High Rate Of Thromboembolic Events Research Articles

Thromboembolic complications after arthroscopic knee surgery. Incidence and risk factors in 101 patients.

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are less common after knee arthroscopy than after elective hip and knee arthroplasties. There is no consensus on the optimal prophylaxis. In this prospective cohort study, we used ultrasound, phlebography and lung scan pre- and postoperatively to assess the incidence of thromboembolic complications in 101 consecutive patients who underwent knee arthroscopy. Preoperatively, patients were screened for typical risk factors for DVT such as age, obesity, varicose veins, contraceptive pills and nicotine abuse. All patients received a once-daily injection of 5000 IU of low molecular weight heparin, at least 12 hours prior to surgery. 5 weeks after surgery, the same screening tests were repeated. In 12 of the 101 patients either DVT or PE was diagnosed. DVT occurred in 8 cases, 4 of which were silent and 4 symptomatic. The number of PEs was 9, 8 silent and 1 symptomatic. We found no correlation between DVT or PE and individual clinical risk factors, but there was a tendency towards the development of DVT and PE, with a higher number of risk factors. We found no correlation between DVT and intraoperative risk factors such as use of a tourniquet, type of anesthesia or duration of surgery. The relatively high rate of thromboembolic events after knee arthroscopy in our study suggests the need of all patients for routine use of thromboprophylaxis, probably in a higher dose than given.

Temporal Bone Tumors

Aneurysm embolization using Guglielmi detachable coils(GDC) is gaining acceptance as a viable alternative to surgery in the treatment of cerebral aneurysms. During GDC treatment of cerebral aneurysms, thromboembolic events are the most frequent complications. As risk factors of thromboembolic events, large aneurysms, wide-necked aneurysms, use of the balloon-assisted technique and protruding coils into the parent arteries are previously reported. From March, 1997 till August, 2004, 270 consecutive patients were treated with GDC embolization at our institute. Fourteen (5.2%) patients with 14 aneurysms of these 270 patients presented with protruding coils into the parent vessels. Twelve aneurysms of these 14 aneurysms were small (diameter 4 mm). The fundus-to-neck ratio ranged from 1.04 to 2.78, with an average of 1.53. In this series, ten patients (71%) were treated with balloon-remodelling technique because every patient had either a wide-necked aneurysm or complicated morphologic factors. These 14 aneurysms were divided into two groups according to the mode of coil protrusion, loop type and tail type protrusion. The first coil was protruded in five (36%) cases of 14 patients, four of these five cases presented with the loop type protrusion. The last coil was protruded in seven cases (50%), Five of these seven cases presented with the tail type protrusion. Diffusion-weighted imaging abnormalities were found for seven (50%) of 14 patients within 24 hours of the coiling procedures. Three (21%) of 14 patients showed small lesions ( 5 mm) were detected. Symptomatic complications occurred in four (29%) patients, and all of these four patients presented the loop type protrusion. One patient who had small infarctions experienced minimal deficits (slight motor weakness, quadrantic hemianopsia) after six days postprocedure and fully recovered by discharge after stronger systemic heparinization (24000U, for three days), aspirin (100 mg/day) and Ticlopidine (100 mg/day). Three patients who had large territorial infarctions experienced moderate deficits. Two patients were treated with stronger systemic heparinization and one with Argatroban (60 mg/day, for two days), and following aspirin (100 mg/day) and Ticlopidine (100 mg/day). Finally, two patiens were discharged with permanent minimal deficits (hypoesthesia only) and one with moderate hemiparesis. The infarctions related to the GDC procedures were more common sequelae in wide-necked aneurysms and coil protrusions, especially loop type protrusion. Although permanent neurological deficits were rare, the high rate of thromboembolic events associated with coil protrusion suggest that more aggressive medical treatment should be considered.

Increased thromboembolic incidence in anti-cardiolipin-positive patients with malignancy

This study was undertaken to determine the prevalence of anti-cardiolipin antibodies (ACLAs) in patients with malignancy and to investigate a possible association of ACLAs with thromboembolic events in such patients. The study included 216 patients with solid and non-solid malignancies and an age-matched control group of 88 healthy subjects. ACLA levels were measured and related to thromboembolic phenomena (diagnosed by imaging methods) that occurred within 12 months of the diagnosis of cancer. Forty-seven patients (approximately 22%) with cancer were ACLA positive as compared with only three subjects (approximately 3%) in the control group (P < 0.0001). The ACLA-positive cancer patients had a significantly higher rate of thromboembolic events than ACLA-negative cancer patients: 13 of 47 (28%) vs 24 of 169 (14%), respectively (P < 0.05). High titres of either IgG-ACLA or IgM-ACLA were found in 10 out of 13 ACLA-positive cancer patients with thrombotic complications, but in only 2 out of 34 cancer ACLA-positive patients without thromboembolic events (P < 0.0001). In four cancer patients in whom ACLA levels were followed ACLA decreased after successful surgery/chemotherapy treatment and remained negative and thromboembolic free for 12 months of follow-up. Patients with malignancies show an increased prevalence of ACLA. Furthermore, ACLA-positive patients, mainly those with high titres, are much more prone to thromboembolic events.

Early morbidity after total hip replacement

The authors used the California Health Facilities Discharge data for 1984 and 1985 to compare retrospectively in-hospital morbidity and mortality of all 721 patients with rheumatoid arthritis versus all 8,859 patients with osteoarthritis who underwent a non-emergent, first-time, unilateral total hip arthroplasty. The lengths of hospitalization, in-hospital mortality rates, and incidences of postoperative complications were similar in the two groups except for higher rates of wound infection and wound dehiscence in the patients with rheumatoid arthritis and a higher rate of thromboembolic events in the osteoarthritis group. The short-term outcome of patients with rheumatoid arthritis appears comparable to that of patients with osteoarthritis.

Prosthetic heart valve replacement in children: Results and follow-up of 273 patients

We report the results and long-term follow up in 273 children (aged 2 to 16 years) who underwent prosthetic valve replacement. Mechanical valves (mostly Starr-Edwards) were used in almost all, and in 62 children more than one valve was replaced. Operative mortality was 4.7%. Actuarial survival curves (including hospital mortality) indicate a 86% survival rate at 5 years and 75% at 10 years. For isolated mitral valve prostheses (the largest subgroup), the figures are 87% at 5 years and 82% at 10 and 15 years. The main complication was thromboembolism, which occurred at a linearized rate of 2.7 per 100 patient-years. Actuarial curves indicate that 88% of patients are embolus free at 5 years, and 77% at 10 years. No patient with aortic valve replacement only had an embolism. Five of eight tricuspid prostheses thrombosed. Patients given aspirin and dipyridamole only did not have a higher rate of thromboembolic events than those given warfarin. There were five cases of endocarditis (two fatal) and four of dehiscence. No patient so far has needed replacement of a prosthesis because of somatic growth. Thus valve replacement can be performed with low mortality in children, and with satisfactory long-term survival. Thromboembolism remains a significant problem, although it appears to be less common than in adults. In this study, treatment with antiplatelet drugs only did not carry a higher rate of thromboembolic events than did treatment with warfarin.