Postoperative Deep Vein Thrombosis Prophylaxis Research Articles

Incidence and risk factors of venous thromboembolism in the perioperative period of spine surgery at a tertiary care hospital

Objectives: Spine surgery is considered a moderate risk for developing venous thromboembolism (VTE). To the best of our knowledge, no study has been done to determine the incidence of VTE in our local population. We aimed to study the incidence of VTE and determine the factors associated with developing VTE post-spine surgery. Methods: A retrospective study analyzed 800 adult patients who had undergone elective or emergency spine surgery. The variables included were demographic data, diagnosis, “or trauma if applicable,” type and duration of surgical intervention, and length of hospital stay. In addition, two procedures were used to diagnose VTE, whether it was a pulmonary embolism (PE) or deep vein thrombosis (DVT) pre- and postoperatively. Spiral computed tomography was used to detect PE, whereas duplex ultrasonography was used to confirm DVT. Finally, all patients received post-operative DVT prophylaxis except for cervical spine patients. Results: Eight hundred patients were included in the study. The overall incidence of VTE was 4.1%. The lumbar spine was the most common location operated on. Increasing age and length of hospital stay were both significantly associated with the development of VTE. Furthermore, cervical spine surgery had a lower incidence of VTE than other locations, with a statistically significant difference. Finally, non-ambulatory patients had a higher risk of VTE than patients who could ambulate postoperatively, with a statistically significant difference. Conclusion: The incidence of VTE after spine surgery is considered low but carries high morbidity and mortality rates. Increased age and prolonged hospital stay increase its risk, while early ambulation lowers it. Prophylactic measures against VTE are highly recommended, especially amongst high-risk patients.

Aspirin may not be effective in prevention of deep vein thrombosis after meniscus root repair: a retrospective cohort study

Background:Arthroscopic knee surgery has been associated with a low risk of symptomatic deep vein thrombosis (DVT), with previous studies demonstrating a risk of 0.12% to 3.7%. This risk of DVT and ideal prophylaxis in cases of meniscus root repair are unknown. The authors sought to determine the effectiveness of aspirin as DVT prophylaxis after meniscus root repair. The hypothesis was that there is no significant difference in the risk of symptomatic DVT after meniscus root repair with aspirin prophylaxis as compared with low molecular weight heparin (LMWH) or apixiban.Methods:Patients treated with repair of medial or lateral meniscus root tears over a 3 yr period were identified retrospectively. The risk of subsequent development of a symptomatic DVT was compared based on whether postoperative DVT prophylaxis was undertaken with aspirin or a stronger anticoagulant such as LMWH or apixiban.Results:Fifty-eight patients who underwent root repair (19 lateral and 39 medial) were identified. No symptomatic DVTs were identified in 42 patients (0%) who received LMWH or apixiban, but DVTs were identified in 3 of 16 patients (19%) who received aspirin (P=0.018). No significant differences in patient gender or body mass index, laterality of repair, associated procedures, or smoking history were noted between the groups. The aspirin group included older patients (mean age 49 yr) than those in the LMWH/apixiban group (mean age 39 yr).Conclusions:Aspirin alone may not be sufficient to prevent DVT after meniscus root repair. Additional work is required to clarify ideal DVT prophylaxis following this procedure.Level of Evidence:Level III.

Comparison of the Efficacy of Aspirin with Rivaroxaban in Postoperative DVT Prophylaxis after Hip Arthroplasty

Background: Patients suffering from severe hip arthritis and osteonecrosis are increasingly turning to total hip arthroplasty (THA) as a treatment option, according to recent research. If deep vein thrombosis (DVT) is not treated properly, it can result in a life-threatening pulmonary embolism as well as other potentially life-threatening consequences (PE). Aim: To compare the efficacy of aspirin with rivaroxaban in postoperative dvt prophylaxis after hip arthroplasty in patients at tertiary care hospital, Karachi Methodology: The College of Physicians and Surgeons of Pakistan approved this study prior to its completion. The Department of Orthopedics at JPMC, Karachi, chose those who had complete hip arthroplasty for the study. The school's ethical committee approved the study before it could begin. Before participating in the trial, all patients signed an informed consent form granting them permission to do so. Results: Patients from JPMC Karachi's Department of Orthopedics were included in the study. They were aged 49 to 75. Travel time to the hospital was an average of 58.878.19 years. They were aged 49 to 75. For every month, hour, and day spent in hospital, there are 14.416.14. Eighty people used aspirin, 32(40%) were 40-60 and 48(60%) were 61-75. In the rivaroxaban group, 40 patients (50%) were 40-60, and (61-75). The aspirin group had 80 patients, 38 male (47%) and 42 female (42%) (52.5%). One hundred and twenty-five patients (68.8%) were on rivaroxaban (31.2%). Conclusions: People who have a spontaneous venous thromboembolism should not be given long-term thromboprophylaxis after taking oral anticoagulants until more research is done. It is very important to figure out what DVY risk factors are in order to come up with preventative measures that are both safe and affordable. People can live longer if they get an early diagnosis and get treatment quickly, so they can live longer. High-quality, large-scale studies must be done before a conclusion can be drawn. Keywords: DVY risk, thromboembolism, thromboprophylaxis, arthroplasty

Cervical Spinal Fusion in Adult Patients With Rheumatoid Arthritis: A National Analysis of Complications and 90-day Readmissions.

Retrospective cohort study. The purpose of this study was to utilize the National Readmission Database to determine the national estimates of complication and 90-day readmission rates associated with cervical spinal fusion in adult patients with rheumatoid arthritis (RA). RA patients who undergo cervical spine surgery are known to be at high risk for readmissions, which are costly and may not be reimbursed by Medicare. The National Readmission Database was queried for adults (>18 years) diagnosed with RA undergoing cervical spine fusion. Patient, operative, and hospital factors were assessed in bivariate analyses. Independent risk factors for readmissions were identified using stepwise multivariate logistic regression. From 2013 to 2014, a total of 5597 RA patients (average age: 61.5 ± 11.2 years, 70.9% female) underwent cervical spine fusion. A total of 691 (12.3%) patients were readmitted within 90 days (). Index inpatient complications included dysphagia (readmitted: 7.9% vs. non-readmitted: 5.1%; P = 0.003), urinary tract infection (UTI) (8.8% vs. 3.7%; P < 0.001), respiratory-related complications (7.6% vs. 3.4%; P < 0.001), and implant-related complications (5.4% vs. 2.7%; P < 0.001). Multivariate logistic regression demonstrated the following as the strongest independent predictors for 90-day readmission: intraoperative bleeding (odds ratio [OR]: 3.6, P = 0.001), inpatient Deep Vein Thrombosis (DVT) (OR 4.1, P = 0.004), and patient discharge against medical advice (OR 33.5, P = 0.001). Readmission rates for RA patients undergoing cervical spine surgery are high and most often due to postoperative infection (septicemia, UTI, pneumonia, wound). Potential modifiable factors which may improve outcomes include minimizing intraoperative blood loses, postoperative DVT prophylaxis, and discharge disposition. 3.

Trends in Deep Vein Thrombosis Prophylaxis and Deep Vein Thrombosis Rates After Total Hip and Knee Arthroplasty.

Patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are at high risk of deep vein thrombosis (DVT) postoperatively, necessitating the use of prophylaxis medications. This investigation used a large claims database to evaluate trends in postoperative DVT prophylaxis and rates of DVT within 6 months after THA or TKA. Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases were reviewed from 2004 to 2013 for patients who underwent THA or TKA. Data were collected on patient age, sex, Charlson Comorbidity Index, and hypercoagulability diagnoses. Postoperative medication claims were reviewed for prescribed aspirin, warfarin, enoxaparin, fondaparinux, rivaroxaban, and dabigatran. A total of 369,483 patients were included in the analysis, of which 239,949 patients had prescription medication claims. Warfarin was the most commonly prescribed anticoagulant. Patients with a hypercoagulable diagnosis had markedly more DVTs within 6 months after THA or TKA. More patients with a hypercoagulable diagnosis were treated with warfarin or lovenox than other types of anticoagulants. A multivariate regression analysis was performed, showing that patients prescribed aspirin, fondaparinux, and rivaroxaban were markedly less likely than those prescribed warfarin or enoxaparin to have a DVT within 6 months after THA or TKA. After THA and TKA, warfarin is the most commonly prescribed prophylaxis. Patients with hypercoagulability diagnoses are at a higher risk of postoperative DVT. The likelihood of DVT within 6 months of THA and TKA was markedly higher in patients treated with warfarin and lovenox and markedly lower in those treated with aspirin, fondaparinux, and rivaroxaban. Level III.

Independent Predictors of 30-Day Perioperative Deep Vein Thrombosis in 1346 Consecutive Patients After Spine Surgery

Deep vein thrombosis (DVT) is a morbid postsurgical complication. Identifying the perioperative DVT risk profile will improve surgeons' ability to assess patients for surgical candidacy. In addition, these data will help to identify patients who would benefit from DVT chemoprophylaxis. We evaluated all medical records for 1346 consecutive patients who underwent spinal surgery at Duke University for incidence of DVT within 30 days of surgery and documented all demographic, preoperative, operative, and postoperative variables. DVT treatment and long-term outcomes were also documented. Associations between postoperative DVT and individual risk factors in all patients were determined using adjusted logistic regression analysis. Patients were stratified into emergent and elective groups and a similar analysis was performed. Overall, 15 patients (1.1%) had a DVT in the 30 days after surgery, 7 patients (0.6%) after elective surgery and 8 patients (4.2%) after emergent surgery (P = 0.03). Overall, multivariate logistic regression determined that previous DVT, postoperative urinary tract infection, and creatinine level >2.0 mg/dL were identified as positive predictors. When stratified by emergent surgery, we found packed red blood cell transfusion, surgical blood loss >2.0 L, and deep surgical site infection to be independently associated with increased risk of postoperative DVT. When stratified by elective surgery, we found that coronary artery disease and atrial fibrillation were associated with increased risk of DVT. No patients died in the 30-day perioperative period and 5 (33.3%) patients died within 1 year. This study identifies patient factors predictive of postoperative DVT. Postoperative DVT prophylaxis may be warranted for patients undergoing emergent spine surgery because these patients have significantly higher risk of developing postoperative DVT.

A randomised clinical trial comparing the patient comfort and efficacy of three different graduated compression stockings in the prevention of postoperative deep vein thrombosis.

To compare the comfort levels of patients regarding the use of three different graduated compression stockings and to analyse the efficacies of the graduated compression stockings in relation to patient comfort and compliance in prevention of postoperative deep vein thrombosis. Graduated compression stockings are very important with other prophylaxis methods in postoperative deep vein thrombosis prophylaxis. In meta-analyses and systematic review studies, it was reported that knee-length and thigh-length graduated compression stockings had similar efficacies. However, there is no randomised study in literature regarding the patient problems and levels of comfort with the use of graduated compression stockings of different sizes and pressures. A randomised clinical trial design. A total of 219 patients were randomised into three groups (n=73 in each group). Group I was given low-pressure, knee-length graduated compression stockings, group II was given low-pressure, thigh-length graduated compression stockings and group III was given moderate-pressure, knee-length graduated compression stockings. The level of patients comfort regarding the graduated compression stockings and occurrence of deep vein thrombosis were examined. The vast majority of the patients (79·5%) in group III and 52·1% of the patients in group II stated experiencing problems during the use of the graduated compression stockings (p<0·001). The graduated compression stockings were reported by the patients as being very comfortable in the group I (p<0·001). No findings of thrombosis were observed in any of the groups. The low-pressure, knee-length graduated compression stockings are as effective as the other graduated compression stockings of different pressures and sizes in the postoperative deep vein thrombosis prophylaxis, and the patients have fewer problems while using these graduated compression stockings with a high satisfaction. The combined use of pharmacological, mechanical and physical methods and patient education is effective in the prevention of postoperative deep vein thrombosis. The use of low-pressure, knee-length graduated compression stockings in clinical practice may be recommended, as the patients have fewer problems while using these graduated compression stockings with a high satisfaction.

Quantification of chondroitin sulfate and dermatan sulfate in danaparoid sodium by 1H NMR spectroscopy and PLS regression

Danaparoid sodium (the active pharmaceutical ingredient in Orgaran; Merck Sharp and Dohme) is a biopolymeric non-heparin drug used as anticoagulant and antithrombotic agent approved for the prophylaxis of post-operative deep-vein thrombosis, which may lead to pulmonary embolism in patients undergoing, e.g., elective hip replacement surgery. It consists of a mixture of three glycosaminoglycans (GAGs): heparan sulfate (HS), dermatan sulfate (DS), and chondroitin sulfate (CS). Currently, the CS and DS content are quantified by means of a time-consuming enzymatic method. In this paper the use of (1)H NMR in combination with multivariate regression (partial least-squares, PLS) is proposed as a new method. In order to evaluate the proposed method, a series of danaparoid sodium samples were analyzed and the results were compared with those obtained by the enzymatic method (reference method). The results showed that the proposed (1)H NMR method is a good alternative for analysis of CS and DS in danaparoid sodium. Accuracy of ±0.7% (w/w) and ±1.1% (w/w) for CS and DS was obtained by the (1)H NMR method and accuracy of ±1.0% (w/w) and ±1.3% (w/w) by the enzymatic method. Furthermore, the use of (1)H NMR in combination with PLS results in a fast quantification. The analysis time is reduced to 35min per sample instead of 60h for a maximum of 16 samples.

Factor V Leiden and the risk of proximal venous thrombosis after total hip arthroplasty

Deep vein thrombosis (DVT) remains a major cause of morbidity in patients undergoing total hip arthroplasty (THA). Despite postoperative DVT prophylaxis, 20–50% of THA patients still develop DVT. Currently, there is no accurate way of predicting which patients will develop DVT despite standard prophylaxis. The presence of factor V Leiden is the most common cause of inherited DVT risk. It has been postulated that patients who have factor V Leiden and are subjected to thrombogenic stressors such as THA would have an increased risk of thrombosis. The factor V Leiden genotype of 36 patients who developed proximal DVT after surgery and 45 control patients who had THA but did not develop DVT was determined. All patients had had prophylaxis against thrombosis using intermittent pneumatic compression alone or in combination with warfarin or aspirin. Surveillance for proximal DVT was performed on all patients prior to discharge by duplex ultrasound. The 2 groups were similar in age, sex, and type of operation. Three of 36 study patients who had developed DVT (8%) and 2 of 45 control patients who had not developed DVT (4%) were heterozygotes for factor V Leiden; these prevalences were not statistically different. Heterozygosity for factor V Leiden is not associated with DVT prophylaxis failure in patients undergoing THA.

The effect of compression on venous stasis.

Skin blood flow in the lower leg is increased by external compression in standing subjects. This prevents the hypoxia induced by standing. The maximum increase in oxygen tension is seen when the external pressure is 40-50 mmHg. Pressures in the range of those produced by lightweight elastic stockings were found to be ineffective. Our results uphold the commonly held clinical opinion that only compression bandages or strong stockings are effective in the treatment of venous ulcers. External compression when the subject is recumbent causes skin oxygen tension to fall. Uniform external pressure exceeding 10 mmHg should therefore be avoided in the prophylactic treatment of post-operative deep-vein thrombosis. This observation suggests that when the patient is confined to bed, only lightweight stockings are safe in the prophylaxis of post-operative deep-vein thrombosis.