Effectiveness Of Venous Thromboembolism Prophylaxis Research Articles

Evaluation of the Effectiveness of Venous Thromboembolism Prophylaxis in Patients Undergoing Major Urological Surgery

Objective: To evaluate the effectiveness of venous thromboembolism prophylaxis in patients undergoing majör urologic surgery. Materials and Methods: Data of patients who underwent major urological surgery between January 2018 and October 2023 were analyzed. Intraoperative age, body mass index, and comorbidities were recorded. All patients received prophylaxis with low molecular weight heparin and graduated compression stockings starting in the preoperative period until mobilization in the postoperative period. The patients' historical data were reviewed, and the development of venous thromboembolism in the one-month postoperative period was investigated. Results: Nephrectomy was performed in 158 patients (45.2%), radical prostatectomy in 142 patients (41.2%), partial nephrectomy in 28 patients (8.1%), and radical cystectomy in 19 patients (5.5%). The mean age at the time of operation was 66.06±9.43 years, and the body mass index was 27.06±4.22. Hypertension was found in 51.6%, diabetes mellitus in 26.1%, coronary artery disease in 13.9%, chronic obstructive pulmonary disease in 8.1%, atrial fibrillation in 2.1%, and valvular heart disease in 1.2%. In the postoperative period, two patients developed pulmonary embolism, and one patient developed deep vein thrombosis. One of the patients with pulmonary embolism had undergone radical prostatectomy, and the other patients had undergone radical cystectomy. There was no mortality after treatment. Conclusion: Venous thromboembolism is a highly preventable when appropriate precautions and prophylaxis are taken. In our study, the incidence of pulmonary embolism and deep vein thrombosis was similar to the literature.

Effectiveness of venous thromboembolism prophylaxis in patients with liver disease

BACKGROUNDPatients with liver disease are concomitantly at increased risk of venous thromboembolism (VTE) and bleeding events due to changes in the balance of pro- and anti-hemostatic substances. As such, recommendations for the use of pharmacological VTE prophylaxis are lacking. Recent studies have found no difference in rates of VTE in those receiving and not receiving pharmacological VTE prophylaxis, though most studies have been small. Thus, our study sought to establish if pharmacological VTE prophylaxis is effective and safe in patients with liver disease.AIMTo determine if there is net clinical benefit to providing pharmacological VTE prophylaxis to cirrhotic patients.METHODSIn this retrospective study, 1806 patients were propensity matched to assess if pharmacological VTE prophylaxis is effective and safe in patients with cirrhosis. Patients were divided and evaluated based on receipt of pharmacological VTE prophylaxis.RESULTSThe composite primary outcome of VTE or major bleeding was more common in the no prophylaxis group than the prophylaxis group (8.7% vs 5.1%, P = 0.002), though this outcome was driven by higher rates of major bleeding (6.9% vs 2.9%, P < 0.001) rather than VTE (1.9% vs 2.2%, P = 0.62). There was no difference in length of stay or in-hospital mortality between groups. Pharmacological VTE prophylaxis was independently associated with lower rates of major bleeding (OR = 0.42, 95%CI: 0.25-0.68, P = 0.0005), but was not protective against VTE on multivariable analysis.CONCLUSIONPharmacological VTE prophylaxis was not associated with a significant reduction in the rate of VTE in patients with liver disease, though no increase in major bleeding events was observed.

Evaluating the safety and effectiveness of venous thromboembolism prophylaxis in patients with sickle cell disease.

Nearly every component of hemostasis is altered in sickle cell disease (SCD), yet little evidence exists to guide utilization of venous thromboembolism prophylaxis (VTEP) in this population. This retrospective cohort study included 135 adult patients admitted with a diagnosis of SCD vaso-occlusive crisis to the general medicine service at a tertiary care academic medical center from August 1, 2011 to August 1, 2013. If VTEP was discontinued, the medical record was reviewed for suspicion of VTE, hemorrhage, heparin-induced thrombocytopenia (HIT), or other adverse events. The primary objective was to characterize the safety and effectiveness of VTEP in SCD. The secondary objective was to assess the correlation of VTE with risk factors documented in the general medical population. Most patients (116/135, 85.9%) were prescribed VTEP upon admission, with early discontinuation in 23 patients (19.8%). Reasons for discontinuation included suspicion of VTE (10/116, 8.6%), hemorrhage (5/116, 4.3%), and/or HIT (4/116, 3.4%). Since patients with SCD receiving standard VTEP regimens appear to have similar outcomes compared to medically ill patients in prospective studies, using these regimens appears to be safe when indicated in the opinion of the provider. Once daily injections may be preferred in order to optimize adherence.