Routine Pharmacological Thromboprophylaxis Research Articles

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.

Low rate of subclinical venous thrombosis in patients with haemophilia undergoing major orthopaedic surgery in the absence of pharmacological thromboprophylaxis.

Deep venous thrombosis (DVT) is a common postoperative complication in patients undergoing major orthopaedic surgery of the lower limbs, such as total hip or knee replacement (THR, TKR). Routine pharmacological thromboprophylaxis with low-molecular-weight heparin (LMWH) or a direct oral anticoagulant agent is strongly recommended in this setting. THR and TKR as well as ankle arthrodesis are frequently performed in people with haemophilia (PWH) and chronic haemophilic arthropathy. Pharmacological thromboprophylaxis in this population remains controversial. We report the results of a single-centre prospective study initiated in 2002 evaluating by systematic Doppler ultrasound the incidence of subclinical DVT in consecutive PWH referred for major orthopaedic surgery and not receiving pharmacological thromboprophylaxis. We included 46 different PWH (39 Haemophilia A, 7 Haemophilia B, 27 severe, 15 moderate and 4 mild forms) undergoing 67 orthopaedic procedures. Most (89.5%) were performed with continuous infusion of clotting factor concentrates. Rehabilitation was usually started on day 1 post-op. No clinical DVT or pulmonary embolism was suspected. In total, there were 5 cases (3 severe, 1 moderate HA and 1 moderate HB) of subclinical DVT which were all distal. Two patients were treated with a short course (10-14days) of LMWH. The overall incidence of DVT was 7.5%. These data provide imaging-based evidence that the risk of DVT following major orthopaedic surgery among PWH is low. Identified DVTs were distal and resolved spontaneously in most cases. Systematic pharmacological thromboprophylaxis in this specific population is probably for most patients not required.

Dose-adjusted enoxaparin thromboprophylaxis in hospitalized cancer patients: a randomized, double-blinded multicenter phase 2 trial

AbstractHospitalized patients with cancer are at an increased risk of developing venous thromboembolism (VTE). The recommendation for routine pharmacologic thromboprophylaxis in hospitalized patients with cancer to prevent VTE is based on extrapolation of results from noncancer cohorts. There are limited data to support the efficacy and safety of fixed-dose low-molecular-weight heparin (LMWH) regimens in high-risk hospitalized patients with cancer. We conducted a randomized, double-blinded, phase 2 trial in hospitalized patients with active cancer at high risk of developing VTE based on Padua risk score. Patients were randomly assigned to fixed-dose enoxaparin (40 mg daily) vs weight-adjusted enoxaparin (1 mg/kg daily) during hospitalization. The primary objectives were to evaluate the safety of dose-adjusted enoxaparin and evaluate the incidence of VTE with fixed-dose enoxaparin. Blinded clinical assessments were performed at day 14, and patients randomly assigned to fixed-dose enoxaparin subsequently underwent a bilateral lower extremity ultrasound. A total of 50 patients were enrolled and randomized. The median weight of patients enrolled in weight-adjusted enoxaparin arm was 76 kg (range, 60.9-124.5 kg). There were no major hemorrhages or symptomatic VTE in either arm. At time of completion of the blinded clinical assessment, there was only 1 incidentally identified pulmonary embolus that occurred in the weight-adjusted arm. In the group randomly assigned to fixed-dose enoxaparin who subsequently underwent surveillance ultrasound, the cumulative incidence of DVT was 22% (90% binomial confidence interval, 0%-51.3%). This phase 2 trial confirms a high incidence of asymptomatic VTE among high-risk hospitalized patients with cancer and that weight-adjusted LMWH thromboprophylaxis is feasible and well-tolerated. This trial was registered at www.clinicaltrials.gov as #NCT02706249.

Is there any role of adding routine pharmacologic thromboprophylaxis for gastric cancer surgery in Indian patients?

Is there any role of adding routine pharmacologic thromboprophylaxis for gastric cancer surgery in Indian patients?

Risk and incidence of perioperative deep vein thrombosis in patients undergoing gastric cancer surgery.

Venous thromboembolism (VTE) is a potentially fatal perioperative complication. Understanding the risk factors for deep vein thrombosis (DVT) and initiating appropriate prophylaxis is pivotal for reducing the risk of VTE. The purpose of this study was to clarify the perioperative risk factors for DVT in patients undergoing surgery for gastric cancer. We reviewed the findings of lower limb ultrasonography performed in 160 patients who underwent gastrectomy for gastric cancer. The preoperative and postoperative incidence of DVT was 4.4% (7/160) and 7.2% (11/153), respectively. All postoperative DVTs were of the distal type, whereas preoperative DVTs were of the proximal (n = 3) and distal type (n = 4). None of the patients suffered symptomatic VTE. Multivariate analysis indicated that depth of invasion and D-dimer concentration were independent risk factors for preoperative DVT and that gender and performance status were risk factors for postoperative DVT. Receiver operating characteristic analysis revealed that the optimal cut-off D-dimer concentration was 1.4μg/mL. The incidence of perioperative DVT was low for patients undergoing gastric cancer surgery. Therefore, the risk-stratified application of perioperative pharmacologic thromboprophylaxis is thought to be more appropriate than routine pharmacologic thromboprophylaxis for Japanese patients undergoing surgery for gastric cancer.

Perioperative Pharmacological Thromboprophylaxis in Patients With Cancer: A Systematic Review and Meta-analysis.

To compare the relative effects between pharmacological thromboprophylaxis and no anticoagulation. The efficacy and safety of pharmacological thromboprophylaxis in cancer patients undergoing surgery need to be quantified to guide management. We searched multiple electronic databases (up to March 31, 2016) for trials of cancer patients undergoing surgery that assessed the relative benefits and harms of perioperative pharmacological thromboprophylaxis. Relative risks (RRs) with 95% confidence intervals (CI) were estimated. A total of 39 studies were enrolled in this review. Patients with pharmacological thromboprophylaxis had a relatively reduced incidence of deep venous thrombosis (DVT) compared with those without (0.5% vs 1.2%, RR 0.51, 95% CI 0.27-0.94; P = 0.03) but a significantly increased incidence of bleeding events (RR 2.51, 95% CI 1.79-3.51; P < 0.0001). The incidence of pulmonary embolism (PE) (RR 1.77, 95% CI 0.76-4.14; P = 0.19) and mortality related to venous thromboembolism (VTE) (1/2,811 vs 2/3,380) were similar between the pharmacological thromboprophylaxis group and the no pharmacological thromboprophylaxis group. Low-molecular-weight heparin (LMWH) reduced the incidence of DVT compared with unfractionated heparin (UFH) (RR 0.81, 95% CI 0.66-1.00; P = 0.05), and standard extended thromboprophylaxis after cancer surgery significant decreased the incidence of DVT as compared with conventional thromboprophylaxis (RR 0.57, 95% CI 0.39-0.83; P = 0.003). Routine pharmacological thromboprophylaxis for cancer patients undergoing surgery needs to be carefully considered, because although thromboprophylaxis is associated with lower VTE events, there is a higher incidence of clinically significant bleeding events. If pharmacological thromboprophylaxis is to be used, extended thromboprophylaxis started preoperatively with LWMH might be the most effective strategy.

Managing hip fracture and lower limb surgery in the emergency setting: Potential role of non-vitamin K antagonist oral anticoagulants.

Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thrombo-embolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries. Non-vitamin K antagonist oral anticoagulants (NOACs) are indicated for VTE prevention after elective hip or knee replacement surgery, but at present are not widely recommended for other orthopedic indications despite their advantages over conventional anticoagulants and promising real-world evidence. In patients undergoing HFS or lower limb surgery, decisions on whether to anticoagulate and the most appropriate anti-coagulation strategy can be guided by weighing the risk of thromboprophylaxis against the benefit in relation to each patient's medical history and age. In addition, the nature and location of the fracture, operating times and times before fracture fixation should be considered. The current review discusses the need for anticoagulation in patients undergoing emergency HFS or lower limb surgery together with the current guidelines and available evidence on the use of NOACs in this setting. Appropriate thromboprophylactic strategies and practical advice on the peri-operative management of patients who present to the Emergency Department on a NOAC before emergency surgery are further outlined.

Factors influencing the use of thromboprophylaxis in cancer outpatients in clinical practice: A prospective study

IntroductionCurrent clinical practice guidelines do not recommend routine pharmacological thromboprophylaxis in cancer outpatients receiving chemotherapy. However, a high proportion of cancer-associated venous thromboembolism (VTE) events occur in this setting. There are scarce data on the use of thromboprophylaxis in ambulatory cancer patients in real clinical practice. Material and methodsWe conducted a single-center prospective study aimed to evaluate the use and factors influencing pharmacological prophylaxis in consecutive cancer patients receiving ambulatory chemotherapy. Patients were followed for 90days after inclusion. ResultsA total of 1108 patients were included. According to the Khorana score, 45.8% patients were classified as low-risk, 47.4% intermediate-risk and 6.8% as high-risk. Outpatient pharmacological prophylaxis was administered at any time during follow-up to 157 patients (14.2%) with a median duration of 42days (range 1–90). Main factors influencing thromboprophylaxis were: previous history of VTE (odds ratio [OR], 19.11; 95% CI, 9.61–37.98), intercurrent hospitalization (OR, 5.40; 95% CI, 3.57–8.16), and gastrointestinal or gynecologic cancer (OR, 1.76; 95% CI, 1.11–2.80 and OR, 2.34; 95% CI, 1.05–5.26, respectively). During follow-up 58 (5.2%) VTE events were observed. Independent predictors of VTE were the site of malignancy (OR, 3.04; 95%CI, 1.20–7.71 and OR, 2.47; 95%CI, 1.21–5.01 for pancreas and lung cancer, respectively) and previous VTE (OR, 4.23; 95%CI, 1.26–14.27). Outpatient prophylaxis was associated with a lower risk of VTE during follow-up (OR, 0.30; 95%CI, 0.10–0.95). ConclusionsAlthough the type of malignancy appears as the most relevant variable for decision-making, additional efforts are required to identify patients at particular high thrombosis risk.

Differential Influence of Lung Cancer Stage, Time from Diagnosis and Chemotherapy on Plasma and Cellular Biomarkers of Hypercoagulability. the Roadmap Study

Introduction. In patients with lung adenocarcinoma, metastasis, advanced stage and chemotherapy (CTx) are factors which increase the risk of venous thromboembolism (VTE). However, routine pharmacological thromboprophylaxis is not recommended but individualized risk assessment for VTE is encouraged. The incorporation of hypercoagulability biomarkers (HB) into the risk assessment models (RAM) could improve their sensitivity to identify patients eligible for thromboprophylaxis. To this aim we conducted an observational prospective study to investigate the variability of HB associated with hypercoagulability, with respect to cancer-related characteristics.Patients & Methods. Patients with documented lung adenocarcinoma eligible for CTx at distance of at least 3 months from surgery or hospitalization were included in the study (n=79). Patients were either CTx naive (n=29) or had already received CTx (n=50). The control group (CG) consisted of 30 healthy age & sex-matched individuals. Thrombin generation (TGT) in citrated PPP was assessed with the Thrombogram-Thrombinoscope® assay using PPP-reagent®5 pm TF by Diagnostica Stago. The levels of P-Selectin, heparanase(HPA) in plasma were measured with ELISA Kit (Cusabio Biotech and R&D Systems). The procoagulant phospholipids (PPL) were measured with STA-Procoag-PPL® , Factor VIIa by Staclot VIIa-rTF®, D-Dimers (DDi) by Liatest D-Di (Diagnostica Stago, France), and Tissue Factor activity (TFa) by specific clotting based home test. Mortality and thrombotic events were recorded in 3-month follow-up.Results. Patients showed significantly shortened PPL and significantly higher levels of TFa, D-Dimer and HPA as compared to the CG. The levels of FVIIa were significantly lower in patients compared to CG. P-Selectin levels and endogenous thrombin potential (ETP) did not differ between the two groups. The chronometric parameters of TGT (lag-time, ttPeak) were significantly prolonged, consequently the velocity of the propagation phase of TGT (MRI) was significantly lower in patients as compared to CG. The Naive Group (NG) showed significantly shorter lag-time of TGT and lower ETP as compared to the On Treatment Group (OTG). It showed significantly higher levels of HPA as compared to the OTG. These data are summarized in Table I.The increase of TGT as well as that of HPA, P-Selectin, FVIIa was associated with the grade of the disease. Patients with metastatic cancer had higher levels of P-Selectin, TFa, DDi, FVIIa, TGT and HPA as compared to patients with localized or advanced disease. Patients who experienced a thrombotic episode (8%) had significantly higher baseline levels of DDi, TGT, shorter PPL and lower levels of HPA as compared to those who were without thrombosis. Patients who died within 3-month follow-up (26%) had higher baseline levels of DDi and lower HPA levels as compared to those who were still alive.Conclusion. Our study evaluated a wide spectrum of HB of cellular and plasma hypercoagulability in patients with lung adenocarcinoma. It established that the increase of procoagulant phospholipids in plasma, up regulation of TF pathway, DD formation and HPA release is a universal phenomenon in lung cancer. Variations of TGT and FVIIa levels allow us to identify subgroups of patients who present increased hypercoagulability. CTx has an impact on TGT and HPA levels. Finally, baseline values of TGT, PPL, HPA , DDi were found to be related with 3-month mortality and the incidence of thrombotic episodes. These data allow us to propose that the weighted incorporation of HB of cellular and plasma hypercoagulabilty in RAM for VTE might improve their predictive value. This concept is being studied on an ongoing trial.Table IHB in patients with lung adenocarcinoma.HBAll Patients (n=79)NG(n=29)OTG(n=50)CG(n = 30)PPL-ct (sec)27±6*27±7*27,6±7,5*62,8±9TFa (ng/ml)6.2±4.7*6,2±4*6,6±5,2*0,26±0.1DD (μg/ml)1,8±2,2*1,1±1*1,4±1,2*0,3±0.01HPNS (ng/ml)0,4±1,2*0,32±0.12$*0,23±0,1*0,12±0,02FVIIa (U/ml)37±20*34±16*34±20*50,9±11P-Selectin (ng/ml)65,4±2064,8±1562,6±1962,6±10Lag-time (min)4,3±0,8*3,9±1$4,5±0,9*2,5±0.01ttPeak (min)7.7±1.4*7±18,7±1,3*5±1MRI (nM/min)91±40*94±4187,3±33*110±24Peak (nM)279±71*279±76284±62*288±36ETP (nM.min)1583±3281567±3261673±315*$1496±191* p<0,05 versus CG$ p<0,05 versus NG DisclosuresNo relevant conflicts of interest to declare.

Multicentric Study Evaluating Venous Thrombosis Among Patients with Haemophilia Undergoing Major Orthopaedic Surgery

▪Deep venous thrombosis (DVT) is a common postoperative complication in patients undergoing major orthopaedic surgery of the lower limbs, such as total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery (HFS). In the absence of thromboprophylaxis, subclinical venous thrombosis rates as high as 60% have been reported when using systematic bilateral phlebography after orthopaedic surgery. As a result, routine pharmacological thromboprophylaxis with low-molecular-weight heparin (LMWH) or a new oral anticoagulant agent is strongly recommended in patients undergoing these procedures.With the availability of efficient and safe clotting factor concentrates, THR, TKR, as well as ankle arthrodesis are frequently performed in subjects with haemophilia suffering from chronic haemophilic arthropathy. Yet, pharmacological prophylaxis of venous thromboembolism (VTE) in this patient group remains controversial. With the exception of retrospective case reports and small series, the incidence of VTE disease in haemophilic patients after major orthopaedic surgery is still unclear. Surveys suggest that more than half of hemophilia treatment centers in the United States and Europe use thromboprophylaxis in patients with haemophilia (PWH) who require major orthopedic surgery. However, this is not supported by evidence or surgical practice guidelines, and simply increases the risk of bleeding in such patients. Given the aging nature of the haemophilia population and the incidence of joint disease, the question of the thrombotic risk associated with major orthopaedic surgery and joint replacement surgery in particular is highly relevant. Few studies have addressed this issue and more information is needed on which to base optimal preventive strategies for venous thrombosis in patients with haemophilia undergoing elective major orthopedic surgery.We here report the results of 2 parallel and independent prospective studies from Belgium and Norway currently evaluating by systematic US-Doppler imaging the incidence of subclinical deep venous thrombosis in consecutive haemophilic patients referred for major orthopaedic surgery. In Belgium, the study has so far included 36 different patients (32 HA, 4HB) undergoing 50 major orthopaedic procedures of the lower limbs. In Norway, the study has involved 29 patients (26 HA, 3 HB, all with severe haemophilia) undergoing 29 orthopaedic procedures, most of the lower limbs. In both countries, most patients were treated with continuous infusion of clotting factor concentrates and none of them did receive antithrombotic pharmacological prophylaxis.In the 2 studies that included in total 65 patients undergoing 79 major orthopaedic procedures, no case of clinically patent DVT or PE was detected (Table 1). In total there were 5 cases of DVT evidenced by US imaging which were all distal, not complicated by PE and treated with a short course of low-molecular weight heparin in most cases. The overall incidence of subclinical DVT calculated on the whole population was 6%.In conclusion, these data provide for the first time multicentric and imaging-based evidence that the risk of DVT following major orthopaedic surgery among patients with haemophilia undergoing major orthopaedic surgery is very low and that systematic pharmacological thromboprophylaxis in this specific population is for most patients not required. The two studies are still ongoing and should include a larger number of participants in the future. Table 1Characteristics of patients with haemophilia undergoing major orthopaedic surgeryHTC BrusselsHTCOsloTotalPatients362965Haemophilia A322658Haemophilia B437Severe252954Moderate909Mild202Procedures502979Knee301141Ankle81220Hip729Femur404Lumbar101Elbow044Venous thrombosis415HTC: Haemophilia Treatment Center DisclosuresNo relevant conflicts of interest to declare.

Thromboembolism During Neoadjuvant Therapy for Gastrointestinal Cancer

Thromboembolism a common, costly, and morbid complication that is also associated with decreased survival in cancer patients. The risk of thromboembolism in cancer patients is underappreciated. In addition to symptomatic deep venous thrombosis and pulmonary embolism, asymptomatic and arterial thromboembolic events are important consideration in ambulatory cancer patients receiving neoadjuvant chemoradiotherapy (nCRT). No specific randomized trial examining thromboprophylaxis (TP) during nCRT for gastrointestinal cancer has been performed, and none is accruing. Most guidelines currently recommend against TP in ambulatory cancer patients due to a lack of data rather than proof of harm or lack of efficacy. It is clear that robust data are urgently required, and that treatment with nCRT in patients with gastrointestinal malignancy is not an indication for routine pharmacological TP at the present time.

CP-055 Effect of rivaroxaban on wound healing after elective tibial osteotomy

BackgroundAfter elective tibial osteotomy patients are considered at high risk of venous thromboembolism (VTE) due to prolonged immobilisation. Routine pharmacological thromboprophylaxis for these patients is widely adopted in clinical practice...

A prospective study on the incidence of postoperative venous thromboembolism in Korean gastric cancer patients: An inquiry into the application of western guidelines to Asian cancer patients.

e15129 Background: Several Western guidelines recommend the routine use of pharmacologic thromboprophylaxis for cancer surgery patients to prevent venous thromboembolism (VTE). However, the necessity of routine pharmacologic perioperative thromboprophylaxis in Asian gastric cancer (GC) patients has not been clearly determined. Methods: To determine the necessity of routine perioperative pharmacologic thromboprophylaxis in Korean gastric cancer patients, the incidence of postoperative VTE was prospectively evaluated in gastric cancer patients receiving surgery. Among 610 GC patients who had received surgery, 375 patents prospectively underwent routine duplex Doppler ultrasonography (DUS) on days 5-12 following surgery to detect VTE and then VTE-related symptoms and signs were checked at 4 weeks after surgery (cohort A). The 235 patients that declined DUS were registered to cohort B and the occurrence of postoperative VTE was retrospectively analyzed. Results: In cohort A, symptomatic or asymptomatic VTE until 4 weeks after surgery was detected in 9 patients [2.4%; 95% confidence interval (CI); 0.9-3.9]. Tumor stage was a significant factor related to VTE development [stage I, 1.4%; stage II/III, 2.4%; stage IV, 9.7% (P = 0.008)]. In multivariate analysis, patients with stage IV had a higher postoperative VTE development [odds ratio, 8.18 (95% CI, 1.54-43.42)] than those with stage I. In cohort B, a low incidence of postoperative VTE was reaffirmed; only one postoperative VTE case (0.4%) was observed. Conclusions: The incidence of postoperative VTE in Korean GC patients was only 2.4%. Risk-stratified applications of perioperative pharmacologic thromboprophylaxis are thought to be more appropriate than the routine pharmacologic thromboprophylaxis in Korean GC patients receiving surgery.

A Prospective Study on the Incidence of Postoperative Venous Thromboembolism in Korean Gastric Cancer Patients: An Inquiry into the Application of Western Guidelines to Asian Cancer Patients

Several Western guidelines recommend the routine use of pharmacologic thromboprophylaxis for cancer surgery patients to prevent venous thromboembolism (VTE). However, the necessity of routine pharmacologic perioperative thromboprophylaxis in Asian gastric cancer (GC) patients has not been clearly determined. To determine the necessity of routine perioperative pharmacologic thromboprophylaxis in Korean gastric cancer patients, the incidence of postoperative VTE was prospectively evaluated in gastric cancer patients receiving surgery. Among 610 GC patients who had received surgery, 375 patents underwent routine duplex Doppler ultrasonography (DUS) on days 5–12 following surgery to detect VTE and then VTE-related symptoms and signs were checked at 4 weeks after surgery (cohort A). The 235 patients that declined DUS were registered to cohort B and the occurrence of postoperative VTE was retrospectively analyzed. In cohort A, symptomatic or asymptomatic VTE until 4 weeks after surgery was detected in 9 patients [2.4%; 95% confidence interval (CI); 0.9–3.9]. Tumor stage was a significant factor related to VTE development [stage I, 1.4%; stage II/III, 2.4%; stage IV, 9.7% (P = 0.008)]. In multivariate analysis, patients with stage IV had a higher postoperative VTE development [odds ratio, 8.18 (95% CI, 1.54–43.42)] than those with stage I. In cohort B, a low incidence of postoperative VTE was reaffirmed; only one postoperative VTE case (0.4%) was observed. In conclusion, the incidence of postoperative VTE in Korean GC patients was only 2.4%. Risk-stratified applications of perioperative pharmacologic thromboprophylaxis are thought to be more appropriate than the routine pharmacologic thromboprophylaxis in Korean GC patients receiving surgery.

Incidence of Acute Deep Vein Thrombosis and Pulmonary Embolism in Foot and Ankle Trauma: Analysis of the National Trauma Data Bank

The incidence of deep vein thrombosis (DVT) after foot and ankle surgery is generally believed to be low. However, little information is available regarding DVT as it specifically relates to foot and ankle trauma. The National Trauma Data Bank data set (2007 to 2009) was used to evaluate the incidence of thromboembolism in foot and ankle trauma. Also, the risk factors associated with the thromboembolic events were identified. Data regarding the demographics, comorbidities, procedures, trauma types, and complications, including DVT and pulmonary embolism (PE), were collected from the data set for analysis. The incidence of DVT and PE was 0.28% and 0.21%, respectively. The risk factors statistically significantly associated and clinically relevant for both DVT and PE in foot and ankle trauma were older age (DVT, odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01 to 1.03; PE, OR 1.02, 95% CI 1.01 to 1.03), obesity (DVT, OR 2.35, 95% CI 1.33 to 4.14; PE, OR 3.06, 95% CI 1.68 to 5.59), and higher injury severity score (DVT, OR 1.22, 95% CI 1.16 to 1.28; PE, OR 1.21, 95% CI 1.14 to 1.29). Owing to the low incidence, routine pharmacologic thromboprophylaxis might be contraindicated in foot and ankle trauma. Instead, careful, individualized assessment of the risk factors associated with DVT/PE is important.

Deep Venous Thrombosis and Pulmonary Embolism are Uncommon in East Asian Patients after Total Hip Arthroplasty

In Western countries, deep vein thrombosis (DVT) and pulmonary embolism (PE), are relatively common after THA and many surgeons recommend routine pharmacologic thromboprophylaxis. There is some suggestion in the literature that the incidences of DVT and PE may be lower in East Asian patients. Therefore, it would be important to establish the incidences in a large number of East Asian patients who did not receive pharmacologic thromboprophylaxis. We therefore determined the incidence of DVT and PE and evaluated the associated risk factors in a series of East Asian patients who underwent primary THA without pharmacologic prophylaxis. We retrospectively evaluated all 861 patients who underwent 992 elective primary THAs from May 2003 to December 2009. We identified patients with symptomatic DVT, symptomatic PE, and fatal PE. For potential risk factors we considered age, gender, body mass index (BMI), administration of aspirin, type of anesthesia, operation time, approach, simultaneous bilateral THAs, and duration of immobilization between symptomatic and asymptomatic patients. We identified eight patients with symptomatic DVT, one of whom also had a symptomatic PE; there were no cases of fatal PE. The incidences of fatal PE, symptomatic PE, and symptomatic DVT were 0 %, 0.1 %, and 0.8 %, respectively. Longer duration of immobilization predicted symptomatic DVT or PE. East Asian patients have a low incidence of symptomatic DVT and PE and virtually no fatal PEs after primary THA. The incidences and risk factors should be taken into consideration when deciding whether to prophylactically treat these patients with pharmacologic agents. Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Low incidence of deep vein thrombosis after knee arthroscopy without thromboprophylaxis: A prospective cohort study of 335 patients

Background There is little data on the risk of deep vein thrombosis after knee arthroscopy.Patients and methods We performed a prospective cohort study to establish the incidence of venous thrombo-embolic (VTE) complications after knee arthroscopy in daycare, as detected by bilateral complete compression ultrasonography (CCUS) at day 14 (11–17) postoperatively. 335 patients completed bilateral extended ultrasound. No thromboprophylaxis was given.Results 19 (5.7%; 95% CI: 3.5%–8.7%) showed VTE on CCUS, of whom 2 were symptomatic. 1 patient developed a non-fatal pulmonary embolus during the 8-week follow-up period. There was no difference in immobilization characteristics between the patients who developed postoperative DVT and those who did not; nor could other risk factors be identified.Interpretation Since the incidence of VTE is low and a specific high-risk group for the development of VTE could not be identified, it seems justified to withhold routine pharmacological thromboprophylaxis after arthroscopy of the knee in a daycare setting.