Venous Thromboembolism In Orthopedic Patients Research Articles

Clinical Application of Acupoint Massage Combined with Chinese Medicine Foot Bath in Prevention of Venous Thromboembolism in Orthopedic Patients

Clinical Application of Acupoint Massage Combined with Chinese Medicine Foot Bath in Prevention of Venous Thromboembolism in Orthopedic Patients

Current DVT prophylaxis: a review

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) is a serious, preventable disease occurring frequently in the UK and globally. The costs to NHS related to VTE are likely to be underestimated but the risk of developing VTE is significant in surgical patients. The overall incidence of VTE in orthopaedic patients is up to 40–60%. Patients following orthopaedic surgery have multiple risk factors making them vulnerable to developing VTE. VTE prophylaxis can be divided into general, mechanical and pharmacological methods. General methods, including early mobilization and optimizing hydration, are simple approaches widely. Mechanical methods include anti-embolism stockings, intermittent pneumatic compression devices and foot pumps. These are commonly used in combination with pharmacological agents. The latter include antiplatelet and anticoagulant drugs such as aspirin, unfractionated heparin, low-molecular-weight heparin (LMWH), vitamin K antagonists, factor Xa inhibitors and direct thrombin inhibitors. Chemical thromboprophylaxis and antithrombotic drugs continue to be an area of debate and controversy within orthopaedics. There is no single universal answer to thromboprophylaxis but, in the UK, The National Institute for Health and Care Excellence (NICE) has produced guidelines and every surgeon and hospital should have an evidence-based protocol to adhere to.

A portable pneumatic compression device to prevent venous thromboembolism in orthopedic patients with the highest risks of both venous thrombosis and bleeding: A case series study.

There is a pressing need for safe venous thromboembolism (VTE) prophylaxis in orthopedic patients with the highest risks of both venous thrombosis and bleeding. Portable intermittent pneumatic compression device (IPCD) has proven to be effective and safe in patients with a high risk of venous thrombosis and low bleeding risk. Therefore, this study examined the effectiveness, safety, and wearing compliance of portable IPCD for postoperative VTE prophylaxis in patients with the highest risks of both venous thrombosis and bleeding. The cases consisted of 38 patients who had used a portable IPCD and had the highest risks of both venous thrombosis and bleeding. We examined the incidence of VTE to assess the effectiveness of the portable IPCD, the presence of hemorrhagic adverse events to assess safety, and the wearing rate to assess wearing compliance. The incidences of asymptomatic and symptomatic deep vein thrombosis were 5.3% and 2.6%, respectively. The incidence of hemorrhagic adverse events was 21.1% in patients who received anticoagulants and wore an IPCD simultaneously and 0% in patients who wore an IPCD but did not receive anticoagulants. The wearing rate (i.e. ≥18 h/day) was 100%. Portable IPCD has the potential for safe VTE prophylaxis in patients at high risks for both venous thrombosis and bleeding. Therefore, we suggest that such patients use a portable IPCD for VTE prophylaxis.

Routine Chemoprophylaxis for Venous Thromboembolism in Orthopedic Patients: Is it Justified?

Routine Chemoprophylaxis for Venous Thromboembolism in Orthopedic Patients: Is it Justified?

Review Article: Anti-Embolism Stockings

The National Institute for Health and Clinical Excellence (NICE) guidelines recommend combined mechanical and pharmacological prophylaxis to reduce the risk of venous thromboembolism (VTE) in patients undergoing orthopaedic surgery. There is increasing evidence that anti-embolic stockings (AES) have little effect on reducing such risk. Articles in the MEDLINE, EMBASE, and Cochrane Library were reviewed. Studies on the use of pharmacological prophylaxis recommended in the 2010 NICE guidelines including low-molecular-weight heparin, unfractionated heparin, rivaroxaban, and dabigatran with and without AES in patients undergoing orthopaedic surgery were included. A total of 1171 trauma and elective orthopaedic patients in 4 studies were included; 587 received pharmacological prophylaxis alone, and 584 received a combination of pharmacological prophylaxis and above- or belowknee AES. Of the respective patients, 44 (7.5%) and 31 (5.3%) developed deep vein thrombosis (p=0.1587) and 7 (1.2%) and 9 (1.5%) developed pulmonary embolism (p=0.8493). The overall VTE rates did not differ significantly (p=0.2864). No death from VTE was reported. Addition of AES did not confer significant benefit in terms of reducing the risk of VTE in orthopaedic patients.

Aspirin Versus Anticoagulation for the Prevention of Venous Thromboembolism in Orthopedic Patients After Lower Extremity Reconstructive Surgery — A Systematic Review

Aspirin Versus Anticoagulation for the Prevention of Venous Thromboembolism in Orthopedic Patients After Lower Extremity Reconstructive Surgery — A Systematic Review

Advances in oral anticoagulation treatment: the safety and efficacy of rivaroxaban in the prevention and treatment of thromboembolism

Arterial and venous thromboembolic diseases are a clinical and economic burden worldwide. In addition to traditional agents such as vitamin K antagonists and heparins, newer oral agents – such as the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, and the direct thrombin inhibitor dabigatran – have been shown to be effective across several indications. Rivaroxaban has been shown to have predictable pharmacokinetic and pharmacodynamic properties, including a rapid onset of action. In addition, there is no requirement for routine coagulation monitoring; and no dose adjustment is necessary for age alone, sex, or body weight. Rivaroxaban has successfully met primary efficacy and safety endpoints in large, randomized phase III trials across several indications, including: prevention of venous thromboembolism in orthopedic patients undergoing elective hip or knee replacement surgery; treatment of deep vein thrombosis and secondary prevention of deep vein thrombosis and pulmonary embolism; stroke prevention in patients with atrial fibrillation; and secondary prevention of acute coronary syndrome. Rivaroxaban and the other newer oral anticoagulants are likely to improve outcomes in the prevention and treatment of thromboembolic events, and will offer patients and physicians alternative treatment options.

Identifying and reducing the incidence of post discharge Venous Thromboembolism (VTE) in orthopaedic patients: a systematic review.

BACKGROUND: The risk of venous thromboembolism for orthopaedic patients is often high due to the length of surgery, damage from trauma to bone and soft tissues and lengthy periods of immobility or reduced mobility. Although venous thromboembolism occurs mainly in inpatients a significant number of patients develop venous thromboembolism post discharge OBJECTIVES: To synthesise the best available evidence on strategies that effectively reduce post discharge venous thromboembolism in orthopaedic patients. INCLUSION CRITERIA: Patients regardless of age, gender or co-morbidities that have been admitted with an acute orthopaedic injury (unplanned) or a planned orthopaedic surgery/procedure and then followed up after discharge. Only papers describing the incidence and prophylaxis treatment used in non-Asian patients were considered for inclusion. Any interventions of combinations of chemoprophylaxis and/or mechanical prophylaxis to prevent venous thromboembolism incidence extending beyond hospital admission. Outcomes included diagnosis of venous thromboembolism following an orthopaedic admission/surgery for up to 6 months post discharge and the incidence of any significant bleeding or death related to venous thromboembolism or haemorrhage.The review considered any randomised controlled trials; in the absence of RCTs other research designs, such as non-randomised controlled trials and before and after studies, were considered SEARCH STRATEGY: Search strategy considered only papers in English from 2000 to March 2012. METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed using standardised critical appraisal instruments from the Joanna Briggs Institute. DATA COLLECTION: Data was extracted from the studies using the standardised Johanna Briggs Institute data extraction form. DATA SYNTHESIS: Of the included studies none matched methodology, treatment or comparator that allowed meta-analysis. The results were therefore presented in a narrative form and were structured using patient population, then intervention and then analysis of results. RESULTS: 20 articles were included in the systematic review. The overall incidence of post discharge venous thromboembolism in orthopaedic patients is not possible to determine due to the variability in reporting criteria and poor follow-up. Use of Low Molecular Weight Heparins was generally shown to be effective in preventing venous thromboembolism. The new generation Factor Xa inhibitors were shown to improve venous thromboembolism prevention however had a slightly higher risk of bleeding. There was limited high level research presented to allow effective assessment of aspirin and/or mechanical compression devices. CONCLUSIONS: Prevention of post discharge venous thromboembolism is complex due to the number of variables that can influence its occurrence. The risk of post discharge venous thromboembolism varies among different patient populations so consideration must be given to matching the risk for each of those groups with available interventions.For higher risk orthopaedic patient groups such as those with large joint replacements and femoral fractures low molecular weight heparins should be considered and continued where possible post discharge for thirty days however the risk profile for venous thromboembolism and bleeding must be considered for both populations and individuals.Consideration in future research design must be given to factors such as: adequate follow-up time, and standardised criteria to measure the incidence of post discharge venous thromboembolism. • Save items Add to Favorites View more options Similar articles Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review. [JBI Libr Syst Rev. 2010] The Effectiveness of Integrated Care Pathways for Adults and Children in Health Care Settings: A Systematic Review. [JBI Libr Syst Rev. 2009] Review The effect of insulin therapy algorithms on blood glucose levels in patients following cardiac surgery: A systematic review. [JBI Database System Rev Implem...] Continuous Subcutaneous Insulin Infusion (CSII) Pumps for Type 1 and Type 2 Adult Diabetic Populations: An Evidence-Based Analysis. [Ont Health Technol Assess Ser....] Review The effectiveness of ayurvedic oil-based nasal instillation (Nasya) medicines in the treatment of facial paralysis (Ardita): a systematic review. [JBI Database System Rev Implem...] See reviews... See all... Cited by 1 PubMed Central article A systematic scoping review on the consequences of stress-related hyperglycaemia. [PLoS One. 2018] Related information Cited in PMC Search details 27820532[uid] Search See more... Recent Activity ClearTurn Off Effectiveness of tight glycemic control in the medical Intensive Care Unit: a sy... PubMed 27820532[uid] (1) PubMed 27820349[uid] (1) PubMed Effectiveness of Tight Glycemic Control in the Medical Intensive Care Unit: A Sy... PubMed

The Plasma Coagulation Cascade: Potential Targets for Novel Anticoagulants in Major Lower Limb Surgery

Strategies for prevention of venous thromboembolism in orthopaedic patients undergoing major lower limb surgery include pharmacological prophylaxis. Over the last three decades, the search for new safe and effective approaches for the prevention of venous thromboembolism in these patients has continued. Increased understanding of the haemostatic process has led to a clearer appreciation of the mechanisms of action of antithrombotic drugs already in use as well as the identification of new targets for novel drug development. As a result, the development of new anticoagulants has advanced rapidly over recent years. The molecular targets of several novel anticoagulants, and their effectiveness in early Phase II and Phase III trials are reviewed.

Tromboembolismo venoso in chirurgia ortopedica. Aspetti clinici e medico-legali

The incidence of venous thromboembolism in orthopaedic patients is high and can lead to pulmonary thrombo-embolism (PTE). Deaths caused by PTE are often of forensic interest, due to the suddeness of death, and possible professional responsibility. Early diagnosis of vein thromboembolism is often difficult, therefore prevention and clinical management deserves special attention: a lack of prophylaxis, inadequate prophylaxis, lack of monitoring of coagulative parameters, insufficient duration of prophylaxis, lack of diagnostic testing can frequently lead to legal suits. In order to avoid blame on the profession to choose suitable and correct treatment is essential. The availability and the adoption of pharmacological methods has revealed a costant and continuous reduction of events during which orthopaedic and trauma patients were affected by TEP. Guidelines recommend pharmacological prophylaxis with low molecular heparin or fondaparinux in patients with total hip and knee arthroplasty and with proximal femur fractures. We report two cases: the first one illustrates an example of lack of adequate prophylactic measures, the second one describes the clinical risk correlated to underdosage. These cases are the premise for a brief pharmacological and clinical description of deep venous thrombosis prophylaxis and for some considerations regarding professional responsibility.

Intrinsic foot motion measured in vivo during barefoot running

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) is a serious, preventable disease occurring frequently in the UK and globally. The costs to NHS related to VTE are likely to be underestimated but the risk of developing VTE is significant in surgical patients. The overall incidence of VTE in orthopaedic patients is up to 40–60%. Patients following orthopaedic surgery have multiple risk factors making them vulnerable to developing VTE. VTE prophylaxis can be divided into general, mechanical and pharmacological methods. General methods, including early mobilization and optimizing hydration, are simple approaches widely. Mechanical methods include anti-embolism stockings, intermittent pneumatic compression devices and foot pumps. These are commonly used in combination with pharmacological agents. The latter include antiplatelet and anticoagulant drugs such as aspirin, unfractionated heparin, low-molecular-weight heparin (LMWH), vitamin K antagonists, factor Xa inhibitors and direct thrombin inhibitors. Chemical thromboprophylaxis and antithrombotic drugs continue to be an area of debate and controversy within orthopaedics. There is no single universal answer to thromboprophylaxis but, in the UK, The National Institute for Health and Care Excellence (NICE) has produced guidelines and every surgeon and hospital should have an evidence-based protocol to adhere to.

Prevention of venous thromboembolism in orthopaedic patients

Prevention of venous thromboembolism in orthopaedic patients