Prevention Of Venous Thromboembolic Complications Research Articles

Indirect Electroimpulse Myostimulation and Its Role in Treatment of Patients with Shin Bone Fractures

Prospective randomized controlled study to evaluate the efficacy of electric muscle stimulation (EMS) of calf muscles in prevention of venous thromboembolic complications (VTEC), shortening of treatment and rehabilitation terms in patients with shin bones fractures was performed. The study included 60 patients, aged 19-67 years, with isolated shin bones fractures. All patients were admitted at early (from 0.5 to 3 hours) terms after injury. For final fixation either intramedullary or plate osteosynthesis were used. All patients were on anticoagulant therapy for VTEC prevention. In the study group ( n =30) 2 séances of EMS, 3 hours each, were performed daily from the first day of hospitalization. In 30 patients from the control group EMS was not performed. It was shown that application of EMS ensured the shortening of treatment and rehabilitation terms, better quality of life and enabled to avoid VTEC development. Achieved preliminary data are indicative of the expediency of EMS application in traumatologic patients at early hospital stage.

Prevention of Venous Thromboembolic Complications in Wounded with Gunshot Femur Fractures

Analysis of different measures for the prevention of venous thromboembolic complications (VTEC) in 128 wounded with gunshot femur fractures was performed. Patients from control group (58) received pharmacologic prevention only at the step of specialized medical care provision. In the main group (70) combined VTEC prevention was provided at both the step of expert and specialized care. Rate of lower extremity deep vein thrombosis (LEDVT) made up 27.1% in the main group and 55.2% (p<0.05) in the control one. Pulmonary embolism was recorded in 1.6% of wounded from the control group. Laboratory examinations showed the presence of thrombinemia within 30 days of hospital treatment that is indicative of the necessity of long term complex VTEC prevention. Study of the allele polymorphism of genes participating in thrombogenesis process revealed congenital thrombophilias in 61.9% of wounded.

Prevention of Venous Thromboembolic Complications in Wounded with Gunshot Femur Fractures

Analysis of different measures for the prevention of venous thromboembolic complications (VTEC) in 128 wounded with gunshot femur fractures was performed. Patients from control group (58) received pharmacologic prevention only at the step of specialized medical care provision. In the main group (70) combined VTEC prevention was provided at both the step of expert and specialized care. Rate of lower extremity deep vein thrombosis (LEDVT) made up 27.1% in the main group and 55.2% (p

Use of Dabigatran Etexilate for Prevention of Venous Thromboembolic Complications in Long Bone Fractures

Complex dynamic examination of 68 patients with fractures of lower extremities long bones. In first comparative group (36 patients, mean age 36.3±1.4 years) prevention of thromboembolic complications was performed with parenteral direct anticoagulants followed by vitamin K antagonists. In second group (32 patients, mean age 39.3±2.0 years) dabigatran etexilate was used. Duration of anticoagulant therapy made up 30 days. It was noted that in fractures of long bones of the extremities application of dabigatran etexilate ensured effective, prognosticating, stable anticoagulant action and did not require routine control of coagulation parameters that enabled to recommend that drug for wider use in trauma and orthopaedic patients.

Use of Dabigatran Etexilate for Prevention of Venous Thromboembolic Complications in Long Bone Fractures

Complex dynamic examination of 68 patients with fractures of lower extremities long bones. In first comparative group (36 patients, mean age 36.3±1.4 years) prevention of thromboembolic complications was performed with parenteral direct anticoagulants followed by vitamin K antagonists. In second group (32 patients, mean age 39.3±2.0 years) dabigatran etexilate was used. Duration of anticoagulant therapy made up 30 days. It was noted that in fractures of long bones of the extremities application of dabigatran etexilate ensured effective, prognosticating, stable anticoagulant action and did not require routine control of coagulation parameters that enabled to recommend that drug for wider use in trauma and orthopaedic patients.

Prevention of venous thromboembolic complications with and without intermittent pneumatic compression in neurosurgical cranial procedures using intraoperative magnetic resonance imaging. A retrospective analysis

ObjectTo evaluate the introduction of intraoperative and postoperative pneumatic compression additionally to the use of compression stockings, low molecular weight heparin-LMWH and early mobilization, a retrospective study in cranial neurosurgery using intraoperative MRI was performed. MethodsA retrospective analysis of 207 neurosurgical patients using intraoperative MRI was performed. A group of 86 patients was treated with the additional use of intraoperative and postoperative pneumatic compression until mobilization out of bed. One hundred twenty-one patients were treated without the use of additional pneumatic compression. Postoperatively the patients were screened for deep venous thrombosis by ultrasound and pulmonary embolism by CT-scan if suspicious. Statistical analysis was performed. ResultsThe development of deep venous thrombosis was reduced from 9.9% to 3.5% in our patients with the additional use of intraoperative and postoperative pneumatic compression. That is a 64.6% relative risk reduction to develop deep venous thrombosis with the use of intraoperative and postoperative pneumatic compression.An additional 52% relative risk reduction was found for the chance of developing pulmonary embolism.In the 15 patients with detected deep venous thrombosis, the OR-time was more than 100min longer than in the 192 patients without detected deep venous thrombosis. The difference between both groups was significant. ConclusionThis study demonstrates the benefit of pneumatic compression with a risk reduction for the development of thromboembolic complications. OR-time is another risk factor that attributes to a significant risk for the development of thromboembolic complications.

Multimodal prevention of venous thromboembolic complications after total hip and knee joint endoprosthesis

Multimodal prevention of venous thromboembolic complications after total hip and knee joint endoprosthesis

Assessment of the adequacy of the prevention of thromboembolic complications in patients after major orthopedic operations in ukraine (study ENOVA)

Among the complications occurring in patients after severe orthopedic surgeries the most dangerous stuff for life is venous thromboembolism the likelihood of which persists for several weeks after leaving of inpatient department. However, over 40 % of patients with an increased risk of venous thromboembolic complications (VTEC) do not receive any preventive treatment. In Ukraine there was conducted the first multicentre non-interventional observational study ENOVA on analysis of prevention of VTEC after major orthopedic operations. Primary objective: to compare the actual duration of pharmacological prophylaxis of VTEC in patients after major orthopedic surgery to the recommended national and international guidelines. Secondary objectives: 1) to compare the frequency of prevention of VTEC with low molecular weight heparin (LMWH) to using other anticoagulants; 2) to assess patient adherence to medications recommended by the physician at discharge from the hospital. Methods: 304 patients from 11 centers after hip replacement, knee replacement or surgery in cases of hip fractures were included in this study. Demographic data, date and type of surgery, comorbidities, prescribed preventive therapy and its duration were recorded in the registration form for each patient. For statistical analysis there was used sequential method for selecting data. Results: The true picture of thromboprophylaxis in patients in hospital and after discharge was revealed. There was established that for all patients in the inpatient department for prevention of VTEC anticoagulants were prescribed. However, the duration of thromboprophylaxis in the most cases did not meet international and national guidelines. In addition, about a quarter (23.56 %) patients did not adhere to the proposed extended thromboprophylaxis. Leading position among prescribed anticoagulant take LMWH.

Тромбопрофилактика в акушерстве: кому, когда и чем?

The article highlights the current issues of the use of anticoagulants (unfractionated and low molecular weight heparin) for the prevention of venous thromboembolic complications in obstetric practice. The assessment of risk factors, depending on the stage of pregnancy and delivery, comorbidities and indications for pharmacologic thromboprophylaxis; preventive and therapeutic doses of unfractionated and low molecular weight heparin. The use of anticoagulants on delivery stage requires special attention, due to the risk of hemorrhagic complications during surgery and neuraxial analgesia/anesthesia. The use of pharmacological thromboprophylaxis should be in accordance with current protocols.

OPTIMAL PREVENTION OF HOSPITAL VENOUS THROMBOEMBOLISM WITH THE HELP OF MEDICAL INFORMATION SYSTEM

Deep vein thrombosis and pulmonary embolism are an important medical and social problem, contributing to the structure of morbidity and mortality in the developed countries. Despite the availability of clinical guidelines for the prevention of venous thromboembolic complications there is a gap between scientific knowledge and clinical practice. Clinical decision support systems (CDSS) are confirmed to be effective tool for the implementation of clinical guidelines in daily practice. CDSS should be based on national and international clinical guidelines; their effectiveness depends upon successful integration with other health information systems and care flow processes.

AB0342 Prevention of venous thromboembolic complications in total hip and total knee arthroplasty for patients with rheumatic diseases

BackgroundDeep venous thrombosis of the lower limbs occur in 42-65% of the total knee and total hip arthroplasty.ObjectivesTo evaluate the efficiency of oral anticoagulants in the post operational period for...

Prevention of venous thromboembolic complications and heparin-induced thrombocytopenia in patient with acute inflammatory polyneuropathy (Guillain-Barre syndrome)

The case of severe thrombocytopenia caused by direct anticoagulant therapy, immunologically confirmed in patient with Guillain-Barre syndrome, is presented. The clinical presentation was characterized by acute peripheral tetraparesis, accompanied by multiple embologenic thrombosis in deep venous system of shanks. As a result of direct anticoagulant treatment, improvement of ultrasonic image was demonstrated. At the same time the decay of the thrombocytes level and development of haemorrhagic syndrome were observed. The assay of coagulation factors didn’t demonstrate consumption coagulopathy. The results of the bone marrow examination excluded the oncological process in haematopoietic system. Considering that the thrombocytopenia developed exactly 10 days after the onset of the direct anticoagulant therapy, the analysis of the antibodies to the platelet factor 4/heparin complex was performed; the result was positive. Withdrawal of fraxiparine and implementation of plasmapheresis to eliminate the antibodies improved the patient’s condition. The presented case demonstrates the necessity of regular control of all parts of haemostasis, because treatment with remedies intended to correct the coagulation system may cause itself strong hemorheological disorders.

What is the Effect of Low-molecular Weight Heparin for Venous Thromboembolism Prophylaxis Compared With Mechanical Methods, on the Occurrence of Hemorrhagic and Venous Thromboembolic Complications in Patients With Intracerebral Hemorrhage?

Patients with intracerebral hemorrhage (ICH) are at risk for venous thromboembolic (VTE) complications after stroke. The dilemma remains on whether it is safe to initiate low-dose low-molecular weight heparin (LMWH) in patients with ICH without risking expansion of the initial bleed. To critically assess current evidence regarding the safety of low-dose LMWH in the prevention of VTE complications in patients with acute ICH. The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of vascular and hospital neurology. A recent quasi-randomized controlled trial was selected for critical appraisal. This trial assigned 75 ICH patients to subcutaneous LMWH or long compression stockings for deep venous thrombosis and pulmonary embolism prophylaxis. In patients who received low-dose LMWH, there was no hematoma enlargement at 72 hours, day 7, or day 21 compared with the compression stocking group. There was hematoma enlargement in 9 patients at 24 hours, 6 of which were in the LMWH group, but this was before the initiation of the LMWH, which occurred at 48 hours. Adverse events were VTE complications in 4 of 39 patients in the LMWH group and in 3 of 36 patients in the long compression stocking group. Initiation of low-dose LMWH in spontaneous ICH patients for the purpose of VTE prophylaxis is likely safe. However, a clinical decision based solely on the results of this study cannot be made due to numerous methodological and design shortcomings. A well-designed randomized controlled trial is still needed to answer this clinical question.

Prevention of Venous Thromboembolic Complications in Orthopaedic Surgery: New Possibilities

The causes of significant rate of venous thromboembolic complications after orthopaedic operations were analyzed basing on literature review and author's experience. Importance of orthopaedic surgeons' education in modern standard for such complication prevention as well as necessity of modern drugs application was presented. Data on the efficacy of new direct per oral anticoagulant Dabigatran etexilate (Pradax) were given.

Safety of low-dose subcutaneous enoxaparin for the prevention of venous thromboembolism after primary intracerebral haemorrhage

Background The risks and benefits of low molecular weight heparins (LMWH) for the prevention of deep-vein thrombosis (DVT) and pulmonary embolism (PE) after intracerebral haemorrhage (ICH) have not been assessed. The few studies on this subject have revealed conflicting results. Methods We retrospectively evaluated whether subcutaneous enoxaparin (20 mg daily) reduced symptomatic venous complications or caused increased 3-month death rate. We included 407 patients who were admitted to a stroke unit and survived the first two days after onset of ICH. There were 232 patients who received anticoagulant treatment for the prevention of DVT and PE and 175 who did not. Results Despite the fact that the treated patients were in worse clinical condition at the start of the treatment, 3-month death rate was 19% among them compared to 21% among those not receiving anticoagulant therapy. Low-dose subcutaneous enoxaparin (20 mg once daily) induced a significant plasma anti-factor Xa activity 2-3 hours after administration (p = 0.018). Haematoma enlargements (33%) occurred in 9% and 7% of the treated and untreated patients, whereas symptomatic venous thromboembolic complications were observed in 3% and 2%, respectively. Conclusions We did not observe any increased mortality among ICH patients who survived the first 2 days after the onset of ICH and were thereafter treated with enoxaparin 20 mg daily relative to patients remaining untreated. A randomized trial of the effect of LMWH with a higher dose in prevention of venous thromboembolic complications would be indicated.

Chronic Venous Insufficiency.

Patients with chronic venous insufficiency arguably have been relegated to a standard of care that is lower than that for those with the more appealing entity of peripheral arterial disease. Fortunately, the collaboration of an expanding group of clinicians (including cardiologists and vascular medicine specialists) with vascular surgeons is stimulating a renewed interest in the management of patients afflicted with venous disease. With the increased level of awareness of venous disease, technologic advances undoubtedly will augment the armamentarium available for the treatment of patients with chronic venous insufficiency. The focus on the prevention of venous thromboembolic complications has been advanced greatly, as witnessed by the growth of new pharmacologic agents, such as heparinoids, antiplatelet agents, direct thrombin inhibitors, thrombolytics, and pentasaccharides. In addition, the more aggressive strategy of intervening in acute deep venous obstruction by using thrombolytic agents and adjunctive mechanical thrombectomy devices potentially may obviate the future sequelae of chronic venous insufficiency. The tremendous growth of endovascular techniques in recent years has revolutionized the management of problems due to acute and chronic arterial obstructive disease. The application of these techniques in the future may have a similar impact in improving the clinical outcomes of patients with chronic venous disease and potentially, if proven safe and efficacious in clinical trials, may lower the threshold for intervention to an earlier disease stage. Similarly, with the advent of endovascular and endoscopic techniques, surgical procedures will also continue to evolve, with these procedures complementing one another, as opposed to serving as surrogates, which traditionally has been the case.