Risk Of Postoperative Venous Thrombosis Research Articles

Association of prothrombin complexe concentrate with venous thrombosis after cardiac surgery: a case-control study.

Prothrombin complex concentrate (PCC) enhances coagulation and controls bleeding. We aimed to assess whether perioperative infusion of PCC is associated with venous thrombosis after cardiac surgery. We conducted a case-control study of patients undergoing cardiac surgery at our hospital in 2021. Multivariate logistic regression was used to assess the correlation between perioperative PCC infusion and postoperative venous thrombosis in cardiac surgery. Stratified analysis was also performed by age, hospitalization days, and whether warfarin, warfarin combined with heparin, warfarin combined with antiplatelet drugs were used postoperatively. Data from 161 patients undergoing cardiac surgery were included in the analysis. Of these, 37 (23.0%) patients in the case group developed venous thrombosis, and 124 (77.0%) patients in the control group did not develop venous thrombosis. In the analysis without adjustment for confounders (model 1), perioperative PCC infusion significantly increased the risk of postoperative venous thrombosis (OR: 3.10, 95% CI: 1.26-7.59, P = 0.0135). In the model analysis adjusted for sex, age, and hospitalization days (model 2), perioperative PCC infusion was no longer significantly associated with the risk of postoperative venous thrombosis (OR: 1.76, 95% CI: 0.56-7.59, P = 0.3317). In the fully adjusted model (model 3), there was a marginally significant association between perioperative infusion of PCC and the risk of postoperative venous thrombosis (OR: 0.03, 95% CI: 0.00-1.23, P = 0.0637). Our findings show no significant association between perioperative PCC infusion in cardiac surgery and the development of postoperative venous thrombosis. Randomized controlled trials are needed to determine the causal relationship between perioperative PCC infusion and venous thrombosis in cardiac surgery.

Новый фактор послеоперационного венозного тромбоза в онкологии: миф или реальность?

Введение. Эндовенозная термическая абляция (ЭТА) поверхностных вен, включая лазерную абляцию или радиочастотную абляцию, широко применяется в лечении варикозной болезни нижних конечностей. Учитывая высокую частоту встречаемости варикозной болезни, частоту венозных тромбоэмболических осложнений (ВТЭО) после данного вмешательства, логично предположить, что выполнение ЭТА увеличит риск возникновения послеоперационного венозного тромбоза у онкологических больных. Существует недостаток данных о частоте ВТЭО в онкохирургии при ЭТА в анамнезе. Цель исследования: оценить влияние ранее проведенной ЭТА поверхностных вен нижних конечностей на послеоперационные ВТЭО в онкохирургии. Материалы и методы. Одноцентровое исследование с ретроспективным анализом онкологических больных на хирургическом этапе лечения злокачественных опухолей абдоминальной, гинекологической или урологической локализации проведено с мая 2013 г. по ноябрь 2018 г. В исследование были включены 36 пациентов, перенесших ЭТА более 3 мес назад (319 мес). Ультразвуковое дуплексное исследование вен нижних конечностей проводили перед операцией (за 110 дней) по поводу онкологического заболевания всем пациентам. Полная облитерация ствола большой подкожной вены (БПкВ) обнаружена в 66,7 случаев (n 24), реканализация в 33,3 (n 12). Все пациенты получали стандартную антикоагулянтную профилактику (надропарин по 0,4 мл/сут подкожно). Проведен морфологический анализ 3 случаев послеоперационного венозного тромбоза. Результаты. ВТЭО возникли в 20,8 (n 5) случаев при полной облитерации БПкВ, в 66,7 (n 8) с реканализацией ствола (95 ДИ 1,37,7) в послеоперационном периоде. Реканализация вены увеличила частоту развития послеоперационного венозного тромбоза в 3,2 раза. Заключение. ВТЭО часто возникают после неполной облитерации при ЭТА в отдаленном периоде при наличии дополнительных факторов риска. Учитывая широкое распространение данного типа операций во флебологии и возможность серьезных осложнений, необходимы дальнейшие исследования частоты венозного тромбоза при ЭТА в анамнезе у онкологических больных и определение стратегии профилактики ВТЭО. Introduction. Endovenous thermal ablation of saphenous vein (EVTA SV) including laser ablation or radiofrequency ablation widely used in varicose veins treatment of the lower extremities. EVTA SV can increase the risk of postoperative venous thrombosis in cancer patients. There is a deficiency of data examining rates of thrombotic events (VTE) in oncological patients. Aim: to assess influence of previously performed EVTA SV on postoperative VTE in oncosurgery. Materials and methods. This was a single centre study with retrospective analysis of consecutive oncological patients who underwent abdominal, gynecological or urological surgery from May 2013 to November 2018. 36 patients were included who underwent EVTA SV more than 3 month ago (319 months). Duplex ultrasound (DUS) was performed before oncological surgery (110 days). Complete SV obliteration was found in 66.7 of cases (n 24), recanalization in 33.3 (n 12). All patients had standard anticoagulant prophylaxis nadroparin 0.4 ml per day. We performed a morphologic analysis of 3 VTE cases. Results. Thrombotic complications occurred in 20.8 (n 5) of cases with complete SV obliteration, in 66.7 (n 8) with recanalization (95 CI 1.37.7). Recanalization of SV increased rate of postoperative cancer-associated VTE in 3.2 times. Conclusion. Thrombotic events occur frequently following incomplete obliteration after procedures EVTA SV. Taken account of the high rate of this procedures and the potential for serious consequences, further research is needed on VTE сomplications in oncology and their management.

Impacts of laparoscopic hysterectomy on functions of coagulation and fibrinolysis system.

The main objective of the study is to compare the impacts of laparoscopic hysterectomy and total abdominal hysterectomy on the functions of coagulation and fibrinolysis system. Seventy-five patients who had undergone hysterectomy were randomly divided into laparoscopic hysterectomy group (n = 38) and total abdominal hysterectomy group (n = 37). The prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, D-dimer, von Willebrand factor, α-granule membrane protein-140, thrombin-activated fibrinolysis inhibitor (TAFI) and platelet count were detected at preoperative 24 h (N0), postoperative 24 h (N1) and postoperative 48 h (N2). Compared with N0, values of PT, APTT and TT were significantly decreased at N1 in both groups, whereas von Willebrand factor, platelet count and α-granule membrane protein-140 levels at N1 were significantly increased (P < 0.05). There was no significant difference between N0 and N2 (P > 0.05). Compared with N0, fibrinogen, D-dimer and TAFI levels in both groups were significantly higher at N1 (P < 0.05), and there was no significant difference between N0 and N2 (P > 0.05). The intergroup comparison showed no significant difference of above indexes between two groups (P > 0.05). The univariate analysis showed that TAFI was negatively correlated with TT (r = -0.365, P < 0.01), APTT (r = -0.183, P < 0.05) and PT (r = -0.121, P < 0.05), whereas not correlated with other indicators. Laparoscopic hysterectomy may increase the risk of postoperative venous thrombosis.

A sustained decrease in plasma fibrinolytic potential following partial liver resection or pancreas resection

BackgroundPatients undergoing partial hepatectomy have a substantial risk for postoperative venous thrombosis even in the presence of optimal thromboprophylaxis. Recently we demonstrated a hypercoagulable state following a partial hepatectomy which was related to decreased plasma levels of natural anticoagulants and elevated levels of FVIII. The fibrinolytic status following partial hepatectomy has not been studied, but may display unique features as a result of temporarily decreased synthesis of fibrinolytic proteins. MethodsWe included 17 patients undergoing a partial hepatectomy and determined plasma fibrinolytic potential and measured plasma levels of individual fibrinolytic proteins in serial samples taken perioperatively. Results were compared to ten patients undergoing pancreas resection and twenty-four healthy volunteers. Results and conclusionFollowing both partial hepatectomy and pancreas resection plasma fibrinolytic potential decreased at the end of surgery, normalized on post-operative day 1, and decreased again on post-operative day 3 after which the hypofibrinolytic state gradually resolved. The hypofibrinolytic state on day 1 associated with increased plasma levels of PAI-1 in both groups. Plasma levels of plasminogen, α2-antiplasmin and TAFI all decreased following partial hepatectomy and pancreas resection and levels recovered over time. The kinetics of recovery were different for the different proteins and were slower in the liver resection group, resulting in a unique ratio of pro-to-anti-fibrinolytic proteins at each time point. This may explain the hypofibrinolytic status from day 3 onwards. A sustained plasma hypofibrinolytic state in combination with the hypercoagulable state we previously identified may contribute to the increased risk of thrombotic complications after partial liver resection.

Preoperative Pneumonia and Postoperative Venous Thrombosis: A Cohort Study of 427,656 Patients Undergoing Major General Surgery

The literature is sparse regarding the association between pneumonia and venous thrombosis in surgical patients. The aim of this study was to investigate the risk of postoperative venous thrombosis in patients who fit the criteria for preoperative pneumonia using data from the ongoing American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database while adjusting for potential confounders. This is a cohort study using data from the ACS NSQIP database participating sites from 2008 (211 sites) and 2009 (237 sites). 427,656 patients undergoing major general surgery were included. The 30-day risk of postoperative venous thrombosis including deep vein thrombosis (DVT) and pulmonary embolism (PE) was evaluated in patients with preoperative pneumonia diagnosed before undergoing major general surgery. Patients with preoperative pneumonia had a higher incidence of both 30-day DVT and PE than patients without preoperative pneumonia. After adjusting for all potential confounders, the effect estimates for the association between preoperative pneumonia and venous thrombosis were DVT, OR: 1.67 (95% CI 1.32-2.11) and PE, OR: 2.18 (95% CI 1.48-3.22). A large, multicenter database of surgical patients showed that preoperative pneumonia may increase risk for developing venous thrombosis. This adds to our understanding of risk factors for venous thrombosis and suggests a potential benefit of diagnosing preoperative pneumonia in patients undergoing major general surgery.

Хірургічний стрес – фактор ризику розвитку післяопераційного тромбоемболізму

Включення фактора хірургічного стресу в шкалу J. Caprini et al. (2012) [1] об’єктивізує систему визначення ризику розвитку післяопераційних венозних тромбоемболічних ускладнень і створює можливість здійснити розподіл пацієнтів із плановою хірургічною патологією  на групи з високим, помірним та низьким ризиком розвитку післяопераційного венозного тромбозу. При цьому частота розвитку післяопераційного тромбозу в басейні нижньої порожнистої вени при високому рівні хірургічного стресу перебуває на рівні 25,68 %, при помірному ступені хірургічного стресу – 19,31 %, при низькому – 13,75 %.

Clotting system activation in patients with cancer undergoing major surgery: The role of heparin prophylaxis

Hemostatic system activation occurs in cancer patients and the risk of postoperative venous thrombosis is increased when they undergo major surgery. Preventing this complication is of interest, since surgery is the first line therapy in many tumors. To estimate clotting activation in the presence and the absence of heparin prophylaxis (either UFH or LMW), we have measured, at different time intervals from surgery, the plasma levels of TAT complex and of both total (FVIIt) and xymo@l FVII (NIIz) in 117 patients with cancer (80% of the GI tract, 20% of lung, breast, kidney and thyroid; 75 males and 42 females, age range 40-60). Patients were on prophylaxis from day 0 (day of surgery) through day 7 and were divided in 3 8roups (G): Gl (n-39), on UFH 5000 I.U./b.i.d.; 02 (n-44), on LMW CY216 7500 I.C.U/dl and G3 (n-34), no prophylaxis. TAT complex was determined by the Enxygnost TAT kit (Istituto Behring), FVIIt by the Asserachrome VIk Ag (Diagnostica Stage) and FVIIz by an Elisa using the MoAb 23 l-7 specific to FVIIz (provided by EA. Ofosu, Hamilton). Tests were performed on day (D): -1, 0, 1,3,5 and 7; results are expressed as mean zt SD. Gn -1 the 3 parameters were not significantly different among Gl, G2 and G3 (TAT 3.4& 2.9; 3.2 * 1.7 and 4.2 i 2.7 @ml; FVIIt = 1 f 0.2; I * 0.2 and 0.9 f 0.2 U/ml; FVlIz 1 f 0.2; 1 f 0.2 and 0.9 f 0.2 U/ml; respectively). On D 0 all groups had an increase of TAT levels (G 1 30 f 46; G2 2 1 i 23; G3 15 * 23 q/ml, p ns.), followed (from day 1 on) by a decmase in G I and G2, but by a htrther increase in G3; on 3 and 7 values of G3 were significantly (p < 0.05) higher (24 f 35 and 2 1 r 35 m G2 = 1.07 f 0.3; G3 0.95 ztO.2 U/ml), in contrast FVIIz remained significantly lower in G3 (0.78 & 0.2 U/ml, p c 0.05) as compared to G 1 ( 1.1 i 0.2 U/ml) and G2 ( 1.1 f 0.4 U/ml), indicating that in 03 a higher proportion of FVIIt was activated FVII protein. The incidence of thrombosis, assessed by venography, was: 0139 in G I, l/44 in G2 (2%), 8/34 in G3 (23%). In conchision, although these results need to be conlirmed by means of appropriate prospective clinical trials, our study on 117 patients with solid tumors suggests that: 1. heparin prophylaxis can modulate the generation of TAT complex and activated FVll after major surgery; 2. evaluation of these parameters can possibly be of aid to identify those individuals at particularly high risk of post-operative thrombosis.

Oral contraceptives and postoperative venous thrombosis

A nationwide surveillance of mortality associated with sterilization led to the identification of the death of a woman who was using oral contraceptives (OCs) prior to operation and died as a result of mesenteric venous thrombosis after tubal sterilization. This case is reported as a reminder of the increased risk of postoperative thromboembolism associated with OC use and to suggest how this risk can be decreased. The patient was a healthy, 24-year-old, white woman with 2 living children. She did not smoke and had no history of thromboembolic disorders. She had been using OCs for several years and continued their use until the time of hospitalization for operation. The specific OC preparation she was using is unknown. The first 48 hours following the operation the patient did well except for some mild to moderate lower abdominal pain. On the 4th day, she developed severe, acute abdominal pain and suffered a cardiovascular collapse for which she required resuscitation. She was considered to be septic and dehydrated; thus, treatment with intravenous fluids and antibiotics was initiated. An echogram obtained on the 5th day after sterilization suggested the possibility of an abdominal mass on the right sight, and an exploratory laparotomy was performed. There was 2000 ml of clear fluid in the peritoneal cavity. The cecum and ascending colon were necrotic with thrombosis of the colic and ileocolic veins. The pelvis and the appendectomy stump appeared normal. A right hemicolectomy and resection of the distal ileum were performed followed by a primary side-to-side ilecolostomy. The patient's condition deteriorated after laparotomy despite vigorous management, and she died the next morning, 7 days after the sterilization operation. Significant findings at postmortem examinations were thrombosis of both the ileocolic vein and the superior mesenteric vein and inflammation in the area of colon adjacent to the anastomosis. The cause of death was determined to be endotoxic shock secondary to large bowel necrosis which resulted from thrombosis of the mesenteric veins. This patient was at increased risk for postoperative venous thrombosis because she continued to use OCs during the month before the operation. 2 carefully conducted case-control studies have shown that OCs increase by more than 3-fold the risk of postoperative thromboembolism. It is unclear how much the knowledge of this risk has altered preoperative management of women having elective operation in the U.S. At least 1 prospective study has found no difference in incidence of idiopathic deep venous thrombosis with increasing estrogen doses, but the risk of postoperative thromboembolism associated with OCs containing a lower estrogen content has not been studied.