Deep Venous Thrombosis Prophylaxis Research Articles

#2147 Enoxaparin dosing in advanced chronic kidney disease: importance of monitoring with anti-Xa levels

Abstract Background and Aims Enoxaparin is a low-molecular-weight heparin (LMWH) that is commonly used in the prevention of deep venous thrombosis (DVT) and the treatment of acute thomboembolic diseases. Current literature indicates that in advanced chronic kidney disease (CKD), there is a reduced clearance and increased half-life of LMWH and therefore, a dose adjustment is recommended. The prescription label recommends a dose adjustment of enoxaparin to 0.5 mg/kg/day for prophylaxis of DVT and 1 mg/kg/day for therapeutic anticoagulation when eGFR <30 ml/min. The aim of this study was to examine the accuracy of this dosing strategy to achieve the desired target of anticoagulation in advanced CKD. Method We conducted a prospective study in patients admitted from May 2019 to April 2023 in the Nephrology ward at our centre, who started anticoagulant treatment with enoxaparin during their in-hospital stay for prophylactic or therapeutic indications. We excluded patients with eGFR >30 ml/min at the onset of anticoagulation with enoxaparin. The dosing strategy was 0.5 mg/kg/day for prophylaxis of DVT and 1 mg/kg/day for therapeutic anticoagulation in all patients. Blood samples were drawn 4 hours after the third dose of enoxaparin to monitor anti-Xa levels in all cases. Results The study included 153 patients; 70 patients with stage 4-5 CKD and 83 patients on renal replacement therapy. 132 patients (86.3%) received enoxaparin for a therapeutic indication, while 21 patients (13.7%) received it as prophylaxis of DVT. In patients receiving enoxaparin for a therapeutic indication, 73 patients (55.3%) reached the therapeutic target anti-Xa levels (0.6-1), while 32.6% of patients had peak anti-Xa levels below the therapeutic target (<0.6) and 12.1% were over-anticoagulated (>1). There was an inverse relationship between the proportion of patients who were adequately anticoagulated and CKD stage; 66.7%, 58.6% and 48.6% of patients reached the target peak anti-Xa levels in CKD stage 4, 5 and 5D respectively. There was no significant association between anti-Xa levels and obesity or liver disease. In patients receiving enoxaparin for prophylaxis of DVT, 42.9% reached the target anti-Xa levels for prophylaxis (0.3-0.6), while 38.1% had anti-Xa levels below this range and 19% were over-anticoagulated. Conclusion The enoxaparin dosing recommendations indicated by its label entails a high proportion of patients with advanced CKD who do not achieve the target therapeutic levels of antiXa, especially in patients on renal replacement therapy. To ensure adequate anticoagulation in these patients, we recommend using individualized dosing adjustments based on monitoring of anti-Xa levels for the prevention of thromboembolic events and reducing the risk of hemorrhagic events.

Incidence of deep venous thrombosis in patients with hemophilia undergoing bilateral simultaneous total knee arthroplasty: a retrospective cohort study

BackgroundHemophilic arthropathy usually affects the knees bilaterally. In order to reduce costs and improve rehabilitation, bilateral simultaneous total knee arthroplasty (TKA) can be performed. However, pharmacological prophylaxis for deep venous thrombosis (DVT) remains controversial in patients with severe hemophilia. The purpose of this study was to establish the incidence of DVT in severe hemophilia A patients undergoing bilateral simultaneous TKA without pharmacological thromboprophylaxis.MethodsConsecutive patients with severe hemophilia A undergoing bilateral simultaneous TKA at a single center between January 2015 and December 2020 were retrospectively reviewed. All patients received a modified coagulation factor substitution regimen. Tranexamic acid (TXA) was used for hemostasis in all patients during surgery. All patients followed a standardized postoperative protocol with routine mechanical thromboprophylaxis, and none received anticoagulation. D-dimer was measured preoperatively, on the day of the operation and on postoperative days 1, 7 and 14. Ultrasound (US) of the lower extremities was performed before (within 3 days of hospitalization) and after surgery (days 3 and 14) to detect asymptomatic DVT. Patients were followed up until 2 years after surgery for the development of symptomatic DVT or pulmonary embolism (PE).Results38 male patients with severe hemophilia A underwent 76 simultaneous TKAs. Mean (± standard deviation) age at the time of operation was 41.7 (± 17.1) years. Overall, 47.3% of patients had D-dimer concentrations above the threshold 10 µg/mL on day 7 and 39.5% on day 14. However, none of the patients had DVT detected on postoperative US, nor developed symptomatic DVT or PE during the 2-year follow-up.ConclusionsThe risk of DVT in patients with severe hemophilia A after bilateral simultaneous TKA is relatively low, and routine pharmacological thromboprophylaxis may not be needed.

Don't Fear the Bleed: Assessing Postoperative Bleeding Incidence After Instituting a Standardized Prophylactic Heparin Protocol in Bariatric Patients.

Background: Bariatric surgery is a frequently performed procedure in the United States, accounting for ∼40,000 procedures annually. Patients undergoing bariatric surgery are at high risk for postoperative thrombosis, with a venous thromboembolism (VTE) rate of up to 6.4%. Despite this risk, there is a lack of guidelines recommending postoperative VTE prophylaxis and it is not routine practice at most hospitals. The postoperative bleeding rate after bariatric surgery is only 1.5%; however, the risk of bleeding may lead to hesitancy for more liberal VTE prophylaxis. Methods: This is a retrospective analysis of bariatric surgeries at a single institution in 2019 and 2021. Data were obtained from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and electronic medical record review for all patients undergoing sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or conversion to RYGB. The primary outcomes were composite bleeding events, which included postoperative transfusion, postoperative endoscopy or return to operating room (OR) (for bleeding), intra-abdominal hematoma, gastrointestinal (GI) bleeding, or incisional hematoma. Results: There were a total of 2067 patients in the cohort, with 1043 surgeries in 2019 and 1024 surgeries in 2021. There was no difference between bleeding events after instituting a deep venous thrombosis (DVT) prophylaxis protocol in 2021 (27 versus 28 events, P = .76). There was no difference in individual bleeding events between 2019 and 2021. Additionally, there was no significant difference in the rate of VTE between 2019 and 2021 (2 versus 5 events, P = .28). Conclusions: After instituting a standard protocol of prophylactic heparin postdischarge, we did not find an increased rate of bleeding events in patients undergoing bariatric surgery. Thus, surgeons can consider prescribing postdischarge chemical VTE prophylaxis without concern for bleeding.

Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after cesarean section women: a single-center observation study of Chinese Han population

BackgroundVenous thromboembolism (VTE) is most prevalent among parturients following a cesarean section (CS). The objective of this study was to assess the practical utility of bilateral compression ultrasonography (CUS) of the lower limbs, coupled with D-dimer monitoring, in the early diagnosis of VTE within the Han Chinese population.MethodsOur prospective observational study included 742 women who underwent CUS and D-dimer testing on the first day post-CS. Subsequently, telephone or outpatient follow-ups were conducted until 42 days postpartum. States of hypercoagulation and thrombosis, as indicated by CUS, were classified as CUS abnormal. A D-dimer level ≥ 3 mg/l was considered the D-dimer warning value. Early ambulation and mechanical prophylaxis were universally recommended for all parturients post-CS. A sequential diagnostic strategy, based on the 2015 RCOG VTE risk-assessment tool, was employed. Therapeutic doses of low-molecular-weight heparin (LMWH) were administered for the treatment of thromboembolic disease. Prophylactic doses of LMWH were given for VTE prophylaxis in parturients with hypercoagulative status accompanied by D-dimer levels ≥ 3 mg/l. All high-risk women (RCOG score ≥ 4 points) were additionally treated with preventive LMWH. Statistical analyses were conducted using the R statistical software, with a two-sided P value < 0.05 considered statistically significant.ResultsFifteen cases of VTE and 727 instances without VTE were observed. The overall VTE rate post-CS was 2.02% (15/742), with 66.7% (10/15) being asymptomatic. Eleven patients received a VTE diagnosis on the first postpartum day. Among the 41 parturients exhibiting hypercoagulation ultrasound findings and D-dimer levels ≥ 3 mg/l, despite receiving pharmacological VTE prophylaxis with LMWH, 4.88% (2/41) in the high-risk group were eventually diagnosed with VTE. A total of 30.86% (229/742) exhibited normal ultrasound findings and D-dimer levels < 3 mg/l on the first day post-CS, with no VTE occurrences in the postpartum follow-up. According to RCOG’s recommendation, 78.03% (579/742) of cesarean delivery women should receive prophylactic anticoagulation, while only 20.62% (153/742) met our criterion for prophylactic anticoagulation.ConclusionThe strategy of timely routine bilateral CUS and D-dimer monitoring is conducive to the early diagnosis and treatment of VTE, significantly reducing the use of LMWH in the Chinese Han population.

Commentary on Modes of Failure in Venous Thromboembolism Prophylaxis

In our previous article, Modes of Failure in Venous Thromboembolism Prophylaxis, we examined the points of failure in deep venous thrombosis prophylaxis in our post-operative population. We retrospectively identified 128 post-operative patients that developed iliofemoral deep venous thrombosis. We showed that there were four primary areas of failure: stratification, ordering the correct intervention, delivering the correct intervention, and continuing the correct intervention. We found that 53% of patients were correctly stratified and only 15% of patients received the appropriate chemoprophylaxis at admission without inappropriately missed doses. Additionally, 89% of patients had a delay or interruption of mechanical prophylaxis and 75% had both inadequate mechanical and chemoprophylaxis.

A comprehensive deep venous thrombosis prophylaxis regimen in isolated coronary artery bypass grafting

ObjectivesDeep venous thrombosis (DVT) is a known surgical complication that can lead to pulmonary embolism with subsequent morbidity and mortality. The incidence of DVT following coronary artery bypass grafting is unclear. Prophylaxis regimens vary and some guidelines advocate against use of routine chemoprophylaxis in patients at low-moderate risk for venous thromboembolism. We utilized postoperative lower extremity venous ultrasound to determine the incidence of DVT following coronary artery bypass grafting in patients with low- to moderate-risk of venous thromboembolism receiving aggressive postoperative DVT prophylaxis. MethodsThis is a single-center, retrospective study of all patients who underwent coronary artery bypass grafting between April 2022 and January 2023. All patients who completed postoperative venous ultrasound of the bilateral lower extremities were initially included. Patients who underwent concurrent valve or aortic surgery, were at high risk of venous thromboembolism, or were receiving anticoagulation therapy for nonvenous thromboembolism indications were excluded. The primary outcome was in-hospital incidence of DVT. Secondary outcomes were rates of mortality, postoperative bleeding, and thromboembolic events from discharge to 30 days postoperatively and from 30 days to 3 months postoperatively. ResultsNo DVTs were observed in 211 included patients. In hospital, there were 3 significant bleeding events and 1 stroke. Following discharge there were 3 additional bleeding events, 1 death, 1 transient ischemic attack, and 1 pulmonary embolism. ConclusionsWe observed a 0% rate of DVT in low- to moderate-risk patients undergoing isolated coronary artery bypass grafting and receiving a comprehensive DVT prophylaxis regimen. In hospital bleeding and other thromboembolic event rates were 2.84% and 0.47% respectively.

Nomogram for predicting postoperative deep vein thrombosis in patients with spinal fractures caused by high-energy injuries.

Deep venous thrombosis (DVT) is a common complication in patients with spinal fractures caused by high-energy injuries. Early identification of patients at high risk of postoperative DVT is essential for the prevention of thrombosis. This study aimed to develop and validate a prediction model based on a nomogram to predict DVT in patients with spinal fractures caused by high-energy injuries. Clinical data were collected from 936 patients admitted to our hospital between January 2016 and December 2021 with spinal fractures caused by high-energy injuries. Multivariate logistic regression analysis was used to identify the risk factors for postoperative DVT and to develop a nomogram. The predictive performance of the nomogram was evaluated by the receiver operating characteristic (ROC) curve and calibration curve. The incidence of preoperative DVT was 15.38% (144/936). The postoperative incidence of DVT was 20.5% (192/936). The multivariate analysis revealed that age, operation time, blood transfusion, duration of bed rest, American Spinal Injury Association (ASIA) score and D-dimer were risk factors for postoperative DVT. The area under the ROC curve of the nomogram was 0.835 and the calibration curve showed good calibration. The nomogram showed a good ability to predict postoperative DVT in patients with spinal fractures caused by high-energy injuries, which may benefit pre- and postoperative DVT prophylaxis strategy development.

The incidence of deep venous thrombosis in Parkinson’s disease

ABSTRACT Introduction Venous thromboembolism is one of the causes of sudden death in Parkinson’s Disease (PD). Few studies have investigated the correlation between PD and deep venous thrombosis (DVT). This study aimed to investigate the frequency of DVT in PD patients prospectively. Material and Method Demographic characteristics of 37 PD patients without known risk factors for DVT, disease duration, Hoehn-Yahr (H – Y) stage, oxygen saturation (SpO2) and heart rate values with pulse oximetry, use of assistive devices, waist and knee circumference measurements, and modified Medical Research Council (mMRC) dyspnea score was recorded. Both legs were evaluated for thrombus by Doppler venous ultrasound (US). Results With the H-Y stage of the disease duration, a positive correlation was determined between the H-Y stage and mMRC. Disease duration was negatively correlated with BMI and positively correlated with the need for assistance. Assistive device use was positively associated with age and mMRC. DVT was detected in only one patient. When our patients’ files were reviewed after 1.5 years, one patient was hospitalized with the diagnosis of submassive pulmonary embolism. Conclusion Attention should be paid to the development of DVT in elderly patients with advanced stages of PD, progression in the H-Y stage, use of assistive devices, and progression in dyspnea scoring. There is also a need for studies on the benefit of DVT prophylaxis in PD patients with a high risk of venous thromboembolism.

Management of the Leaky Wound After Arthroplasty: A Review

Total knee and hip arthroplasty are widely performed surgeries for end stage osteoarthritis with highly successful outcomes. However, prolonged postsurgical wound drainage leads to slower healing and predisposes to periprosthetic joint infection. Persistent wound discharge after joint arthroplasty affects patient satisfaction and outcome measures, can cause unexplained re-admissions, and increases the cost burden on the health system. Preventive measures are crucial and include preoperative nutritional assessment, achieving adequate hemostasis, minimizing dead spaces and watertight wound closure. Monitoring these patients with serial C-reactive protein levels is strongly recommended. Many management strategies have been described for such complications, including cessation of deep venous thrombosis prophylaxis, dressings and wound care, antimicrobial therapy, surgical washout and polyethylene insert replacement. However, these conditions are not addressed thoroughly in the literature and optimal management protocol for such complications is still lacking. This article aimed to review the best available literature to date and summarize the findings to help physicians treating these wounds develop objective guidelines in identifying and managing such conditions.

Self-Reported Height and Weight for BMI Calculation Compared With Measured Height, Weight, and BMI in Patients Undergoing Liposuction of the Upper and Lower Abdomen: A Single-Center Retrospective Review

Self-reported height and weight is commonly used in medical practice for the determination of body mass index (BMI). Self-reported height and weight can be underestimated or overestimated resulting in inaccurate BMI calculations. In our practice the self-reported height and weight are obtained at the time of cosmetic surgery consultation. The purpose of this study is to determine the accuracy of preoperative height, weight, and BMI calculations in patients undergoing liposuction of the abdomen in comparison to measurements obtained by nursing staff the day of surgery. Clinically, these data may affect perioperative risk stratification and preoperative planning with respect to deep venous thrombosis prophylaxis. Using Nextech electronic medical records (EMR) system, charts were reviewed from July 2019 to July 2022. Patients identified as having underwent liposuction of the upper and lower abdomen were reviewed. All patients had been consented for the prescribed procedure. Data extracted included the self-reported height/weight and calculated BMIs obtained at the time of consultation as well as measured height/weight and BMIs from the day of surgery. The study sample included 50 patients (31 women and 19 men), with an average age of 44 ± 11 years (range, 20-71 years). Time from consult to surgery ranged from 2 to 270 days with an average of 58 days. Time of consult (TOC) height average was 169.1 cm (range, 152.4-190.5 cm) versus day of surgery (DOS) height average of 169.5 cm (range, 149-190 cm). Time of consult weight average was 82.4 kg/181.66 lbs (range, 54.5-115.9 kg/120.15-264.89 lbs) versus DOS average of 84 kg/185.19 lbs (range, 53.8-116 kg/118.61-255.74 lbs). Time of consult BMI average was 28.5 kg/m2 (range, 21.1-43.9 kg/m2) with a DOS average of 29 kg/m2 (range, 20.9-47 kg/m2). Height was on average underestimated by 0.03 cm. Weight was on average underestimated by 1.6 kg at the TOC compared with DOS. BMI difference between TOC and DOS had an average underestimate of 0.5 kg/m2. A total of 8 patients upstaged to a higher obesity classification based on DOS BMI calculation. Subgroup analysis of male and female height and weight estimations versus measured data are also reviewed. When averaged the time of consultation height, weight, and BMI correlated with height, weight, and BMIs measured and calculated the day of surgery in patients undergoing liposuction of the abdomen. Sixteen percent of our study population were reclassified to a higher obesity class based on DOS height and weight. For the purposes of accurate perioperative risk management and deep venous thrombosis prophylaxis planning, height and weight should be obtained accurately at the time of consultation or at a preoperative visit within 1 month of surgery.

Stratified Prophylaxis of Deep Venous Thrombosis in Surgical Patients Based on Caprini Risk Assessment: A Pilot Study

Stratified Prophylaxis of Deep Venous Thrombosis in Surgical Patients Based on Caprini Risk Assessment: A Pilot Study

Adults Are Not Just Large Kids: Caring for Adults in Pediatric Hospitals.

Adults Are Not Just Large Kids: Caring for Adults in Pediatric Hospitals.

Surgical Operative Notes Compliance with the Standard Guidelines of the Royal College of Surgeons: A Retrospective Clinical Audit at a Tertiary Hospital in Bangalore, India

Introduction: Operative notes are essential documents that record the operative findings and procedures performed during surgeries. Therefore, it is crucial to document them with clarity and objectivity. They serve various purposes, including auditing, teaching, research, and providing valuable information in medicolegal cases. Aim: To assess the accuracy of operative note-keeping in accordance with the guidelines set by the Royal College of Surgeons (RCS) of England. Materials and Methods: A retrospective clinical audit was conducted to evaluate the quality of operative notes in the Department of General Surgery at St. John’s Medical College and Hospital in Bengaluru, Karnataka, India, from June 2022 to October 2022. A total of 75 surgical notes were analysed, including cases of both elective and emergency surgeries. The audit assessed all 19 parameters mentioned by the RCS. A master sheet was created to record the analysed variables, and each variable was categorised as present, absent, or not applicable. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 21.0, and the results were expressed as percentages. Results: The documentation of the surgeon’s name, diagnosis, intraoperative findings, and procedure performed was accurate in both groups, comprising 45 (100%) cases of elective surgeries and 30 (100%) cases of emergency surgeries. However, there was a lower compliance with Deep Venous Thrombosis (DVT) prophylaxis in both groups, with 10 (22%) cases in elective surgeries and 4 (13%) cases in emergency surgeries. Conclusion: Based on the findings of the present study, it is recommended to adhere more strictly to the guidelines provided by the RCS of England, particularly in emergency cases. Regular audits should be conducted to ensure quality management, enhance surgical training, and address medicolegal implications effectively.

Anesthetic considerations in Hirayama disease: Primum non noncere.

Dear Editor, Hirayama disease is a sporadic, self-limiting juvenile muscular atrophy which affects the muscles of the arm of people of the Asian population in the third decade of life.[1] In the past 35 years, only 279 cases have been reported in India.[2] A 40-year-old male presented with complaints of weakness and pain in the right upper limb with grade 2/5 power and wasting of thenar, hypothenar, interossei muscles, wrist flexors, and extensors with the sparing of the brachioradialis muscle. It is called oblique amyotrophy.[3] The Babinski sign was positive. There was no history of involuntary movements, trauma, exaggeration of symptoms in winter, allergy to peanuts, and sulpha-containing drugs. There was no cranial nerve, sensory, bulbar, bladder, or bowel involvement. The Magnetic Resonance Imaging (MRI) [Figure 1] showed forward displacement of the posterior subdural sac on the flexion of the neck with prominent epidural space. Electromyographic nerve conduction velocity (EMG-NCV) findings showed partial denervation in the upper limb muscles. The thyroid function tests, creatinine kinase, and serum potassium levels were normal.Figure 1: MRI Hirayama diseaseAnticholinergic intravenous glycopyrrolate 0.2 mg was given as an anti-sialagogue. Following an intravenous propofol 1.5 mg/kg induction, we preferred rocuronium bromide 0.9 mg/kg for the neuromuscular blockade, for its rapid onset of action. Injection atracurium was avoided as it has a propensity to raise the ImmunoglobulinE (IGE) levels which precipitate atopic myelitis in the Hirayama disease.[4] Also, in patients with denervation because of spinal cord lesions, an increased number of peri-junctional nicotinic acetylcholine receptors on skeletal muscle can cause hyperkalemia after suxamethonium chloride. Laryngoscopy was performed with manual inline stabilization of the spine (MILS) and a LaerdalR Philadelphia hard cervical collar on, using a McCoy laryngoscope blade and the patient was intubated with a size 8.0 cuffed flexo-metallic tube. The immobilization aims to protect patients with an unstable cervical spine from secondary cervical spine injury induced by accidental movement of the spine.[5] Proning was done by proper precautions, adequate eye care, and padding of pressure points were done. Auto-compression stockings were applied on the lower limbs for deep venous thrombosis (DVT) prophylaxis. Sevoflurane was given to maintain Bispectral Index (BIS)-guided adequate depth of anesthesia. These patients may have a less physiological reserve to tolerate hypotension-induced ischemia and require higher arterial pressures to maintain spinal autoregulation.[5] Injection phenylephrine infusion 1 mg/cc was kept ready. Train Of Four (TOF) monitoring was done intraoperatively and readings were taken before reversal and extubation. Hirayama disease is a sporadic focal degenerative motor neuron disease affecting the cervical cord when the neck is in flexion. Repeated compression changes make the anterior horn cells prone to arterial or venous ischemic injury which causes increased intramedullary pressure and micro-circulatory disturbance.[3] This is in line with the Poisson effect which dictates that if a column of fixed volume is compressed, its cross-sectional area will increase. Conversely, if it is stretched, the cross-sectional area will decrease, which is based on the Chinese finger trap model [Figure 2]. The basic principle is to keep the neck in extension.Figure 2: The Chinese finger trap modelRational airway management, appropriate choice of muscle relaxants in motor neuron diseases, and the use of intraoperative neuromuscular monitoring helped in the optimal, safe, and effective anesthetic management. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given hid consent for his images and other clinical information to be reported in the journal. The patients should understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Evaluation of pharmacological prophylaxis for deep venous thrombosis in hospitalized patients with risk factors at the university teaching hospitals, Lusaka, Zambia

Background: Deep venous thrombosis is a common clinical problem accounting for high rates of morbidity and mortality. The existence of risk factors, which include trauma, venous stasis, and hypercoagulability, is linked to the occurrence of the condition. Objective of current study was to evaluate DVT risk factors and prophylaxis pattern of use for patients who were admitted at the University Teaching Hospitals in Lusaka, Zambia.Methods: A cross-sectional study was conducted using medical files for patients who were hospitalized at the University Teaching Hospitals in Lusaka, Zambia from May 2020 to June 2021. Two hundred and ninety-six patient files were reviewed, and the Caprini risk assessment model was used to stratify patients into DVT risk categories. Multilinear regression analysis was used to identify factors associated with DVT prophylaxis.Results: Of the 296 patient files that were sampled from ICU, medical, and surgical wards, 198 (66.9%) (&gt;2 caprini score) were eligible for DVT prophylaxis, but only 77 (38.9%) of these eligible patients received prophylaxis. The number of eligible patients for DVT prophylaxis per department was as follows; ICU 50 (100%), Medical 71 (57.7%) and Surgery 77 (62.6%) wards. However, DVT prophylaxis was given to 21 (42%), 33 (46.5%), and 23 (29.9%) patients from the ICU, medical, and surgery, respectively. Enoxaparin was the most commonly used anticoagulant for Venous thromboembolism (VTE) prophylaxis with a mean dose of 60mg (SD±5). Across all departments, the most common predisposing risk factors for DVT were bed confinement for &gt;72 hours (167, 56.4%) and age of 41-60 years (118, 39.8%). In the adjusted model, swollen legs (AOR: 3.6, CI: 1.97, 6.57) and history of VTE (AOR: 21.3, CI: 9.87, 46.08) were significantly associated with a higher likelihood of DVT prophylaxis.Conclusions: Pharmacologic thromboprophylaxis is underutilized in patients in ICU, medical and surgical wards at the university teaching hospitals in Lusaka, Zambia. This study underscores the importance of implementing a DVT risk assessment technique for patients in ICU, medical and surgical wards and administering prophylaxis unless contraindicated.

Cardiopulmonary Bypass Surgery in a Patient with Unexpected Heparin-Induced Thrombocytopenia.

We report a case of a 77-year-old woman with massive pulmonary embolism associated with heparin-induced thrombocytopenia. Before developing a pulmonary embolism, the patient underwent gastrectomy due to gastric cancer and received subcutaneous heparin calcium for deep venous thrombosis prophylaxis for 5 d. Then, thrombectomy with cardiopulmonary bypass using full heparinization was successfully performed. The patient was definitively diagnosed with this condition postoperatively, based on elevated serum antibody levels, in addition to pre- and postoperative thrombocytopenia and thrombosis. Intravenous heparin therapy was switched to argatroban. Although it is uncommon, clinicians should consider this condition in patients with a history of heparin exposure.

Commentary on: Does Hip Fracture Admitting Service Affect Proper Deep Venous Thrombosis Prophylaxis? An Investigation at a Level 1 Trauma Center.

Commentary on: Does Hip Fracture Admitting Service Affect Proper Deep Venous Thrombosis Prophylaxis? An Investigation at a Level 1 Trauma Center.

Does Hip Fracture Admitting Service Affect Proper Deep Venous Thrombosis Prophylaxis? An Investigation at a Level 1 Trauma Center.

To examine if rates of appropriate thromboprophylaxis prescribing at the time of discharge would be higher in patients admitted to the orthopaedic service. Second, to see if improvements could be made in the rates of these missed events after a structured intervention. Retrospective Cohort Study, Prospective Interventional. Level 1 Academic Hospital. Two hundred forty-six patients undergoing a hip hemiarthroplasty for femoral neck fracture discharged to an extended care facility. A letter was sent to the internal quality control committee detailing our preintervention study. We looked at the differences among admitting services for missed thromboembolic prophylaxis (TPx) at the time of hospital discharge and rates of appropriate TPx after a structured intervention. No statistically significant differences existed in relation to patient age, gender, body mass index, or postoperative discharge day in the preintervention group. Orthopaedic surgery prescribed adequate TPx at discharge for 76 of 77 patients (98.7%), general trauma surgery for 26 of 30 patients (86.7%), and internal medicine for 85 of 96 patients (86.7%) in the preintervention group. There was a statistically significant difference when comparing adequate TPx between orthopaedic surgery and other services (P < 0.013 and <0.021, respectively). Our postintervention data found a significant decrease in the rates of missed TPx on discharge. In our preintervention sample group compared with our postintervention sample group, we saw a decrease in missed TPx of 5/39 versus 0/43 events (P = 0.021). We found that a letter sent to all members of a hospital internal quality committee decreased incidences of missed TPx. Specifically, this letter explained the details of our study that kept track of rates of missed TPx among different admitting services. We found that after our intervention, which consisted of a letter and a multidisciplinary discussion, the rate of missed thromboembolic prophylaxis events improved from 5/39 (12%) to 0/43 (0%) (P = 0.021). Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Spine

The December 2022 Spine Roundup360 looks at: Deep venous thrombosis prophylaxis protocol on a Level 1 trauma centre patient database; Non-specific spondylodiscitis: a new perspective for surgical treatment; Disc degeneration could be recovered after chemonucleolysis; Three-level anterior cervical discectomy and fusion versus corpectomy- anterior cervical discectomy and fusion “hybrid” procedures: how does the alignment look?; Rivaroxaban or enoxaparin for venous thromboembolism prophylaxis; Surgical site infection: when do we have to remove the implants?; Determination of a neurologic safe zone for bicortical S1 pedicle placement; Do you need to operate on unstable spine fractures in the elderly: outcomes and mortality; Degeneration to deformity: when does the patient need both?

Effect of Prophylaxis for Deep Venous Thrombosis in Traumatic Spinal Cord Injury

Effect of Prophylaxis for Deep Venous Thrombosis in Traumatic Spinal Cord Injury