Perioperative Venous Thromboembolism Research Articles

Perioperative Venous Thromboembolism Chemoprophylaxis Does Not Increase Risk of Complications in Free Flap Breast Reconstruction.

Patients undergoing abdominal-based free flap breast reconstruction are at risk for perioperative venous thromboembolism (VTE), but the optimal anticoagulation protocol remains unknown. We hypothesized that a standardized chemoprophylaxis protocol would minimize VTE events without increasing hematoma, flap loss, or reoperation. A retrospective review was conducted on patients who underwent abdominal-based free flap breast reconstruction from 2010 to 2023. In 2015, we implemented an enhanced recovery after surgery (ERAS) protocol including preoperative enoxaparin. Patients with a BMI < 30 and > 30 received enoxaparin for 7 and 30 days postoperatively, respectively. 2010-2015 patients were pre-ERAS and 2015-2023 patients were the ERAS cohort. Patient demographics, comorbidities, and outcomes were analyzed. The primary outcomes were VTE, hematoma, flap loss, and reoperation. 2317 patients were included: 679 were pre-ERAS and 1638 were in the ERAS cohort. The incidence of deep vein thrombosis (0.7%) and pulmonary embolism (pre-ERAS 0.6% vs. ERAS 0.5%) was low in both cohorts with no significant differences. Hematoma (pre-ERAS 7.2% vs. ERAS 5.5%) and reoperation (pre-ERAS 7.8% vs. ERAS 9.7%) were similar, but the ERAS cohort had significantly lower flap failure (0.7% vs. 2.1%, p < 0.05). A standardized perioperative anticoagulation protocol for abdominal-based breast reconstruction maintained low VTE rates without increasing hematoma, flap failure, or reoperation.

Status of perioperative venous thromboembolism (VTE) prophylaxis in gastrointestinal surgery based on national clinical database (NCD) data in Japan.

To investigate the current status of perioperative venous thromboembolism (VTE) prophylaxis in gastrointestinal surgery in Japan. We reviewed data on eight gastroenterological procedures from the Japanese National Clinical Database (NCD), accrued between 2018 and 2020. Patient characteristics, prophylactic methods, postoperative bleeding, cardiac arrest, and postoperative mortality rate within 30days were retrieved. Despite recommendations, approximately 30% of patients did not receive VTE prophylaxis, suggesting a lack of awareness. Pharmacological prophylaxis was associated with a higher incidence of VTE than mechanical or no prophylaxis for all procedures. Combined prophylaxis resulted in a lower incidence of VTE than pharmacological prophylaxis alone. Pharmacological prophylaxis was also associated with an increased incidence of bleeding events. The risk of cardiac arrest and death was higher in patients with pulmonary embolism (PE), but there was a trend toward lower mortality in the group that received pharmacological prophylaxis. Pharmacological prophylaxis for VTE was limited in reducing the incidence of VTE, but it may reduce the risk of death. Combining pharmacological and mechanical prophylaxis tended to be more effective for preventing VTE than either method alone. Conversely, pharmacological prophylaxis may increase the risk of bleeding.

Influence of postoperative D-dimer evaluation and intraoperative use of intermittent pneumatic vein compression (IPC) on detection and development of perioperative venous thromboembolism in brain tumor surgery

Background ObjectiveVenous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication in craniotomy patients and is associated with increased morbidity and mortality. The duration of surgery is a known risk factor. Other factors such as positioning and tumor entity have hardly been investigated or are controversial.In two pilot studies, the determination of plasma D-dimer concentration led to a high detection rate of DVT, while the use of intermittent pneumatic venous compression (IPC) drastically reduced the incidence of VTE. In the present study we investigated the efficacy of the two approaches, either alone or in combination, in a large patient cohort.Methods1759 patients who underwent elective craniotomy between 2009 and 2023 were retrospectively analyzed. The staggered use of D-dimer determination and intraoperative use of IPC resulted in 3 groups: Group 1: no procedure; Group 2: D-dimer evaluation; Group 3: IPC and D-dimer evaluation. If the D-dimer level was ≥ 2 mg/l (Fibrinogen equivalent units; FEU), venous ultrasound was performed. Age, gender, tumor entity, duration and extent of surgery, patient positioning, type of VTE were also recorded and analyzed.ResultsThe introduction of postoperative D-dimer evaluation increased the rate of detection of thrombosis from 1.7% in group 1 to 22.6% in group 2. The addition of IPC reduced the rate of thrombosis to 4.4%. Age, gender and patient positioning did not affect the rate of VTE. We were able to confirm the duration of surgery as an individual risk factor and showed that WHO grade 4 tumors and metastasis have an increased VTE risk.ConclusionsIf D-Dimer levels are not analyzed routinely about 20% of craniotomy patients suffer from a clinically silent thrombosis. Each with the risk of fate PE. Intraoperative use of IPC during craniotomy dramatically reduces the risk of VTE.

A new simplified risk assessment model enhances postoperative prophylaxis of venous thromboembolism in Chinese adult patients with inguinal hernia (CHAT-3): a prospective, multicenter, randomized controlled trial.

Venous thromboembolism (VTE) significantly affects the prognosis of surgical patients with inguinal hernia. The complex Caprini score, commonly used for postoperative VTE risk assessment, poses practical challenges for surgeons in clinical settings. The CHAT-3 trial, a prospective, multicenter, randomized controlled trial, compared a simple three-factor model to assess VTE risk against routine practices in postinguinal hernia surgery (IHS) patients. The patients were randomly assigned (1:1) to the intervention or control arm. The intervention group used the three-factor model to identify patients at moderate or high risk of VTE for subsequent prophylaxis according to clinical guidelines. Both groups were followed for 4 weeks, with randomization implemented using computer-generated sequences. The primary outcome measured was the rate of VTE prophylaxis. Secondary outcomes included time spent on VTE risk assessment (surgeon self-reported), postoperative D-dimer trends, perioperative VTE occurrence, bleeding events, and the net clinical benefit. Of the 1109 participants, 508 in the experimental group and 601 in the control group completed follow-up. The three-factor model showed higher VTE prophylaxis rates in all patients (pharmacologic prophylaxis: 26.2 vs. 6.00%, P <0.001) and particularly in those at high risk (pharmacologic prophylaxis: 57.3 vs. 9.50%, P <0.001). The experimental group significantly reduced VTE risk assessment time compared to the Caprini score (1.39±0.55min vs. 5.73±1.35min, P <0.001). The experimental group had lower D-dimer levels (0.26±0.73mg/l vs. 0.35±0.55mg/l, P =0.028). In the experimental group, the patients did not experience an increased risk of VTE (0 vs. 1.66%, P =0.268) and bleeding (1.18 vs. 0.67%, P =0.558) compared to the controls. There was no significant difference in net clinical benefit, which combined VTE and bleeding events, between the experimental and control groups (1.18 vs. 0.83%, P =0.559). Applying the simple three-factor model in perioperative VTE management could quickly identify the patient with a high risk of VTE and improve the prophylaxis rate of perioperative VTE.

Defect width and operative time are the most significant predictors of venous thromboembolism in ventral hernia repair

BackgroundVenous thromboembolism is a significant cause of morbidity and mortality among patients undergoing ventral hernia repair. Several risk-assessment models have been developed to predict venous thromboembolism risk for various surgical procedures. However, these models do not include hernia-specific risk factors. Therefore, we sought to evaluate the predictors of venous thromboembolism in patients with a ventral hernia repair in a national hernia-specific database. MethodsThe Abdominal Core Health Quality Collaborative database was retrospectively queried for ventral hernia repair data. The ventral hernia repair procedures were divided into 2 groups on the basis of whether the patients developed perioperative venous thromboembolism. Baseline and operative characteristics and perioperative outcomes were compared between the 2 groups. The logistic regression was used to assess the association between different risk factors and venous thromboembolism. ResultsA total of 43,558 patients were included in the study. The 30-day venous thromboembolism rate among these patients was 0.62% (n = 269). Venous thromboembolism was associated with greater 30-day readmission (odds ratio, 4.29; 95% confidence interval, 3.20–5.76), reoperation (odds ratio, 3.97, 95% confidence interval, 2.63–6.00), and mortality rates (odds ratio, 5.95, 95% confidence interval, 2.62–13.48), all P < .001. Bivariate analysis identified a statistically significant association between several patient characteristics, operation, and hernia- related details; however, multivariate analysis revealed that that only hernia width (each increasing centimeter: odds ratio, 1.07, 95% CI, 1.05–1.09) and operative time compared with 0–59 minutes (60–119 minutes: odds ratio, 4.23; 95% confidence interval, 1.86–9.62; 120–179 minutes: odds ratio, 5.78; 95% confidence interval, 2.57–13.0; 180–239 minutes: odds ratio, 8.01; 95% confidence interval, 3.54–18.10; and 240+ minutes: odds ratio, 17.4; 95% confidence interval, 7.88–38.37) were significantly associated with venous thromboembolism risk. ConclusionsVenous thromboembolism is an uncommon complication of ventral hernia repair. It is associated with increased readmission, reoperation, and mortality rates. Larger defect width and operative time are most predictive of perioperative venous thromboembolism risk for patients undergoing ventral hernia repair.

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.: Chapter 3: Day surgery and fast-track surgery.

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.: Chapter 3: Day surgery and fast-track surgery.

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.: Chapter 9: Surgery during pregnancy and the immediate postpartum period.

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.: Chapter 9: Surgery during pregnancy and the immediate postpartum period.

Variations in Perioperative Thromboprophylaxis Practices: Do the Guidelines Need a Closer Look?

BackgroundIn 2022, the American Association for Thoracic Surgery (AATS) and the European Society of Thoracic Surgeons (ESTS) published joint guidelines regarding the timing, duration, and choice of agent for perioperative venous thromboembolism prophylaxis for thoracic cancer patients. Now, 1 year after their release, we looked to assess practices and general adherence to these recommendations. MethodsWe conducted a survey among board-certified/board-eligible thoracic surgeons in the United States, between July and October 2023. ResultsA total of 103 board-certified thoracic surgeons responded to the survey. Over half of the surgeons reported using preoperative chemical thromboprophylaxis routinely for lobectomy/sublobar resections (56.3%), pneumonectomy/extended lung resections (64.1%), and esophagectomy (67%). Over two thirds of thoracic surgeons limited the duration of postoperative chemical thromboprophylaxis to the patient’s length of hospital stay and never administered chemoprophylaxis post-discharge. Among surgeons who always continued chemical thromboprophylaxis post-discharge, low-molecular-weight heparin (LMWH) was the most commonly used agent (>70%), followed by direct oral anticoagulants (13.8%-16.7%). Only 33.3% of surgeons prescribing post-discharge chemical thromboprophylaxis after lobectomy/sublobar resections continued prophylaxis up to 4 weeks postoperatively. ConclusionsContrary to the 2022 joint AATS/ESTS guidelines, the majority of surveyed thoracic surgeons in the United States do not routinely prescribe postoperative thromboprophylaxis after lung and esophageal cancer resections. The dogma of routine extended thromboprophylaxis must be reevaluated as modern minimally invasive thoracic surgery allows for very earlier ambulation and enhanced recovery. There is a need for randomized controlled trials exploring the utility of extended thromboprophylaxis and newer agents such as direct oral anticoagulants.

Perioperative Venous Thromboembolism Risk in Patients Undergoing Hysterectomy for Fibroids: A US Retrospective Cohort Study

ObjectivesVenous thromboembolism (VTE) occurs in 0.4%–0.7% of benign hysterectomies. Pelvic vascular compression secondary to fibroids may elevate VTE risk. We aimed to evaluate the incidence and timing of VTE among individuals undergoing hysterectomy for fibroids and other benign indications. MethodsRetrospective cohort study of patients who underwent a hysterectomy for fibroid and non-fibroid indications from January 2015 to December 2021. Main outcome measure was VTE consisting of pulmonary embolism or deep venous thrombosis diagnosed during 3 periods: (1) preoperative (1 year before surgery until day before surgery), (2) early postoperative (surgery date through 6 weeks after surgery), and (3) late postoperative (6 weeks to 1 year after surgery). Demographics, comorbidities, surgical characteristics, and VTE rates were compared by indication. ResultsA total of 263 844 individuals with fibroids and 203 183 without were identified. In total, 1.1% experienced VTE. On multivariable regression (adjusted demographic confounders and route of surgery), the presence of fibroids was associated with increased odds of preoperative (adjusted odds ratio [aOR] 1.12; 95% CI 1.03–1.22, P = 0.011) and reduced odds of late postoperative VTE (aOR 0.81; 95% CI 0.73–0.91, P < 0.001). For individuals with fibroids, uterine weight ≥250 g and undergoing laparotomy were independently associated with preoperative (aOR 1.29; 95% CI 1.09–1.52, P = 0.003 and aOR 2.32; 95% CI 2.10–2.56, P < 0.001) and early postoperative VTE (aOR 1.32; 95% CI 1.08–1.62, P = 0.006 and aOR 1.72; 95% CI 1.50–1.96, P < 0.001). ConclusionsPatients with fibroids were at increased odds of having VTE 1 year before hysterectomy. For those with fibroids, elevated uterine weight and laparotomy were associated with greater risk of preoperative and early postoperative VTEs.

Perioperative Estrogen Hormonal Therapy Does Not Increase Venous Thromboembolism Risk in Facial Feminization Surgery.

Conflicting data exist regarding increased perioperative venous thromboembolism (VTE) risk with feminizing hormone therapy. The effect has been poorly studied within the transgender population. Acute perioperative cessation of feminizing hormone therapy often leads to unpleasant side effects and exacerbates gender dysphoria in the perioperative period. The authors sought to identify VTE incidence in patients undergoing facial feminization surgery while continuing hormone replacement therapy throughout the time of surgery. A 38-year retrospective cohort study within a 2-surgeon practice (D.K.O. and J.C.D.-B.) was designed to evaluate postoperative VTE in patients continuing hormone therapy. The primary outcome variable was postoperative VTE. A total of 1715 patients underwent facial feminization surgery within our search window. A total of 953 patients met final inclusion criteria. One patient (0.10%) was diagnosed with a VTE postoperatively, comparable to reported literature rates for similar cosmetic and orthognathic procedures. The average Caprini score of all patients was 3.1 ± 1.0 and the average case length was 491.9 ± 111.0 minutes. Subgroup analysis of patients before and after internal practice changes identified 714 patients (77.7%) continuing full-dose hormonal therapy perioperatively, 197 (20.7%) undergoing hormonal dose reduction to 25% to 50% perioperatively, and 8 who were either not taking hormonal therapy or stopped in the perioperative period. There was no significant difference in VTE incidence among the 3 subgroups ( P > 0.99). Perioperative use of feminizing hormonal therapy does not increase risk for perioperative VTE in patients undergoing facial feminization surgery. Therefore, it is reasonable to continue these medications through the time of surgery. Therapeutic, III.

Enhanced recovery after endoscopic sinus surgery: Establishing comprehensive protocols for improvement of perioperative patient care

AbstractObjectivesEnhanced recovery after surgery (ERAS) protocols for endoscopic sinus surgery (ESS) have not been widely implemented, and a critical review of ERAS recommendations and a comprehensive analysis of the supporting literature has not been undertaken. We describe an ESS ERAS protocol including key perioperative interventions for patients undergoing ESS and assess the available evidence.Data SourcesA search was conducted of all relevant ERAS literature in otorhinolaryngology, anesthesia, and surgery using Medline (via PubMed), and Scopus. Keywords included “endoscopic sinus surgery,” “sinus surgery,” “FESS,” and “ESS” for each area of intervention. Where applicable, the authors considered high‐level evidence for recommendations devised for patient cohorts in otorhinolaryngology not undergoing ESS, as well as cohorts undergoing surgical procedures for which ERAS protocols have been extensively evaluated.MethodsStudies received grades of “low,” “moderate,” or “high” quality evidence based on the Oxford Centre for Evidence‐Based Medicine criteria. Each intervention was subsequently assigned a grade of “strong,” “weak,” or “conditional” based on the available evidence.ResultsStrong recommendations include comprehensive patient education and counseling, minimization of preoperative fasting, application of topical/local anesthetics and vasoconstrictors, use of total intravenous anesthesia, avoidance of pharyngeal packing, and use of postoperative nasal irrigation and multimodal analgesia. Conditional recommendations include antibiotic prophylaxis. Weak recommendations include perioperative venous thromboembolism prophylaxis, controlled hypotension, and use of postoperative nasal packing/dressing.ConclusionA comprehensive ERAS protocol for ESS can include a variety of high yield, evidence‐based interventions that would likely improve surgical outcomes and patient satisfaction.

Seek and ye shall find: The utility of perioperative VTE screening in high-risk oncologic patients undergoing abdominopelvic surgery.

The aim of this study was to evaluate the prevalence and risk factors associated with perioperative venous thromboembolism (VTE) in patients undergoing major oncologic surgery using an epidural catheter (EC) for postoperative analgesia with mechanical prophylaxis and without chemoprophylaxis. Six hundred and twenty-sixpatients undergoing major oncologic surgery from 2009 to 2023 were evaluated. VTE was defined as deep vein thrombosis above the level of the knee. Lower extremity venous duplexes (LEVDs) were done preoperatively and postoperatively after the EC was removed. All patients received mechanical thromboprophylaxis, but not chemical prophylaxis, while the EC was in place. A generalized linear multivariable model was constructed to identify risk factors that predict pre and postoperative VTE. 29/626 patients (4.6%) were found to have preoperative VTE. 16/626 (2.6%) were found to have a postoperative VTE when their preoperative LEVD was negative. In comparison to patients without preoperative VTE, those with VTE were more likely to be male, anticoagulated, and have a history of coronary artery disease.Patients in the postoperative VTE group were older, male, anticoagulated, and had a history of VTE. On multivariable analysis, previous history of VTE was the risk factor most strongly associated with both pre and postoperative VTE. Oncologic patients undergoing elective abdominopelvic surgery with epidural analgesia should be screened in the perioperative setting with LEVD to identify VTE and possibly prevent PE.

(389) Incidence of Venous Thromboembolism and Hematoma Following Placement of Inflatable Penile Prosthetic: Safety of Perioperative Subcutaneous Heparin

Abstract Introduction Patients undergoing inflatable penile prosthetic (IPP) surgery are generally at a higher risk for cardiovascular (CV) complications such as venous thromboembolism (VTE) following surgery, due to pre-existing comorbidities, such as age, obesity, smoking status, and vascular disease, which are associated with erectile dysfunction (ED). The use of perioperative subcutaneous heparin (SqH) along with a surgical drain was shown to be effective in preventing VTE in IPP patients, without increasing hematoma formation. Not all prosthetic surgeons utilize surgical drains postoperatively and this is an unaddressed area of perioperative IPP surgical management. The American Urologic Association (AUA) and European Association of Urology (EAU) perioperative VTE guidelines do not address VTE risk with IPP surgery. Objective In this study we aim to assess the safety and efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain. Methods This was a retrospective review from January 2021-July 2023 of patients who underwent IPP placement or revision and replacement at a single institution. Patient demographics, comorbidities, Caprini risk factor scores, VTE risk factors, hematoma incidence, and 90-day post-operative complications were reviewed. Statistical analyses were performed comparing these variables in men who received SqH and those who did not. Results We reviewed data for 240 patients. Of the 240, 53% (n=127) received perioperative SqH. The incidence of VTE was 0.9% (1/113) in the non-SqH group, no VTE was recorded in the group receiving heparin. There was no statistical difference in hematoma formation between groups (SqH 5.5% vs. non-SqH 6.2% p=.898). Hypertension prevalence was found to be higher in the SqH group (p=.045). There was no statistical significance between other comorbidities including diabetes (p=.343), average BMI (p=.078), vascular disease (p=.155), immunosuppressed status (p=.604), smoker status (p=.530), history of malignancy (p=.513), COPD (p=.084), MI (p=.820), CVA/TIA (p=.158), hyperlipidemia (p=.157), and heart failure (p=.244). Average operative time was found to be slightly higher in the non-SqH group (SqH 78.1 minutes vs. non-SqH 85.9 minutes p=.032). Caprini risk factor scores were similar (SqH 6.79 vs. non-SqH 6.82 p=.474) between groups. 94% of the patients in this study were considered high risk for VTE (≥5 Caprini Risk factor score). Conclusions Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no increased risk of hematoma formation or post-operative complications between the groups. Perioperative SqH should be considered in all patients undergoing IPP surgery. Disclosure No.

Impact of peri-operative venous thromboembolism on survival in patients with endometrial clear cell carcinoma: A 10-year single-institution retrospective study.

Impact of peri-operative venous thromboembolism on survival in patients with endometrial clear cell carcinoma: A 10-year single-institution retrospective study.

Sequential Compression Device Compliance for Venous Thromboembolism in High-Risk Trauma: A Quality Improvement Study.

Hospital-acquired, perioperative venous thromboembolism is a recognized patient safety indicator in the adult trauma patient population. Mechanical prophylaxis has been identified as a standard intervention to reduce the incidence of venous thromboembolism when prescribed along with anticoagulation or if anticoagulation is contraindicated in the surgical population. Adherence to consistent mechanical prophylaxis remains a nursing issue impacted by numerous factors in patient care. The purpose of this quality improvement project was to improve the compliance of sequential compression device utilization to decrease the hospital-acquired, perioperative venous thromboembolism rate in the adult hospitalized trauma patient population. A pre- and postintervention quality improvement approach utilized a nurse-led strategy to engage multidisciplinary team members to increase the consistency of sequential compression device utilization on patients within trauma units. The patient safety indicator rate per 1,000 for hospital-acquired, perioperative venous thromboembolism was monitored for improvement. The patient safety indicator rate per 1,000 for hospital-acquired, perioperative venous thromboembolism demonstrated a decline from 10.60 to 4.95 rate per 1,000 over 12 months. In the trauma units, sequential compression device compliance increased from an initial direct observation audit of only 12% to an average of 65% compliance rate during the last 16-week audits. We found that a multidisciplinary, nurse-driven approach in the trauma units was effective in improving the compliance of sequential compression device utilization and impacted the hospital acquired, perioperative venous thromboembolism rate in the adult trauma patient population.

Application of integrated medical information management system in the risk assessment and prevention of perioperative venous thromboembolism in gynecological patients

Application of integrated medical information management system in the risk assessment and prevention of perioperative venous thromboembolism in gynecological patients

Hormonal Contraception and Menopausal Hormone Therapy: A Reference for Orthopaedic Surgeons

BACKGROUND: Exogenous estrogen is a double-edged sword in the realm of orthopaedic surgery, providing many musculoskeletal health benefits to menopausal women yet adding an additional risk of venous thromboembolism (VTE) in the perioperative setting for patients using certain forms of hormonal contraception and menopausal hormone therapy (MHT). The primary objective of this review is to summarize the known literature regarding the VTE risks of perioperative medications containing exogenous estrogen among orthopaedic patients. A secondary objective is to provide guidance to orthopaedic surgeons regarding perioperative management of commonly encountered forms of hormonal contraception and MHT. METHODS: A summative review of existing literature regarding VTE risk of various forms of hormonal contraception and MHT is provided, with emphasis on perioperative VTE risk surrounding major and minor orthopaedic surgery. RESULTS: Increased risk of VTE has been identified after arthroscopic knee procedures in patients utilizing oral contraceptive pills and after major lower extremity surgery in patients using MHT, yet there is not a clear standard of care as to how to manage these medications after surgery or how and when to adjust VTE prophylaxis. Regardless of the mode of delivery (pills, patches, vaginal rings), hormonal contraception with exogenous estrogen carries some associated VTE risk that can be compounded by surgery. Depo-Provera has also demonstrated increased risk. Forms of hormonal contraception without elevated VTE risk are progestin only pills and intrauterine devices (IUDs) as well as Nexplanon. MHT with systemic level doses of exogenous estrogen delivered orally has associated VTE risk. While systemic transdermal and transvaginal formulations of estrogen have not been shown to increase VTE risk in the non-surgical state, the risk when combined with the perioperative state after major operations is not yet known. Local estrogen therapies for vaginal symptoms of menopause do not increase risk of VTE. CONCLUSION: Given the frequent utilization of hormonal contraception and MHT, orthopaedic surgeons should consider the use of medications containing exogenous estrogen in the perioperative VTE risk assessment of patients. Further discussion toward the perioperative management of these medications and standardization of care for patients with increased VTE risks should be encouraged.

Abstract 13691: New Model for Prevention and Management of Venous Thromboembolism After Heart Valve Surgery

Introduction: Venous thromboembolism (VTE) is one of the possible complications that can occur after heart valve surgery. Exploring effective VTE prevention and management models for post-cardiac surgery is an important issue in perioperative management. Hypothesis: We hypothesized that a new model for VTE prevention and management can effectively reduce the incidence of VTE in patients undergoing heart valve surgery. Methods: A total of 1200 patients who underwent heart valve surgery were included in this study and randomized in a 1:1 ratio into the control group and new management group. The control group received basic VTE prevention measures, while the intervention group implemented a newly designed VTE prevention and management protocol in addition to the basic preventive measures. The protocol included multidisciplinary team training and assessment, a comprehensive VTE evaluation mechanism, proper execution of preventive measures, physical and mechanical prophylaxis, patient rehabilitation training, and education. The primary outcome measure was the incidence of perioperative VTE, and secondary outcome measures included the occurrence of postoperative pulmonary embolism and all-cause mortality after heart valve surgery. Results: The intervention group included a total of 600 patients, with 57.6% being male and an average age of 56.7 ± 13.4 years. The control group also included 600 patients, with 55.5% being male and an average age of 57.5 ± 12.8 years. There were no significant differences in general clinical data between the two groups. The incidence of in-hospital deep vein thrombosis (DVT) in the intervention group was significantly lower than that in the control group (0.3% vs 1.5%, P&lt;0.05). However, there were no significant differences between the two groups in terms of in-hospital pulmonary embolism and early postoperative all-cause mortality. The intervention group showed a significantly higher accuracy rate in VTE risk assessment compared to the control group (91.3% vs 87.9%, P&lt;0.05). Conclusions: The new model for VTE prevention and management can effectively reduce the incidence of VTE in patients undergoing heart valve surgery, providing important evidence for the prevention and management of VTE in cardiac surgery.

Caprini Model Integration into an Electronic Medical Record to Improve Perioperative Venous Thromboembolism Prophylaxis.

This quality-improvement retrospective cohort study of patients undergoing major elective nononcologic gynecologic surgery compares the proportion of patients receiving appropriate perioperative venous thromboembolism (VTE) chemoprophylaxis before and after a novel integration of the Caprini risk-assessment model (RAM) into the electronic medical record (EMR). A sample size of 83 patients in each group (166 total) was calculated to provide 80% power and show a 20% increase in appropriate administration of VTE prophylaxis, with an alpha of 0.05. Heparin was appropriately used in 24 patients (28.9%) in the pre-Caprini-RAM group and 39 patients (47.0%) in the post-Caprini-RAM group ( P =.016). There were no differences in bleeding events, transfusions, or other secondary outcomes. Integrating the Caprini-RAM into an EMR for patients undergoing nononcologic gynecologic surgery significantly improved appropriate use of VTE chemoprophylaxis.

PB1461 Peri-Operative Venous Thromboembolism (VTE) Risk for Below Knee Amputations

PB1461 Peri-Operative Venous Thromboembolism (VTE) Risk for Below Knee Amputations