects of blood stasis, intermittent pneumatic compression device (IPCD) and graduated compression stockings, and mechanical devices. Pharmacological prophylaxis of venous thromboembolism (VTE) is associated with a more significant decrease in the incidence of deep venous thrombosis (DVT) and related complications after knee arthroplasty however anticoagulation may increase the risk of postoperative bleeding and related complications, in particular the need for re-intervention. Aim of present review was to suggest practical approach to DVT prophylaxis in patients undergoing knee arthroplasty. Although parenteral drugs (low dose unfractionated heparin, low molecular weight heparin and fondaparinux) are the more frequently employed agents, limited compliance may be a concern. Recent studies suggest that direct oral anticoagulants, antithrombin and anti Xa agent, might be a useful alternative although safety may limited by an higher rate of local bleeding.

Prophylaxis of Venous Thromboembolism in Major Orthopedic Surgery: A Practical Approach

Deep venous thrombosis (DVT) is a common cause of morbidity after orthopedic surgery, both in the early post operative period when pulmonary embolism may complicate in hospital clinical course or occur after discharge and later due to development of post thrombotic syndrome. At present, clear evidence has been provided that pharmacological primary prophylaxis of venous thromboembolism (VTE) is associated with an impressive decrease in the incidence of DVT and related complications. The main limitation of VTE prophylaxis with anticoagulant drug is the risk of bleeding. Both pharmacological and non pharmacological measures are available and indication, clinical results and limitations will be discussed for each. For drug prophylaxis at present mainly are used as parenteral agents, low dose un fractionated heparin, low molecular weight heparin and fondaparinux; however, limited compliance may be a concern. Newer oral anticoagulants, dabigatran, rivaroxaban and apixiban, may be indicated in elective surgery in particular in patients with expected poor adherence to parenteral route. Non pharmacological treatment includes measures directed to decrease the effects of blood stasis, intermittent pneumatic compression device (IPCD) and graduated compression stockings, mechanical devices, inferior caval vein filters. Aim of the present review was to suggest practical approach to DVT prophylaxis in patients undergoing major orthopedic surgery.

Prevention of Deep Venous Thrombosis and Pulmonary Embolism in Patients With Acute Intracerebral Hemorrhage

Although patients with intracerebral hemorrhage (ICH) are at risk for deep venous thrombosis (DVT), the data about preventive options for DVT prophylaxis in this population is insufficient. We investigated the safety of low dose low molecular weight heparin (LMWH) for DVT prophylaxis in patients with ICH and the effect of heparin on the enlargement of hemorrhage. We prospectively randomized 75 primary ICH patients to subcutaneous LMWH (Enoxaparin sodium 40mg/d) or long compression stockings (CS) after the first 48 hours. All patients had cranial computed tomography (CT) scan at admittance, 24th and 72nd hours, seventh and 21st days, CT pulmonary angiography and bilateral lower extremity venous Doppler at 7th day. Hematoma volumes were calculated on the initial and follow-up CTs with ABC/2 method. Mean +/- SD age of the patients was 68.1 +/- 11.98 and 66.08 +/- 9.55 in LMWH and CS groups, respectively. Twenty-two of LMVH group and 8 of CS group were female. After randomization to LMWH or CS, we did not observe any hematoma enlargement at 72nd hours, 7 and 21st days in both groups. In addition, there was not any other systemic bleeding complication in LMWH group. We detected 4 asymptomatic DVT in our patients (3 in LMWH and 1 in CS group). Although asymptomatic DVT was more common in LMWH group, it was not statistically significant (P = 1). Low dose heparin treatment after 48 hours of stroke in ICH patients is not associated with an increased hematoma growth and should be used for DVT and PE prophylaxis.

48. Incidence of Deep Venous Thrombosis (DVT) related to type of DVT Prophylaxis in Patients with Intracerebral Haemorrhage

48. Incidence of Deep Venous Thrombosis (DVT) related to type of DVT Prophylaxis in Patients with Intracerebral Haemorrhage

The Rate of Bleeding Complications After Pharmacologic Deep Venous Thrombosis Prophylaxis

Major bleeding complications from pharmacologic deep venous thrombosis (DVT) prophylaxis are infrequent. Systematic review of the MEDLINE database from 1965 to August 2005, using the terms DVT, prophylaxis, general surgery, and heparin. Randomized controlled trials evaluating pharmacologic DVT prophylaxis in patients undergoing general surgery. Eight complication categories: injection site bruising, wound hematoma, drain site bleeding, hematuria, gastrointestinal tract bleeding, retroperitoneal bleeding, discontinuation of prophylaxis, and subsequent operation. Fifty-two randomized controlled trials studied DVT prophylaxis; 33 randomized controlled trials with 33 813 patients undergoing general surgery evaluated pharmacologic prophylaxis and quantified bleeding complications. Of the minor complications, injection site bruising (6.9%), wound hematoma (5.7%), drain site bleeding (2.0%), and hematuria (1.6%) were most common. Major bleeding complications, such as gastrointestinal tract (0.2%) or retroperitoneal (<0.1%) bleeding, were infrequent. Discontinuation of prophylaxis occurred in 2.0% of patients and subsequent operation in less than 1% of patients. When analyzed by high- vs low-dose unfractionated heparin, the lower dose had a smaller rate of discontinuation of prophylaxis (P = .02) and subsequent operation (P = .06). Knowledge of bleeding complication rates is important for surgeons because DVT prophylaxis may soon be implemented by Medicare as a quality measure. This level 1 evidence report shows that bleeding complications requiring a change in care occur less than 3% of the time and seem reduced with lower-dose prophylaxis. Given these findings, most patients undergoing general surgery could receive pharmacologic prophylaxis safely.

82-Year-Old Man With Recurrent Syncope

82-Year-Old Man With Recurrent Syncope