Overall Incidence Of Deep Vein Thrombosis Research Articles

Incidence and preventive treatment for deep vein thrombosis with our own preventive protocol in total hip and knee arthroplasty.

The aim of the present study was to investigate the perioperative and postoperative incidence of deep vein thrombosis (DVT) and validate the effectiveness of our own preventive treatment protocol for venous thromboembolism (VTE) occurrence in lower extremity arthroplasty patients. The subjects were 1,054 patients (mean age: 74.3 years) who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) at our institutions between April 2014 and March 2017. We examined the frequencies of pre- and post-operative DVT by lower extremity Doppler images, and the incidence rate at proximal or distal regions as well as that according to preoperative DVT status were evaluated. Preoperative DVT was detected in 6.5% (69 cases) of our cohort and those were located 1.4% (15 cases) at proximal and 5.1% (54 cases) at distal regions. A significantly higher rate of postoperative DVT development was observed in preoperative DVT+ THA patients (P = 0.0075), but not in TKA patients only with a higher tendency (P = 0.56). The overall incidence of DVT up to 2 weeks after surgeries was 27.3% (288 cases); however, the rate in proximal femur regions was suppressed to 2.8% (30 cases), and there was no symptomatic pulmonary thromboembolism (PTE) case. The results demonstrated the importance of regular Doppler examination for early detection of postoperative DVT occurrence and the following immediate treatment initiation. Our own VTE preventive treatment protocol could reduce the development of proximal DVT, and the periodic monitoring as well as prompt treatment might prevent the fatal PTE. osteoarthritis (OA), rheumatoid arthritis (RA).

Incidence and risk factors of deep vein thrombosis in patients with spinal cord injury: a systematic review with meta-analysis.

Spinal cord injury (SCI) is a highly disabling disease with huge public health burden. The complications associated with it, especially deep vein thrombosis (DVT), further aggravate the disability. To explore the incidence and risk factors of DVT after SCI, in order to provide guidance for disease prevention in the future. A search was performed on PubMed, Web of Science, Embase, and Cochrane database up to November 9, 2022. Literature screening, information extraction and quality evaluation were performed by two researchers. The data was later combined by metaprop and metan commands in STATA 16.0. A total of 101 articles were included, including 223,221 patients. Meta-analysis showed that the overall incidence of DVT was 9.3% (95% CI: 8.2%-10.6%), and the incidence of DVT in patients with acute and chronic SCI was 10.9% (95% CI: 8.7%-13.2%) and 5.3% (95% CI: 2.2%-9.7%), respectively. The incidence of DVT decreased gradually with the accumulation of publication years and sample size. However, the annual incidence of DVT has increased since 2017. There are 24 kinds of risk factors that may contribute to the formation of DVT, involving multiple aspects of the baseline characteristics of the patient, biochemical indicators, severity of SCI, and comorbidities. The incidence of DVT after SCI is high and has been gradually increasing in recent years. Moreover, there are numerous risk factors associated with DVT. Comprehensive preventive measures need to be taken as early as possible in the future. www.crd.york.ac.uk/prospero, identifier CRD42022377466.

Is Routine Screening Using Duplex Ultrasonography for Deep Vein Thrombosis Necessary after Shoulder Arthroplasty?

The aims of this study were to examine the incidence, risk factors, and outcomes of deep vein thrombosis (DVT) after shoulder arthroplasty in Korean patients. A total of 265 patients who underwent shoulder arthroplasty were included. The mean age of the patients was 74.6 years, and there were 195 females and 70 males. Clinical data including patient demographics, blood tests, and previous and current medical history were investigated. For screening of DVT, duplex ultrasonography of the operative arm was performed 2 to 5 days after surgery. Of the 265 patients, 10 patients (3.8%) were diagnosed with DVT using postoperative duplex ultrasonography. There were no cases of pulmonary embolism. There were no significant differences between the DVT and no DVT groups regarding all clinical data, except for the Charlson comorbidity index (CCI), which was significantly higher in the DVT group than in the no DVT group (5.0 vs. 4.1; p = 0.029). All patients had asymptomatic DVT that showed complete resolution after administration of antithrombotic agents or close observation without medications. The overall incidence of DVT was 3.8% during a period of 3 months after shoulder arthroplasty in Korean patients, and most cases were asymptomatic. Routine screening for DVT using duplex ultrasonography after shoulder arthroplasty may not be necessary except in patients with high CCI.

Incidence and Predictive Factors of Lower Extremity Deep-vein Thrombosis in Patients with Neurological Diseases in a Sub-Saharan Tertiary Hospital

Background: Deep-vein thrombosis (DVT) is a major cause of morbidity among patients with neurological disease and is implicated in 50%–90% of pulmonary embolisms (PE). Aim: This study aims to identify the incidence and predictive factors of lower extremity (LE) DVT in high-risk neurological patients. Materials and Methods: All patients with neurological diseases who were confined to bed for three days or more, or had elevated D-dimer over a 22 months were included in the study. They all had routine mechanical and chemical prophylaxis. Serial color duplex ultrasonography of the LE was performed for all the patients, and the results were used to stratify them into two groups: DVT positive and DVT negative, and their clinical parameters were recorded and utilised for statistical analysis. Multivariate logistic regression analysis was used to determine the predictive risk factors. Results: A total of 611 patients were admitted, and 107 met the inclusion criteria. The mean age was 57 ± 17 years, with a male-to-female ratio of 1.7:1. Forty-four (41.4%) patients had DVT (overall incidence was 7.2%). Primary intracranial tumours and craniocerebral trauma accounted for 27.2% and 20.5% of aetiology, respectively. The comparative DVT-positive versus DVT-negative group D-dimer levels were 7.9 versus 4.9 mg/L (P = 0.0065), duration of immobility 65.0 versus 35.3 days (P = 0.0001), and length of hospital (LOH) stay 32.5 versus 18.2 days (P = 0.0001). The proximal LE vessels were involved in 64.2%. The PE risk was 0.98%, with three mortalities. The predictive factors on multivariate logistic regression were elevated D-dimers (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.1–4.45 P = 0.030) and preoperative immobility >seven days ([OR] 2.38, 95% [CL] 1.28–4.39 P = 0.042). Gender, C-reactive protein, Glasgow Coma Scale, comorbidities, LOH, and chronic steroid use were not predictive. Conclusion: The overall incidence of DVT and mortality from PE were low among patients with neurological diseases. Most thrombi involved proximal LE veins. Elevated D-dimers and preoperative immobility >seven days were predictive factors for LE DVT.

Patterns and Distribution of Deep Vein Thrombosis and Its Effects on Clinical Outcomes After Opening-Wedge High Tibial Osteotomy.

Background:Although a few studies have reported the incidence of deep vein thrombosis (DVT) after opening-wedge high tibial osteotomy (OWHTO), previous studies focused only on symptomatic DVT. Information is lacking regarding the overall incidence of DVT after OWHTO, thrombus location, and the relationship between DVT and clinical outcome.Purpose:To determine the overall incidence of DVT and classify the location of DVT after OWHTO. We also determined whether significant differences in clinical improvement exist in patients with and without DVT at 6 months and at 2 years after OWHTO.Study Design:Case-control study; Level of evidence, 3.Methods:This study included 46 patients (47 knees) who underwent OWHTO. All patients were instructed to perform knee range of motion exercises and partial weightbearing after drain removal. None of the patients received a chemoprophylaxis for DVT except intermittent pneumatic compression. DVT was diagnosed using 128-row multidetector computed tomography performed before discharge on the fourth postoperative day. The location was classified into 6 segments in the distal portion (muscular and axial veins) and proximal portion (popliteal, femoral, and common femoral veins and veins located above the iliac vein). International Knee Documentation Committee (IKDC) score was assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years using a linear mixed model.Results:Although the incidence of symptomatic DVT was 8.5% (n = 4), the overall incidence of early DVT was 44.7% (n = 21). All DVTs were located in the distal portion of the lower extremity vein, and 76.2% of the DVTs were located in an axial vein. The IKDC scores were 33.6 ± 7.2 and 35.3 ± 9.1 (P = .910) preoperatively, 38.1 ± 5.6 and 40.6 ± 8.4 (P = .531) at 6 months after surgery, and 44.8 ± 6.9 and 45.9 ± 11.4 (P = .786) at 2 years after surgery in patients without and those with DVT, respectively.Conclusion:The overall incidence of early DVT after OWHTO was 44.7%. DVT after OWHTO was found particularly around the osteotomy site (76.2%). Patients with DVT did not have inferior short-term clinical outcomes after surgery.

Venous thromboembolism prophylaxis after ambulatory arthroscopic knee surgery: a systematic review and meta-analysis of incidence and risk factors (109)

Objectives:Over 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the United States annually, yet the reported incidence of venous thromboembolism (VTE) and the use of VTE thromboprophylaxis after ACL reconstruction and other arthroscopic knee surgeries still varies widely. Current VTE risk assessment scores, for example the Caprini score, incorporate arthroscopic surgery as a known risk factor but were not developed for stratification of an outpatient ambulatory surgical patient population. There is no current consensus to guide the orthopedic surgeon in prescribing chemoprophylactic agents after arthroscopic knee surgery. The objectives of this study were to determine the incidence, efficacy, and risk factors for VTE specifically following knee arthroscopic procedures. The null hypotheses of this study was that previously defined risk factors for VTE after ambulatory knee arthroscopy (age over 60 years, BMI greater than 30 kg/m2, tobacco use, prior VTE, malignancy, coagulopathy, oral contraceptive use, family history of coagulopathy, and prolonged tourniquet time greater than 90 minutes) would not reach statistical significance when compared across multiple cohorts. Our hypothesis is that a systematic review and meta-analysis of these variables will reject the null hypotheses with a significance of level of p < .05.Methods:A systematic review and meta-analysis was performed using data collected from 30 cohort and therapeutic trials (721,005 patients) published between January 2000 and April 2020 to compare both the incidence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) and associated risk factors after knee arthroscopy with or without thromboprophylaxis in adults. Ultrasound, venography, and International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes were deemed acceptable detection methods for VTE. We also performed a meta-analysis of published patient characteristics and risk factors in developing VTE after arthroscopic knee procedures. Individual studies were not evaluated for symptomatic versus asymptomatic VTE detection criteria or methods.Results:Of 331 eligible articles, 6 therapeutic RCTs and 24 cohort studies met the inclusion criteria. Overall incidence of DVT and PE was found to be 0.97% and 0.03% respectively. Analysis of the RCTs was found to support the use of prophylactic anticoagulation in preventing DVTs (relative risk: 0.24, 95% confidence interval [CI]: 0.13-0.44). After analysis of the cohort studies, age greater than 60 years was found to be a statistically significant risk factor for VTE (OR: 1.84, 95% CI: 1.03 – 3.29; p=.04) while a history of malignancy (OR: 2.61, 95% CI: 0.97 – 7.00; p=.06), and history of previous VTE (OR: 4.14, 95% CI: 0.90 – 19.14, p=.07) trended toward significance. Other factors such as BMI greater than 30 kg/m2, tobacco use, tourniquet time, personal or family history of coagulopathy, and oral contraceptive use were not found to be statistically significant risk factors for VTE after knee arthroscopy, however there were limited studies (one to three studies per risk factor) available to distinguish of a majority of these variables.Conclusions:Our results show that the overall incidence of DVT in adults after arthroscopic knee surgery is approaching 1% and that of PE is exceedingly rare, however this may be underestimated if asymptomatic VTE is not identified. Despite a low incidence of VTE after knee arthroscopy, thromboprophylaxis is effective in preventing VTE and trends in risk factors exist in ambulatory sports medicine patients diagnosed with VTE post-operatively. The risk for adverse bleeding events while taking chemoprophylaxis and requires further research. Only rejection of the null hypothesis on age over 60 years was statistically significant, however other defined risk factors may be clinically significant. With these results, we conclude that a preoperative assessment may be warranted in identifying at-risk, high risk, or multi-risk patients for which prophylactic anticoagulation postoperatively after knee arthroscopic procedures may be beneficial. A modified version of the Caprini score specifically stratifying these risk factors in an ambulatory sports medicine population may be valuable to the practicing orthopedic arthroscopic surgeon. More research is warranted for identifying risk factors to better stratify this unique patient population.

No difference in the incidence or location of deep venous thrombosis according to use of pharmacological prophylaxis following total knee arthroplasty

BackgroundThe incidence and characteristics of deep vein thrombosis (DVT) following total knee arthroplasty (TKA) without pharmacologic prophylaxis have not been fully investigated. This study aimed to determine whether there are any differences in the incidence, location, and characteristics of DVT following TKA with pharmacologic prophylaxis and without pharmacologic prophylaxis.MethodsA total of 156 knees were retrospectively evaluated for DVT following TKA by duplex ultrasound on postoperative day 7, after excluding 60 knees from 216 consecutive knees because of antiplatelet or anticoagulant use before surgery, history of venous thromboembolism, or bleeding risk. The 156 knees included in the analysis were divided into two groups: with pharmacologic prophylaxis (n = 79) and without pharmacologic prophylaxis (n = 77).ResultsThe overall incidence of DVT was 34% (54/156 knees). DVT was detected in 31.6% of knees with pharmacologic prophylaxis and in 37.6% of knees without pharmacologic prophylaxis; the difference was not statistically significant. Soleal vein thrombus was observed in 74.6% of the knees with DVT and non-floating thrombus was observed in 98.7%. There were no obvious between-group differences in thrombus characteristics such as compressibility, echogenicity, mean vein diameter, and whether the thrombus was attached to the vein wall or free-floating.ConclusionsNo differences were found in the incidence, location, or characteristics of DVT following TKA with or without pharmacological prophylaxis.

The risk of venous thromboembolism in cancer patients receiving chemotherapy: a meta-analysis with systematic review.

BackgroundThe Khorana score was developed to predict the risk of venous thromboembolism (VTE) in cancer patients receiving chemotherapy. However, the utility of the Khorana score remains controversial since different studies report varying results. This meta-analysis aims to analyze the incidence of VTE with different risk stratifications using the Khorana score for overall follow-up time, incidence of deep-vein thrombosis (DVT), incidence of pulmonary embolism (PE) and bleeding in cancer patients receiving chemotherapy.MethodsA systemic search was performed using PubMed, Embase, Cochrane Library and Web of Science for studies describing VTE incidence in cancer patients undergoing chemotherapy. The incidence of VTE was calculated using R computing software.ResultsWe included 13 studies in this meta-analysis, with a total of 5,852 cancer patients and 424 VTE cases. Results revealed that overall incidence of low, intermediate and high-risk groups were 2% (95% CI: 1–6%), 11% (95% CI: 6–18%) and 14% (95% CI: 9–20%), respectively. The overall incidence of DVT and PE were 6% (95% CI: 4–10%) and 4% (95% CI: 2–7%), respectively. Lastly, bleeding rate was 4% (95% CI: 2–8%).ConclusionsAccording to this meta-analysis, the Khorana score is suitable for cancer patients receiving chemotherapy in a 3–6-month timeframe rather than “forever”. The incidence of PE in this population was significantly greater than what was observed for non-cancer patients. More than half of VTE events occurred within 6 months of commencing chemotherapy.

Assessing the Risk for Development of Deep Vein Thrombosis among Chinese Patients using the 2010 Caprini Risk Assessment Model: A Prospective Multicenter Study.

Aim: We sought to validate the 2010 Caprini risk assessment model (RAM) in risk stratification for deep vein thrombosis (DVT) prophylaxis among Chinese bedridden patients.Methods: We performed a prospective study in 25 hospitals in China over 9 months. Patients were risk-stratified using the 2010 Caprini RAM.Results: We included a total 24,524 patients. Fresh DVT was found in 221 patients, with overall incidence of DVT 0.9%. We found a correlation of DVT incidence with Caprini score according to risk stratification (χ2 = 196.308, P < 0.001). Patients in the low-risk and moderate-risk groups had DVT incidence < 0.5%. More than half of patients with DVT were in the highest risk group. Compared with the low-risk group, risk was 2.10-fold greater in the moderate-risk group, 3.34-fold greater in the high-risk group, and 16.12-fold greater in the highest-risk group with Caprini scores ≥ 9. The area under the receiver operating characteristic curve was 0.74 (95% confidence interval, 0.71–0.78; P < 0.01) for all patients. A Caprini score of ≥ 5 points was considered the criterion of a reliably increased risk of DVT in surgical patients with standard thromboprophylaxis. Predicting DVT using a cumulative risk score ≥ 4 is recommended for nonsurgical patients.Conclusions: Our study suggested that the 2010 Caprini RAM can be effectively used to stratify hospitalized Chinese patients into DVT risk categories, based on individual risk factors. Classification of the highest risk levels using a cumulative risk score ≥ 4 and ≥ 5 provides significantly greater clinical information in nonsurgical and surgical patients, respectively.

Central Venous Line Associated Deep Vein Thrombosis in Hospitalized Children.

An increase in the incidence of deep vein thrombosis (DVT) has been reported in pediatric patients over the past decade. The presence of central venous line (CVL) is a major contributing risk factor with conflicting data on the relative risk of DVT with various types of central lines. We aimed to assess the incidence of and identify potential risk factors for DVT overall and with different types of CVL individually. A retrospective chart review of pediatric patients with a CVL placed at Cleveland Clinic Children's from 2011 to 2016 was conducted. Data collected included demographics, potential risk factors, CVL characteristics and related thrombotic events. The study cohort consisted of 376 CVLs in 325 patients between 0 and 26 years of age. There were 1.6 thrombi per 10,000 line-days (95% confidence interval: 1.0, 2.5), and the overall incidence of DVT was 5.1%. The incidence of DVT was highest with tunneled catheters (5/16=31%) versus with peripherally inserted central catheters (4/111=3.6%) or with ports (10/249=4%, P<0.001), and whereas there were overarching significant risk factors for CVL-associated thrombi, these risk factors differed in significance when analyzed by the CVL type. The study supports the need for continued improvement in pediatric hospital practices for early identification of patients at a higher thrombosis risk.

The Optimal Cutoff Level of D-Dimer during Pregnancy to Exclude Deep Vein Thrombosis, and the Association between D-Dimer and Postpartum Hemorrhage in Cesarean Section Patients.

The main purpose was to clarify the optimal D-dimer cutoff level during pregnancy to exclude deep vein thrombosis (DVT) prior to Cesarean section. The secondary purpose was to determine whether D-dimer can predict severe postpartum hemorrhage (PPH) in Cesarean section patients. Two hundred and seventy eight elective Cesarean section cases were enrolled. Clinical factors and blood parameters at 34-37 weeks of gestation were analyzed. To detect DVT, lower extremities veins were examined using color Doppler ultrasonography in cases with D-dimer level ≥ 1.5 μg/mL. In addition, postpartum blood loss amounts during Cesarean section were recorded. Five DVT cases occurred in 250 singleton pregnancies, and 2 DVT cases occurred in 28 twin pregnancies. The overall incidence of DVT was 2.5%. The D-dimer level was higher in DVT cases than in non-DVT cases (3.84±1.97 vs. 2.31±1.48 μg/mL, P<0.01). The optimal D-dimer cutoff level was 2.6 μg/mL with a negative predic tive value of 99.5%, and sensitivity of 85.7%. PPH during Cesarean section was positively correlated with D-dimer level in all pregnancies. However, this relationship disappeared after excluding twin pregnancies. A D-dimer level < 2.6 μg/mL at 34-37 weeks of gestation has the potential to exclude DVT. D-dimer can be an independent predictor for severe PPH for all Cesarean section cases, including twin pregnancies.

Chemoprophylaxis for deep vein thrombosis after hip surgery: The Indian prospective

Background: Deep vein thrombosis (DVT) or venous thromboembolism is a fatal complication of patients undergoing elective hip surgeries. Not much evidence is provided in the Indian literature regarding the incidence of DVT in the Indian population and ideal prophylaxis for the same. This issue has gained much importance in recent history due to the increase in a number of elective hip surgeries. Low-molecular-weight (LMW) heparin is commonly used for chemoprophylaxis against DVT. Our study is to identify the role of LMW heparin (enoxaparin) for prophylaxis against DVT. Materials and Methods: The present study is a prospective study for the role of enoxaparin in prophylaxis against DVT in patients of elective hip surgeries carried out over a period of 2 years. A total of 110 patients were selected based on the stringent inclusion and exclusion criteria. Randomization was done and patients were divided into two groups of 55 patients each. Group 1 (case) received postoperative enoxaparin at a dose of 40 mg subcutaneous daily for 7 days whereas Group 2 (control) did not receive any prophylaxis, following which color Doppler was performed on all patients. Results: The overall incidence of DVT in our study group was found to be 23.6%, of which 61.5% had distal thrombus and 28.5% had thrombus in the proximal vein. The incidence of DVT in case group was 12.5% compared to control group, in which the incidence of DVT was found to be 34.5%; hence, statistically significant difference (P = 0.0071) in the incidence of DVT was found in both groups. Duration of surgery and patient's age were two most significant risk factors associated with the occurrence of DVT. No statistically significant difference was noted regarding postoperative bleeding complications between two groups (P > 0.05). Conclusion: DVT/venous thromboembolism is relatively less common in Indian patients following elective hip surgeries as compared to the Western population, and LMW heparin is a safe and effective method of prophylaxis against DVT.

Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with aortic aneurysms: A nationwide cohort study.

Studies on the association between aortic aneurysm (AA) and the subsequent risk of venous thromboembolism (VTE) are limited to a few case reports and investigations which only focused on surgical effects. Therefore, we used the National Health Insurance Research Database to clarify whether patients with AAs have a heightened risk of subsequent VTEs, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Our retrospective cohort study comprised patients aged ≥ 18 years who received a diagnosis of an AA and were hospitalized at any point during 2000–2010 (n = 16,630). Each AA patient was frequency-matched to 4 non-AA hospitalized patients based on age, sex, and index year (n = 66,453). The Cox proportional hazard regressions model was used to estimate the adjusted effect of AAs on VTE risk. The overall incidence of DVT and PE was higher in the patients with AA than in the non-AA group patients (23.5 versus 13.2 and 13.5 versus 7.98/1,000 person-years). After adjustment for age, sex, duration of hospitalization in the study period, and comorbidities, patients with AAs were associated with a 1.88-fold higher risk of DVT and 1.90-fold higher risk of PE compared to the non-AA cohort. Patients with abdominal AAs were more likely to develop DVT, whereas thoracic AA patients were more likely to develop PE. A diagnosis of a ruptured AA was associated with a substantially increased risk of DVT. Surgical treatment of AAs was associated with a heightened risk of VTE within 6-months post-operation. Our study demonstrates that AAs are associated with an increased risk of subsequent VTE. Future investigations are encouraged to delineate the mechanisms underlying this association and to evaluate the cost-effectiveness of screening for VTEs in patients with AAs.

National Trends in Deep Vein Thrombosis following Total Knee and Total Hip Replacement in the United States

Total knee replacement (TKR) and total hip replacement (THR) are associated with an increased risk of deep vein thrombosis (DVT). Advances in DVT prophylaxis over the past decade have led to a decrease in DVT-related morbidity, but gender, racial, and other demographic factors that contribute to a higher risk of DVT are incompletely characterized. This study aimed to determine the incidence of DVT over the past decade and identify factors that were associated with an increased risk of DVT. Patients who underwent TKR or THR between 2001 and 2011 were identified using the National Inpatient Sample. For patients who developed a DVT, their demographics (including age, gender, and race), comorbidities, and subsequent outcomes (including length of stay [LOS] and mortality) were determined. Differences between patients who developed a DVT and those who did not were determined using multivariate regression analysis. A Mann-Kendall analysis was done to evaluate all trends. Between 2001 and 2011, a total of 1.1 million patients underwent TKR, and 550,000 underwent THR. The overall incidence of DVT decreased for TKR from 0.86% in 2001 to 0.45% in 2011 and decreased for THR from 0.55% to 0.24% for the same period. Patients who developed a DVT after TKR were older (67.7 vs. 66.8, P<0.001); more likely to be African American (P<0.001); and more likely to have significant comorbidities including congestive heart failure, peripheral artery disease, and end-stage renal disease. Findings were similar for patients who developed a DVT after THR. Mortality was significantly greater for patients who developed a DVT (0.4% for TKR and 1.7% for THR), with an almost double LOS. A focus on DVT prophylaxis may have decreased national rates of DVT after TKR and THR. Older patients, African Americans, and patients with more comorbidities appear to be especially at risk for DVT. Mortality is almost 4 to 8 times higher for patients with DVT, and LOS is double. A focus on DVT prophylaxis and perhaps more aggressive management of the at-risk population may further help decrease the rate of DVT.

Deep vein thrombosis in arthroscopic surgery and chemoprophylaxis recommendation in an Asian population.

There are currently no guidelines supporting the use of routine chemoprophylaxis to prevent deep vein thrombosis (DVT) in arthroscopic surgery. Studies and meta-analysis show opposing views on its routine use in arthroscopy. This study aimed to examine the incidence of DVT in a prospective cohort of knee arthroscopy and knee arthroplasty patients, and to analyse the risk factors contributing to DVT. All patients scheduled to undergo knee arthroscopy or arthroplasty over a two-year period were included. A standardised regimen of postoperative mechanical prophylaxis and rehabilitation was applied to all patients. Only patients who were postoperatively symptomatic were referred for ultrasonography. DVT incidence was calculated, and univariate and multivariate analyses of the risk factors were performed. The overall incidence of DVT was 0.5% among the 1,410 arthroscopy patients and 3.1% among the 802 arthroplasty patients. The incidence of proximal DVT among the arthroscopy and arthroplasty patients was 0.4% and 1.1%, respectively. Multivariate analysis showed that age was the only significant predictor of DVT incidence. Using the receiver operating characteristic method, the cut-off age for the arthroscopy and arthroplasty patients was 52 years, while that for the arthroscopy patients only was 40 years (increased risk of DVT: 5.46 and 6.44 times, respectively; negative predictive value: 99.7% and 99.8%, respectively). DVT incidence among Asian arthroplasty and arthroscopy patients remains low, even without chemoprophylaxis. Since age was found to be a significant risk factor for DVT, DVT prophylaxis can be considered for patients in high-risk age groups.

Pharmacological and Mechanical Thromboprophylaxis in Critically Ill Patients: a Network Meta-Analysis of 12 Trials.

Thromboprophylaxis for venous thromboembolism is widely used in critically ill patients. However, only limited evidence exists regarding the efficacy and safety of the various thromboprophylaxis techniques, especially mechanical thromboprophylaxis. Therefore, we performed meta-analysis of randomized controlled trials (RCTs) that compared the overall incidence of deep vein thrombosis (DVT) for between unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and intermittent pneumatic compression (IPC) in critically ill patients. A Bayesian random effects model for multiple treatment comparisons was constructed. The primary outcome measure was the overall incidence of DVT at the longest follow-up. The secondary outcome measure was the incidence of major bleeding, as defined by the original trials. Our analysis included 8,622 patients from 12 RCTs. The incidence of DVT was significantly lower in patients treated with UFH (OR, 0.45; 95% CrI, 0.22–0.83) or LMWH (OR, 0.38; 95% CrI, 0.18–0.72) than in patients in the control group. IPC was associated with a reduced incidence of DVT compared to the control group, but the effect was not statistically significant (OR, 0.50; 95% CrI, 0.20–1.23). The risk of DVT was similar for patients treated with UFH and LMWH (OR, 1.16; 95% CrI, 0.68–2.11). The risk of major bleeding was similar between the treatment groups in medical critically ill patients and also in critically ill patients with a high risk of bleeding. In critically ill patients, the efficacy of mechanical thromboprophylaxis in reducing the risk of DVT is not as robust as those of pharmacological thromboprophylaxis.

A randomized study of the safety and efficacy of fondaparinux versus placebo in the prevention of venous thromboembolism after coronary artery bypass graft surgery

Venous thromboembolism (VTE) after coronary artery bypass graft (CABG) surgery may increase the postoperative morbidity and mortality. Therefore, we examined the current postoperative need for prophylactic antithrombotic therapy after CABG surgery. This randomized, placebo-controlled, double-blind study was designed to compare the safety and efficacy of fondaparinux versus placebo in the prevention of VTE after CABG surgery. Between March 2010 and January 2013, 78 patients free from preoperative deep vein thrombosis (DVT) were enrolled, of whom 37 were randomly assigned to placebo and 41 to treatment with fondaparinux. The primary study end point was a composite, up to day 11, of (a) cumulative incidence of all VTE events, defined as symptomatic and asymptomatic DVT, and fatal and nonfatal pulmonary embolisms (efficacy end point), and (b) cumulative incidence of major hemorrhages (safety end point). A single asymptomatic DVT of a lower extremity was detected by duplex ultrasound at the time of discharge from the hospital in the placebo-treated group, and a single major postoperative hemorrhage occurred in the fondaparinux-treated group. The incidence of postprocedural asymptomatic DVT in this sample of patients undergoing CABG surgery was low. The overall incidence of DVT in the control and investigational treatment groups was similar. Our results showed no benefit of prophylactic postoperative fondaparinux in this population. These findings are congruent with other published studies and provide additional support for recent recommendations not to routinely use anticoagulant prophylaxis after cardiac surgery.

Preoperative Incidence of Deep Vein Thrombosis after Hip Fractures in Korean.

BackgroundThe purpose of the current study was to investigate the incidence of preoperative deep vein thrombosis (DVT) after hip fractures in Korea.MethodsIn this prospective study, we enrolled 152 Korean geriatric patients who had suffered hip fractures due to a simple fall and were hospitalized between January 2013 and December 2013. There were 52 male and 100 female patients, and their mean age was 78.2 years. There were 96 trochanteric fractures and 56 femoral neck fractures. All patients were examined for DVT: 26 by ultrasonography and 126 by computed tomography venography. The patients having DVT underwent inferior vena cava filter insertion before the surgical intervention.ResultsPreoperatively, none of the patients had any signs or symptoms of DVT; however, 4 patients were identified as having asymptomatic DVT. The overall incidence of DVT was 2.6% (4/152). The mean time to arrival at emergency room after injury was 32.6 hours. Mean time elapsed to undergo surgery after hospitalization was 24.9 hours. The average time to hospitalization after injury was 237 hours for patients with DVT versus 27.5 hours for patients without DVT. DVT developed within 72 hours in two of the 137 patients (1.4%) and after 72 hours in two of the remaining 15 patients (13.3%) hospitalized.ConclusionsWhile the preoperative incidence of DVT after hip fractures was relatively low (2.6%) in the Korean geriatric population, we confirmed that getting no treatment within 72 hours after injury increased the incidence of DVT. Thus, we conclude from this study that a workup for DVT should be considered in cases where admission or surgery has been delayed for more than 72 hours after injury.

Abstract 214: Trends in Venous Thromboembolism in Hospitalized Heart Failure Patients in the United States: Analysis of the 2002 to 2011 Nationwide Inpatient Sample Database

Background: Hospitalized patients with heart failure (HF) are at increased risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and these conditions are associated with increased in-hospital mortality, longer length of stay and higher healthcare costs. Guidelines have emphasized the need for DVT prophylaxis, but it is unclear if the incidence of VTE has changed or remained constant over the past years. Objectives: To determine temporal trends in incidence and outcomes of VTE in hospitalized HF patients. Methods: We used the 2002 to 2011 Nationwide Inpatient Sample databases to identify all HF-associated hospitalizations in patients aged ≥18 years. Patients with VTE (DVT or PE) were then identified using appropriate ICD-9-CM codes. We stratified patients according to age, gender, and primary or secondary HF hospitalizations. Logistic regression analysis was used to examine temporal trends in incidence and outcomes of VTE as well as to compare outcomes between HF patients with or without VTE. Results: The overall incidence of DVT, PE and VTE among 42,573,726 HF-associated hospitalizations was 1.5%, 1.0% and 2.5%, respectively. From 2002 to 2011, there was a significant increase in the incidence of DVT (1.2% to 1.6%, adjusted OR 1.35, 95% CI 1.33-1.36), PE (0.8% to 1.2%, adjusted OR 1.91, 95% CI 1.88-1.93), and VTE (2.0% to 2.8%, adjusted OR 1.56, 95% CI 1.55-1.58). Similar upward trend was observed in all age groups, men and women, as well as primary and secondary HF hospitalizations. In-hospital mortality decreased in HF patients without VTE (6.9% to 5.0%; adjusted OR 0.81, 95% CI 0.80-0.81) as well as those with VTE (13.3% to 9.8%, adjusted OR 0.79, 95% CI 0.74-0.85) during the study period. However, compared to HF patients without VTE, those with VTE had significantly higher in-hospital mortality, longer length of stay, and higher total hospital charges (Table). Conclusion: Despite the aggressive guidelines for DVT prophylaxis, the overall incidence of VTE in hospitalized HF patients has increased over the past 10 years. This may be explained by increasing co-morbidities and aging of the HF population. Further studies are needed to explain these adverse trends and to examine rates of adherence to VTE prophylaxis guidelines in this high-risk patient population.

Correlation of Missed Doses of Enoxaparin With Increased Incidence of Deep Vein Thrombosis in Trauma and General Surgery Patients

Enoxaparin sodium is widely used for deep vein thrombosis (DVT) prophylaxis, yet DVT rates remain high in the trauma and general surgery populations. Missed doses during hospitalization are common. To determine if missed doses of enoxaparin correlate with DVT formation. Data were prospectively collected among 202 trauma and general surgery patients admitted to a level I trauma center. Deep vein thrombosis screening was performed using a rigorous standardized protocol. The overall incidence of DVT was 15.8%. In total, 58.9% of patients missed at least 1 dose of enoxaparin. The DVTs occurred in 23.5% of patients who missed at least 1 dose and in 4.8% of patients who did not (P < .01). On univariate analysis, the need for mechanical ventilation (71.8% vs 44.1%), the performance of more than 1 operation (59.3% vs 40.0%), and male sex (75% vs 56%) were associated with DVT formation (P < .05 for all). A bivariate logistic regression was then performed, which revealed age 50 years or older and interrupted enoxaparin therapy as the only independent risk factors for DVT formation. The DVT rate did not differ between trauma and general surgery populations or in patients receiving once-daily vs twice-daily dosing regimens. Interrupted enoxaparin therapy and age 50 years or older are associated with DVT formation among trauma and general surgery patients. Missed doses occur commonly and are the only identified risk factor for DVT that can be ameliorated by physicians. Efforts to minimize interrupted enoxaparin prophylaxis in patients at risk for DVT should be optimized.