High Risk Of Deep Venous Thrombosis Research Articles

Is it safe for the spinal metastasis patients with preoperative deep vein thrombosis to use low-molecular-weight heparin before surgery? A prospective study

Spine surgeons should weigh the risks of anticoagulants against their benefits in preventing deep venous thrombosis (DVT), as they may increase the risk of bleeding. Spinal metastasis patients undergoing decompression with fixation are at a high risk for DVT, which may occur preoperatively. Therefore, anticoagulants should be administered preoperatively. This study aimed to evaluate the safety of the administration of anticoagulants in treating spinal metastasis patients with preoperative DVT. Therefore, we prospectively investigated the prevalence of DVT in these patients. Patients who were diagnosed with preoperative DVT were included in an anticoagulant group. Subcutaneous low-molecular-weight heparin (LMWH) was administered. Patients without DVT were included in a non-anticoagulant group. Data on patient information, clinical parameters, blood test results, and bleeding complications were also collected. Moreover, the safety of anticoagulants was analyzed. The prevalence of preoperative DVT was 8.0%. None of the patients developed pulmonary thromboembolism. Furthermore, no significant differences in blood loss, drainage volume, hemoglobin levels, number of transfusions, or preoperative trans-catheter arterial embolization were observed between the two groups. None of the patients developed major bleeding. However, two patients experienced wound hematoma and one experienced incisional bleeding in the non-anticoagulant group. Therefore, LMWH is safe for spinal metastasis patients. Future randomized controlled trials should be conducted to evaluate the validity of perioperative prophylactic anticoagulation therapy in these patients.

Testosterone Replacement Therapy (TRT) is not Associated with a Higher Risk of DVT: Retrospective Analysis of US Claims Data

ABSTRACT Introduction As the prevalence of male hypogonadism (HG) has increased, more patients are prescribed TRT. TRT may be associated with an increased risk of deep venous thrombosis (DVT). Although in recent years there have been more studies dedicated to adverse effects of TRT, the literature is mixed on whether TRT increases the risk of DVT. Objective This study evaluates the risk of developing DVT in men with hypogonadism based on which types of treatments trends they receive using the MarketScan insurance claims database. Methods We performed a retrospective analysis of the IBM MarketScan™ Commercial Claims and Encounters database between 2008-2017. We identified all men with an HG diagnosis using the International Classification of Disease 9th edition (ICD-9) or 10th edition (ICD-10). We recorded how often they received TRT (including formulations as oral, topical/transdermal gels/creams/patches, intranasal, injections, and pellet implants). We followed men to see how many were diagnosed with DVT or pulmonary embolism. We excluded men who had a record of thromboembolic events before their first HG diagnosis. We performed univariate tests of variation across different demographics in three separate stratifications: 1) In all patients stratified by whether they suffered DVT; 2) In patients with DVT stratified by whether they received any kind of treatment at any time; 3) In patients with DVT and any treatment stratified by the type of treatment. Hazard Ratios from Cox Models were calculated for the effects of TRT in the previous 6 months on DVT controlling for the following confounding variables: age and comorbidities such as smoking, drug abuse, obesity, heart disease, cardiovascular problems and surgery/immobilization. Age and TRT in the previous 6 months were included as time-varying covariates. Results We identified 1,853,889 total men with HG, of which 21,414 (1.16%) were diagnosed with DVT. Among men who suffered DVT, 7,487 (34.96%) received TRT at some point compared to 605,534 (33.04%) of the men who did not suffer DVT. Results from time-varying Cox models suggest that receipt of TRT in the previous 6 months does not significantly increase the risk of developing a DVT (hazard ratio (HR) 1.049; 95% CI: 0.85, 1.29) among men with HG. Conclusions Our study suggests that TRT is not associated with a higher risk of developing DVT. DVT has evidence that the association was more pronounced among patients of later middle age and with chronic disease, whether with or without TRT. Further investigation is warranted to assess the risk effect of TRT on DVT development, which may allow for a more proactive approach in management. Disclosure No

Preoperative incidence and risk factors of deep vein thrombosis in patients with an isolated patellar fracture

PurposeThis study aimed to investigate the incidence, location, and related factors of preoperative deep venous thrombosis (DVT) in patients with isolated patellar fractures.MethodsPatients with an isolated patellar fracture, admitted between January 2013 and December 2019 at our institution, were retrospectively analyzed. Upon admission, patients underwent routine Doppler ultrasound scanning (DUS) of the bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patients in both groups did not perform preoperative off-bed weight-bearing exercises. Data on demographics, comorbidities, and laboratory test results upon admission were extracted. Variables were evaluated between the two groups using univariate analyses, and independent risk factors associated with DVT were identified by logistic regression analysis.ResultsDuring the study period, 827 patients were included, of whom 5.8% (48/827) were found to have preoperative DVT. In DVT patients, 85.4%(41/48) were injured, 8.3%(4/48) were not injured, and 6.3%(3/48) were lower limbs. Multivariate analysis showed that male (male vs. female, odds ratio, OR = 2.25), delayed from injury to DUS (in each day, OR = 1.29), and elevated plasma D-dimer level (> 0.5 µg/mL, OR = 2.47) were independent risk factors associated with DVT.ConclusionsDespite the low prevalence of DVT after an isolated patellar fracture, this study underscores the importance of identifying those with a high risk of DVT, especially those with multiple identifiable factors, and encourage the early targeted use of anti-thromboembolic agents to reduce DVT occurrence.

Prevalence and Clinical Characteristics of Proximal Deep Venous Thrombosis After a High-Density Coronavirus Disease 2019 Cluster in a Japanese Psychiatric Hospital.

The prevalence of deep venous thrombosis (DVT) among hospitalized psychiatric patients after coronavirus disease 2019 (COVID-19) infection remains unclear.Methods and Results:We retrospectively investigated the prevalence of proximal DVT after COVID-19 infection among 50 hospitalized patients in a Japanese psychiatric hospital that in which a COVID-19 cluster developed between August and September 2020. The prevalence of proximal DVT was 10.0%. Patients with proximal DVT had a lower body weight and higher maximum D-dimer levels and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) VTE scores. After COVID-19 infection, hospitalized psychiatric patients are at high risk of DVT and should be carefully followed up.

Incidence and risk factors of preoperative deep venous thrombosis following pelvic and acetabular fractures: a retrospective case\u2013control study

The objective of this study was to investigate the prevalence of preoperative deep venous thrombosis (DVT) in the pelvic cavity and lower extremities following pelvic and acetabular fractures and to identify the risk factors of the occurrence of DVT. Duplex ultrasound (DUS) screening and blood tests were conducted in patients admitted from June 2012 to December 2020 for surgical treatment of pelvic and acetabular fractures. Univariate analyses were performed on data of demographics, comorbidities, time from injury to surgery, injury mechanism, accompanied injury, and laboratory results. The optimal cutoff values of continuous variables with statistical significance were obtained by using the receiver operating characteristic (ROC) curve. A multivariate logistic regression analysis was then employed to examine the independent values in terms of predicting preoperative DVT. A total of 607 patients with pelvic and acetabular fractures were included, among whom 82 (13.5%) patients sustained preoperative DVTs. Specifically, 31.7% (26/82) were diagnosed with proximal DVTs. Fifty-two (63.4%) patients had DVT within 7 days after injury, and 67 (81.7%) patients within 10 days. The multivariate logistic regression analysis identified 6 factors independently associated with the presence of preoperative DVT, including age > 46 years (odds ratio [OR] = 2.94), BMI > 26.73 kg/m2 (OR = 3.91), time from injury to surgery > 9 days (OR = 5.39), associated injury (OR = 7.85), ALB < 32.8 g/L (OR = 2.71) and FIB > 3.095 g/L (OR = 3.34). Despite the modern prophylactic regimen, the preoperative DVT in patients with pelvic and acetabular fractures still draws the attention of orthopaedic surgeons. Better understanding these risk factors can help surgeons refine the risk stratification profile and perform early interdisciplinary management for patients at high risk of DVT.

Prevalence and risk factors for venous thromboembolism in spinal metastasis patients undergoing decompression with internal instruments: Prospective cohort study

Objectivere is paucity in the literature on the epidemiological evidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in spinal metastatic tumor patients. The aim of our study was to identify the incidence and risk factors for VTE in spinal metastasis patients treated with decompression with internal instruments. MethodsWe prospectively investigated the occurrence of VTE after decompression with internal fixations in 80 spinal metastasis patients. DVT was diagnosed by using a duplex ultrasonographical. PE was diagnosed by multidetector computed tomographic (CT) pulmonary angiography. Patient information and clinical parameters were collected. Risk factors were analyzed by comparing the difference between VTE and non-VTE cases. ResultsThe incidence of developing a DVT was 6.3% (5/80). No patient suffered PE. In univariate analysis, the mean length of hospital stay after surgery until discharge for VTE group was longer than non-VTE group, ODI scores and AIS in VTE group were significantly worse than non-VTE group, D-dimer one-day postoperatively for VTE group was significantly higher than non-VTE group. In logistic regression, D-dimer at one-day postoperatively was the only risk factor. The areas under the ROC curves for the D-dimer (post) to distinguish between non-VTE and VTE was 0.971(P value=0.000). By means of the ROC analysis, the optimum thresholds of D-dimer(post) were determined to be 9.51 mg/L. The sensitivity and specificity for the optimum threshold were 100.0% and 92.0%. ConclusionThe prospective study of 80 patients with spinal metastasis who underwent decompression with internal fixation revealed an incidence of DVT of 6.3%, patients with increasingly D-dimer level at one-day postoperatively had a higher risk of DVT, and the optimum thresholds of D-dimer(post) were determined to be 9.51 mg/L.

Association Between Monocyte Count and Preoperative Deep Venous Thrombosis in Older Patients with hip Fracture: A Retrospective Study.

PurposeTo analyze the relationship between monocyte count and preoperative deep venous thrombosis (DVT) in older patients with hip fracture.MethodsConsecutive older patients with hip fracture undergoing surgery were included from January 2014 to December 2021. Monocyte count was measured on admission, and Doppler ultrasonography was performed for DVT screening prior to surgery. Univariate and multivariate logistic regression analyses were used to assess the association between monocyte count and DVT.ResultsA total of 674 patients were finally included, and 128 patients (19.0%) were diagnosed with preoperative DVT. Patients with DVT exhibited a higher monocyte count than patients without DVT [0.55 (0.43-0.72) × 109/L versus 0.49 (0.38-0.63) × 109/L, P = 0.007]. Multivariate logistic regression analysis showed that a high monocyte count (> 0.6 × 109/L) was independently associated with a higher risk of DVT (OR = 1.705, 95% CI: 1.121-2.593, P = 0.013), and for every 0.1 × 109/L increase in monocyte count, the risk of DVT increased by 8.5% (OR = 1.085, 95% CI: 1.003-1.174, P = 0.041). Other risk factors associated with DVT included intertrochanteric fracture (OR = 1.596, 95% CI: 1.022-2.492, P = 0.040), and elevated fibrinogen level (OR = 1.236, 95% CI: 1.029-1.484, P = 0.023).ConclusionA high monocyte count is associated with an increased risk of DVT in older patients with hip fracture. Future studies should evaluate the potential role of monocyte in the prevention and treatment of thrombosis.

Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders

BackgroundAlthough the incidence of symptomatic pulmonary thromboembolism after elective surgery for degenerative musculoskeletal disorders is comparatively low, it is extremely detrimental to both patients and health-care providers. Therefore, its prevention is mandatory. We aimed to perform a cross-sectional analysis of deep venous thrombosis (DVT) before elective surgery for degenerative musculoskeletal disorders, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery, and identify the factors associated with the incidence of preoperative DVT.MethodsThe clinical data of patients aged ≥ 30 years who underwent TKA or THA, and spine surgery for lumbar or cervical degenerative disorders at our institution were retrospectively collected. D-dimer levels were measured preoperatively in all the patients scheduled for surgery. For the patients with D-dimer levels ≥ 1 µg/mL or who were determined by their physicians to be at high risk of DVT, the lower extremity vein was preoperatively examined for DVT on ultrasonography.ResultsOverall, we retrospectively evaluated 1236 consecutive patients, including 701 men and 535 women. Of the patients, 431 and 805 had D-dimer levels ≥ 1 and < 1 µg/mL, respectively. Of 683 patients who underwent lower extremity ultrasonography, 92 had proximal (n = 7) and distal types (n = 85) of DVT. The preoperative prevalence of DVT was 7.4 %. No patient had the incidence of postoperative symptomatic venous thromboembolism. A multivariate analysis revealed that age ≥ 80 years (odds ratio [OR], 95 % confidence interval [CI]: 2.8, 1.1–7.3), knee surgery (2.1, 1.1–4.0), American Society of Anesthesiologists (ASA) grade 2 (2.8, 1.2–6.8), ASA grades 3 or 4 (3.1, 1.0–9.4), and malignancy (1.9, 1.1–3.2) were significantly associated with DVT incidence.ConclusionsThis is the first study to conduct a cross-sectional analysis of preoperative DVT data of patients scheduled for elective surgery for degenerative musculoskeletal disorders. Although whether screening for preoperative DVT is needed to prevent postoperative symptomatic pulmonary thromboembolism remains to be clarified, our data suggested that DVT should be noted before surgery in the patients with advanced age, knee surgery, high ASA physical status, and malignancy.

IS XARELTO SUPERIOR TO ASPIRIN FOR POSTOPERATIVE VTE PROPHYLAXIS AFTER ORTHOPEDIC SURGERY?

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: One of the biggest complications that arise from a Major Joint Surgery (MJS): Total Knee Arthroplasty (TKA), Total Hip Arthroplasty (THA), and Hip Fracture Surgery (HFS) are Venous Thrombo-Embolism (VTE) disorder. VTE encompasses both Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE), a major cause of mortality and morbidity in these patients. Without proper prophylaxis after MJS, patients are at high risk for DVT with an incidence of 40%-85% and PE 1-2%. Conventional drug therapies that are used as prophylaxis currently are includes Enoxaparin, Coumadin and Xarelto. However, the American Academy of Orthopedic Surgeons and American College of Chest Physicians have no consensus regarding the best drug for prophylaxis. METHODS: A systematic review was conducted through PubMed to identify relevant studies from January 2014- December 2019 with comparative data on aspirin versus rivaroxaban for VTE prophylaxis after MJS. The primary outcomes that were analyzed were DVT, PE, and any VTE rates. Secondary outcomes included were major bleeding events (bleeding into joint space), other bleeding events, wound complications, and readmissions. Results are expressed as Standard Difference in means with Standard Error (SD+SE). Statistical analysis was done using Random-Effects Meta-Analysis to compare the mean value of the two groups (Comprehensive Meta Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ). RESULTS: Ten out of the 3530 studies were quantitatively assessed and included for meta-analysis. TKA was performed in 528,549 patients, THA in 242,756 patients and HFS in 329 patients. Aspirin was administered in 34,330 patients and Xarelto in 90,482 patients. The incidence of VTEs (0.314 ± 0.087; p=0.000) and DVTs (0.231 ± 0.074; p=0.002) were higher in the Aspirin group when compared to Xarelto use.PE (0.155 ± 0.19; p=0.414), Major bleeding events (-0.015 ± 0.365; p=0.967) , Overall bleeding events (-0.148 ± 0.080; p=0.064), Wound complications (-0.312 ± 0.326; p=0.339) and Readmissions (0.132 ± 0.147; p=0.369) were similar in both groups. CONCLUSIONS: Xarelto is superior to Aspirin for post operative prophylaxis of Venous Thromboembolism after Major Orthopedic Surgical procedures. CLINICAL IMPLICATIONS: The controversial drug Aspirin which is cost-effective with less bleeding compared to the conventional medications has been reported in many studies to be effective at preventing VTE. This study aims to compare post-operative surgical and thromboembolic complications following the use of Aspirin or Xarelto as VTE prophylaxis after MJS. DISCLOSURES: No relevant relationships by Ardica Kamaalananthan, source=Web Response No relevant relationships by Aliu Sanni, source=Web Response

Point-of-care ultrasound for deep venous thrombosis of the lower limb.

The incidence and morbidity of deep venous thrombosis (DVT) and pulmonary embolus are high. Although efforts to increase screening for DVT have been recommended, this is limited by resources. Venous duplex ultrasound has replaced venography as the first-line investigation of choice for DVT, increasing availability and reducing patient exposure to radiation and intravenous contrast. Furthermore, an abbreviated ultrasound where DVT is inferred from incomplete venous compressibility has an equivalent accuracy to venous duplex, requiring less time and training enabling its widespread usebyemergency, critical care and anaesthesia clinicians. In this review, the evolution and method of lower limb venous compression ultrasound is described along with evidence for its use in patients at high risk for DVTin these clinical settings.

Clinical Risk Factors of Asymptomatic Deep Venous Thrombosis in Patients With Acute Stroke

Background:Deep venous thrombosis (DVT) is a common complication after stroke. It is easy to identify the patients with symptomatic DVT; however, the tool for asymptomatic high-risk population needs to be further explored. Our aim was to explore the risk factors of acute stroke patients with asymptomatic DVT.Methods:We performed a prospective observation study among 452 patients with acute stroke who had a stroke within 14 days. Ultrasound examination of deep veins was repeatedly performed in each patient for DVT every 7 days during his admission. The dynamic rate of DVT in acute stroke was analyzed. Then risk factors were compared between DVT patients and non-DVT patients. The predictive model was explored based on thr cox proportion model.Results:Asymptomatic DVT was detected in 52 (11.5%) patients with stroke and 85.9% of thrombi were identified in their distal veins. Patients with longer length of stay (P = .004), more severe stroke (P = 0.001), higher level of D-dimer (P = .003), and higher blood glucose level were associated with higher risk of DVT, while patients with higher triglyceride level (P = .003) were less likely to have DVT, after adjusting age and sex. With the median of D-dimer (0.38 FEU mg/L) as cutoff value. Patients with higher level of D-dimer might have a higher risk of DVT with a significant statistical difference. Also, the severity of stroke differed DVT risk in Kaplan-Meier model. Using cox-proportion hazard regression model, asymptomatic DVT could be predicted (area under the curve 0.852).Conclusion:Our data showed that asymptomatic DVT was common in patients with acute stroke and most of thrombosis occurred in distal veins. Combination of clinical manifestation and laboratory results might be helpful predict DVT. DVT prophylaxis should be condisdered in high risk.

Prophylactic use of the Angel® Catheter in a patient with paraneoplastic syndrome scheduled for surgical tumor resection: A case report and literature review

Introductio. The Angel? catheter (BiO2 Medical Inc, San Antonio, Texas, USA) is a novel device that combines a triple lumen central venous catheter with an inferior vena cava filter for prevention of pulmonary embolism (IVC filtercatheter). Case report. We present the case of a 53- yearold male patient with renal carcinoma and a history of recent deep venous thrombosis (DVT) on oral anticoagulation who was scheduled to undergo open radical nephrectomy. Because of concerns about the risks from documented pre-existing DVT, we decided to insert the Angel? catheter preoperatively in order to have central venous access during surgery and also to reduce the risk of perioperative pulmonary embolism. On the first postoperative day, active gastric bleeding was detected and nadroparine was stopped. Before removal of the Angel? catheter, a pre-removal cavagram revealed large thrombus mass in the catheter filter. Because of the presence of the thrombus mass, the catheter was removed surgically, after a permanent vena cava filter was inserted. Conclusion. This case suggests that the use of the Angel? IVC filter/3-lumen central catheter combination could be a reasonable option for pulmonary embolism prophylaxis in the patients at a high risk for DVT, such as the patients with malignant disease, paraneoplastic syndrome and chemotherapy who need to undergo surgery.

PROSPECTIVE STUDY OF ASPIRIN FOR THROMBOEMBOLISM PROPHYLAXIS IN TOTAL HIP ARTHROPLASTY.

ABSTRACTObjectives:To evaluate the effectiveness of aspirin as prophylaxis for deep venous thrombosis (DVT) in patients undergoing total hip arthroplasty (THA), and to analyze the incidence of bleeding during the post-operative period. Methods:This prospective study carried out in 2017 consisted of 37 patients indicated for THA with high risk for DVT. Immediately after the procedure, aspirin, elastic compression socks and early deambulation were initiated. Doppler ultrasound was performed in the legs 6 days and 6 weeks post-procedure to rule out venous thromboembolism. Hematometric variables and clinical criteria were used to detect bleeding. Results:The incidence of VTE (venous thromboembolism) 6 days post-procedure was 21.6%. By 6 weeks post-procedure, it dropped to 8.1%, (p = 0.102). Only 2.7% were diagnosed with VTE, 6 days and also 6 weeks post-procedure. Within the immediate postoperative period, hemoglobin was lower (p < 0.001), in contrast to 6 weeks after surgery, when it returned to baseline levels. Conclusion:Aspirin was an effective chemical prophylaxis for venous thromboembolism in high-risk patients who underwent THA. There was no clinical record of postoperative bleeding and hematometric levels suggested that there was no chronic bleeding. Level of Evidence II; Prospective study.

Pilot study evaluating the efficacy of exergaming for the prevention of deep venous thrombosis.

Current prophylactic protocols fail to prevent deep venous thrombosis (DVT) in a significant minority of patients, and it remains one of the leading causes of preventable death. We therefore quantified the efficacy of novel game-based exercises (exergaming) to augment femoral venous parameters relative to ankle movement and muscle flexion. Healthy volunteers were recruited to perform a series of ankle and foot exercises using a wireless foot sensor (LEGSys; BioSensics LLC, Watertown, Mass) to navigate a computer cursor sequentially on a screen to the center of 200 circular targets. A single ultrasound technician (W.A.M.) measured each patient's mean flow volume, peak flow velocity, mean flow velocity, and cross-sectional area of the right femoral vein at baseline and obtained immediate postexercise (PEX), 5-minute PEX, and 15-minute PEX measurements. Electromyography (EMG) was performed at baseline and during the exercise. Baseline demographics and medical and surgical comorbidities were also recorded. The primary end point was the difference between baseline and immediate PEX mean flow volume estimates. We secondarily explored the association of baseline characteristics and EMG measurements with femoral vein parameters. Fifteen healthy subjects (53% male; 28.1± 4.6years) completed the exergaming task within a mean of 4minutes, 2± 21seconds. Immediately after exercise, the femoral vein mean flow volume, mean velocity, and peak systolic velocity increased by 49%, 53%, and 48%, respectively (P< .02 for each). Mean flow volume and velocity remained significantly elevated 5minutes after exercise (P< .04 for each). Plantar flexion and dorsiflexion velocities and EMG frequency and intensity were not significantly correlated with PEX mean flow volume estimates (P > .05). Subgroup analysis revealed that women (P< .01) and Hispanics (P< .01) exhibited significantly slower PEX responses. Subjects with the largest improvements in mean flow volume had lower peak plantar flexion velocities (P< .01). Exergaming increases mean flow volume, mean flow velocity, and peak systolic velocity within the femoral vein by approximately 50% above baseline. Exergaming represents a novel and potentially attractive method of DVT prevention by augmenting femoral vein mean volume flow and capitalizing on biofeedback. Less forceful but more uniform contractions were found to be most effective at augmenting venous blood flow. Exergaming will require further validation in larger study bases, among patients at higher risk of DVT.

A retrospective study on the classification prevention of early deep venous thrombosis after posterior/transforaminal lumbar interbody fusion

Objective To investigate the safety and efficacy of the classification prevention of early deep venous thrombosis(DVT) after posterior/transforaminal lumbar interbody fusion(PLIF/TLIF). Methods From August 2012 to January 2015, 1 549 patients were separated after PLIF/TLIF procedure with DVT risk factors into low, medium, high and extremely high risk groups for 139, 353, 805 and 252 cases respectively. Basic prevention measures were used in the low risk group. Physical prevention measures such as thigh-length thromboembolic deterrent stockings(TEDS) and pneumatic sequential compression device(PSCD) were used in medium risk group. In high and extremely high risk groups, low molecular weight heparin(LMWH) was applied in addition to basic and physical prevention measures. Lower limb vascular doppler ultrasonography was used to monitor DVT pre-and postoperatively. The occurrences of epidural or wound hematoma were monitored. Results All of 1 057 patients(68.3%) suffered a high risk or extremely high risk of DVT, who have three or more risk factors. Only 139 patients(8.9%) were low risk population. Among the 1 549 cases of patients with PLIF/TLIF procedure, DVT occurred in 27 cases, and the incidence was 1.74%. There were 0, 3, 15 and 9 patients with positive findings of DVT on duplex uitrasonograph respectively in low, medium, high and extremely high risk groups. Two patients were experienced fibular veins thrombosis, and one with posterior tibial vein thrombosis. All of the remaining was thrombus in calf. However, all of them were asymptomatic. There was no case of pulmonary embolism(PE) or case with epidural or wound hematoma. No thrombus progressed was found in 3 months after operation. Among them, one case with fibular veins thrombosis and 11 cases with calf muscular veins thrombosis were recanalized. Conclusion According to the risk factors of DVT after PLIF/TILF, the classification prevention of early DVT is safe and effective. On the basis of basic and physical prevention measures, the combined use of LMWH has important significance to prevent DVT in patients with high and extremely high risk. Key words: Lumbar vertebrae; Spinal fusion; Venous thrombosis; Heparin, low-molecular-weight; Risk factors

Predicting of Venous Thromboembolism for Patients Undergoing Gynecological Surgery.

The purpose of this study was to determine the risk stratification of deep venous thrombosis (DVT) in patients undergoing gynecological surgery.A retrospective study was conducted with a cohort of 739 consecutive female patients undergoing gynecological surgery between May 2008 and July 2013 in Beijing Chao-yang hospital. DVT of the leg was detected using complete compression and color Doppler ultrasound. Pulmonary embolism (PE) was diagnosed by computed tomography pulmonary angiogram (CTPA).The overall incidence of DVT was 9.20% (68/739) in this patient population, including 16 (2.17%) symptomatic DVT and 52 (7.04%) silent DVT. A total of 66 (97.06%) DVT events were found within 7 days of surgery and 2 (2.94%) after 1 week. 94.82% thrombi were located in distal vein, and the rest 5.18% located in proximal and distal veins. Among the 68 patients with DVT, 46 patients with suspected PE received CTPA and 21 (45.65%) were confirmed with PE.Six independent factors including varicose vein, bed rest time ≥48 h, length of operation ≥3 h, laparotomy surgery, hypertension, and age ≥50 years significantly increased the incidence of postoperative DVT on multivariate analysis. Patients with none risk factor are at low risk, with 1 or 2 risk factors are at moderate risk, and with ≥3 factors are at high risk of DVT.The incidence of postoperative DVT and PE after gynecological surgery is high in patients with moderate or high-risk level. Noninvasive detection of DVT in 7 days after surgery is necessary because most patients showed no typical symptoms. Appropriate prophylaxis could be performed in patients at moderate or high risk of DVT.

Deep venous thrombosis in children with sickle cell disease.

Deep venous thrombosis (DVT) is rare in children compared to adults. Its incidence and risk factors in children are not well known. This study determined these aspects of DVT in children with sickle cell disease (SCD). A retrospective, observational and descriptive study was performed. Patients born between October 2000 and October 2012 with SCD and registered in HEMORIO, including those who died in HEMORIO, were included in this study. Patients whose medical records were inaccessible, who died in institutions other than HEMORIO, who died with implanted deep venous catheters, and those who were not monitored in HEMORIO for a period of 1 year or more were excluded from the study. Of a total of 1,519 patients, 456 were excluded and 1,063 patients were included in the study. Data were obtained from the computer system and the medical records at HEMORIO. Of the 1,063 patients, 2 (0.2%) developed DVT with both cases being related to central venous catheters (CVCs) (P-value <0.001). Of the patients who required CVCs, the prevalence of DVT was 10%. No other variable was clinically or statistically significant with respect to DVT. The establishment of CVCs in children with SCD poses a high risk for DVT. If this procedure is necessary, the internal jugular vein should be utilized instead of the subclavian and femoral veins. The identification of associated risk factors may justify antithrombotic prophylaxis.

Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: a systematic review and meta-analysis.

Hip fracture surgery and lower extremity arthroplasty are associated with increased risk of both venous thromboembolism and bleeding. The best pharmacologic strategy for reducing these opposing risks is uncertain. To compare venous thromboembolism (VTE) and bleeding rates in adult patients receiving aspirin versus anticoagulants after major lower extremity orthopedic surgery. Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library through June 2013; reference lists, ClinicalTrials.gov, and scientific meeting abstracts. Randomized trials comparing aspirin to anticoagulants for prevention of VTE following major lower extremity orthopedic surgery. Two reviewers independently extracted data on rates of VTE, bleeding, and mortality. Of 298 studies screened, 8 trials including 1408 participants met inclusion criteria; all trials screened participants for deep venous thrombosis (DVT). Overall rates of DVT did not differ statistically between aspirin and anticoagulants (relative risk [RR]: 1.15 [95% confidence interval {CI}: 0.68-1.96]). Subgrouped by type of surgery, there was a nonsignificant trend favoring anticoagulation following hip fracture repair but not knee or hip arthroplasty (hip fracture RR: 1.60 [95% CI: 0.80-3.20], 2 trials; arthroplasty RR: 1.00 [95% CI: 0.49-2.05], 5 trials). The risk of bleeding was lower with aspirin than anticoagulants following hip fracture repair (RR: 0.32 [95% CI: 0.13-0.77], 2 trials), with a nonsignificant trend favoring aspirin after arthroplasty (RR: 0.63 [95% CI: 0.33-1.21], 5 trials). Rates of pulmonary embolism were too low to provide reliable estimates. Compared with anticoagulation, aspirin may be associated with higher risk of DVT following hip fracture repair, although bleeding rates were substantially lower. Aspirin was similarly effective after lower extremity arthroplasty and may be associated with lower bleeding risk. Journal of Hospital Medicine 2014;9:579-585. © 2014 Society of Hospital Medicine.

Deep Venous Thrombosis after Saphenous Endovenous Radiofrequency Ablation: Is it Predictable?

Endovenous radiofrequency ablation (RFA) is a safe and effective treatment for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) is a known complication of this procedure. The purpose of this study is to describe the frequency of DVT after RFA and the associated predisposing factors. A retrospective analysis was performed using prospectively collected data from December 2008 to December 2011; a total of 277 consecutive office-based RFA procedures were performed at a single institution using the VNUS ClosureFast catheter (VNUS Medical Technologies, San Jose, CA). Duplex ultrasonography scans were completed 2 weeks postprocedure in all patients. Risk factors assessed for the development of DVT included: great versus small saphenous vein (SSV) treated, right versus left side treated, number of radiofrequency cycles used, hypercoagulable state, history of DVT, tobacco use, medications (i.e., oral contraceptives, aspirin, warfarin, and clopidogrel), and vein diameter at the junction of the superficial and deep systems. Seventy-two percent of the patients were women, 56% were treated on the right side, and 86% were performed on the great saphenous vein (GSV). The mean age was 54 ± 14 years (range: 23-88 years). Three percent of patients had a preprocedure diagnosis of hypercoagulable state, and 8% had a history of previous DVT. On postprocedural ultrasound, thrombus protrusion into the deep system without occlusion (endovenous heat-induced thrombosis) was present in 11 patients (4%). DVT, as defined by thrombus protrusion with complete occlusion of the femoral or popliteal vein, was identified in 2 patients (0.7%). Previous DVT was the only factor associated with postprocedural DVT (P = 0.018). Although not statistically significant, there was a trend toward a higher risk of DVT in SSV-treated patients. Factors associated with endovascular heat-induced thrombosis alone were male sex (P = 0.02), SSV treatment (P = 0.05), aspirin use (P = 0.008), and factor V Leiden deficiency (P = 0.01). The use of RFA to treat patients with symptoms caused by saphenous reflux involves a small but definite risk of DVT. This study shows that the risk of post-RFA DVT is greater in patients with previous DVT, with a trend toward an increased risk in patients having treatment of the SSV. Periprocedural anticoagulation may be considered in this subset to reduce the risk of DVT after RFA. Thrombus protrusion without DVT was found to be more likely in patients with hypercoagulability, male sex, SSV treatment, and aspirin use. Additional prospective studies are required to analyze these and other factors that may predict thrombotic events after endovenous RFA.

Deep Venous Thrombosis After Saphenous Endovenous Radiofrequency Ablation: Is It Predictable?

Endovenous radiofrequency ablation (RFA) is a safe and effective treatment for varicose veins secondary to saphenous reflux. Deep venous thrombosis (DVT) is a known complication of this procedure. The purpose of this study is to describe the frequency of DVT after RFA and associated predisposing factors. We performed a retrospective data analysis from December 2008 to December 2011, during which 277 consecutive office-based RFA were performed in our institution using the VNUS ClosureFast catheter. Duplex scans were completed 2 weeks postprocedure in all patients to confirm saphenous vein obliteration and evaluate the deep venous system for thrombosis. Risk factors assessed for development of DVT included greater vs lesser saphenous, side treated, number of cycles used, hypercoagulable state, history of DVT, tobacco use, medications (oral contraceptives, aspirin, warfarin, clopidogrel), and vein diameter at the junction of the superficial and deep systems. Seventy percent of the patients were female, 56% were right side, and 86% were performed on the greater saphenous vein. Mean age was 54 ± 14 (range, 23-88 years). 3% of patients had a diagnosis of hypercoagulable state and 8% had a history of DVT. Follow-up ultrasound imaging showed thrombus protrusion into the deep system without occlusion was present in 11 patients (4%). DVT, as defined by thrombus protrusion with complete occlusion of the femoral or popliteal vein, developed in two patients (0.7%). Previous DVT was the only factor associated with DVT (P = .018). Although not statistically significant, there was a trend toward higher risk of DVT in LSV patients. Factors associated with protrusion into the deep system were lesser saphenous vein (P = .035), and factor V Leiden (P = .026). The use of RFA to treat patients with saphenous reflux involves a small but definite risk of DVT. This study demonstrates that the risk of DVT or any thrombus protrusion in to the deep system is greater in patients with previous DVT, factor V Leiden, and treatment of the lesser saphenous vein. Periprocedural anticoagulation should be considered in this subset to reduce the risk of complication after RFA.