Venous Thromboembolism In Surgical Patients Research Articles

Risk factor analysis and prediction model construction for surgical patients with venous thromboembolism: A prospective study

Abstract Objective: Patients undergoing surgery are at high risk of developing venous thromboembolism (VTE). This study aimed to determine the predictive value of risk factors for VTE in surgical patients and to develop a prediction model by integrating independent predictors. Methods: A total of 1111 patients who underwent surgery at clinical departments in a tertiary general hospital were recruited between May and July 2021. Clinical data, including patient-related, surgery-related, and laboratory parameters, were extracted from the hospital information system and electronic medical records. A VTE prediction model incorporating ten risk variables was constructed using artificial neural networks (ANNs). Results: Ten independent factors (X1: age, X2: alcohol consumption, X3: hypertension, X4: bleeding, X5: blood transfusions, X6: general anesthesia, X7: intrathecal anesthesia, X8: D-dimer, X9: C-reactive protein, and X10: lymphocyte percentage) were identified as associated with an increased risk of VTE. Ten-fold cross-validation results showed that the ANN model was capable of predicting VTE in surgical patients, with an area under the curve (AUC) of 0.89, a Brier score of 0.01, an accuracy of 0.96, and a F1 score of 0.92. The ANN model slightly outperformed the logistic regression model and the Caprini model, but a DeLong test showed that the statistical difference in the AUCs of the ANN and logistic regression models was insignificant (P>0.05). Conclusion: Ten statistical indicators relevant to VTE risk prediction for surgical patients were identified, and ANN and logistic regression both showed promising results as decision-supporting tools for VTE prediction.

Prevention of venous thromboembolism in surgical patients: A proposal for a protocol based on the reality of a university hospital

Introduction: Venous thromboembolism (VTE) results from the formation of thrombi in the endothelial space, following factors related to endothelial injury, venous stasis and coagulation disorders. This scenario can result in deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), which is the third leading cause of cardiovascular death worldwide. Given the possibility of preventing VTE in the majority of in-hospital cases, it is recommended that every hospital has a formal strategy for VTE prevention, including in patients undergoing elective surgery. To this end, it is possible to use risk stratification scales, both for the development of VTE and the baseline risk of bleeding in post-operative patients. Objective: To provide an institutional protocol that is systematized and updated according to the main national and international literature on the prevention of venous thromboembolism in elective surgeries at the Júlio Muller University Hospital (HUJM/ UFMT). Materials and Methods: A protocol was drawn up based on a systematic analysis of up-to-date scientific evidence on thromboprophylaxis in elective surgeries, adapted to the routine of the Júlio Muller University Hospital (HUJM/UFMT), using the UpToDate, Pubmed and Cochrane Library platforms, as well as the Guidelines of the Brazilian Society of Angiology and Vascular Surgery (SBACV) and the American College of Chest Physicians (ACCP). Conclusion: The patient's risk of developing VTE is largely due to avoidable or predictable risk factors, depending on the type of surgery, mobilization time and risk of bleeding. The use of a protocol for the prevention of venous thromboembolism through risk stratification will allow greater individualization of the patient in relation to established prophylaxis, based on scientific evidence. Further studies on the subject are still needed, especially in the setting of elective surgery.

Venous Thromboembolism Prophylaxis and Screening: A Clinical Audit

Objective: We aimed to audit venous thromboembolism in surgical patients at risk of VTE presented to surgical department in 2021 using the caprini risk assessment model. Methodology: This clinical audit was conducted in surgical D unit department of Surgery, Khyber Teaching Hospital, Peshawar from July 2021 to December 2021. A total of 150 patients each for the audit group and the re-audit group were selected through non-probability consecutive sampling for both genders. A predesigned proforma according to caprini risk assessment model was used to assess the patient’s individual risk for DVT and provision of appropriate prophylaxis. Data was entered into Microsoft excel, analyzed through SPSS version 23 and results were presented in the form of descriptive writing and tables. Results: The mean age of the study population was 50.47 with relatively equal selection from both genders. None of the patients in the audit group were properly grouped for their risk of DVT and management needed as mentioned in the caprini RAM guidelines. In the re-audit group, 100% of the patients were accurately categorized into groups and the VTE risk assessment percentage significantly improved from 0% to 80.8%. Conclusion: The audit showed noticeable deficiencies in record keeping and clinical assessment of VTE risk in the management of hospital patients. However, through appropriate measures this insufficiency can be amended with appreciable results.

Thromboprophylaxis in Urological and Andrological Surgery (Review article)

Last decades urologist started to performed big amount of complicated oncological operation with substantial risk of both venous thromboembolism (VTE) and bleeding. Prophylaxis of VTE remains a vital problem, as it is potentially fatal and is associated with significant morbidity. Prophylaxis of this complication is not clearly defined and is mainly based on information from other surgical specialties (like orthopedic or general surgery). Scientific publications dedicated VTE prophylaxis in field of urology were reported only in the last decade. Most studies showed that pharmacological prophylaxis decreases the relative risk of VTE in surgical patients by approximately 50%, but with an increase in the relative risk of postoperative major bleeding of 50%. Main models for evaluation of different VTE risk factors were analyzed. The most important risk factors for VTE are age of 75 or more, body mass index 35 or more, prior VTE or VTE in 1st degree relative. As for urological procedure, deep venous thrombosis rates of 0.2–7.8% and pulmonary embolism of 0.2–7% have been reported. It was shown that recommendations for VTE prophylaxis varies in different guidelines and their summary for most popular operations were described. Generally, most recommendations state that low-risk procedures need no prophylaxis or solely mechanical prophylaxis. Moderate-risk categories can either have mechanical or pharmacological prophylaxis. The high-risk category should have both mechanical and pharmacological prophylaxis, and extended prophylaxis should be considered. Despite massive evidences about risk of VTE among different types of surgical patients, real clinical practice doesn’t show the strict adherence to VTE prophylaxis recommendations.

Outcomes after implementation of prophylactic protocol for venous thromboembolism in surgical patients: A retrospective cohort study

IntroductionVenous thromboembolism (VTE) in surgical patients is a preventable cause of hospital death. In previous studies, the prevalence of VTE decreased after implementing a prophylactic protocol. Because of the low rate of VTE prophylaxis in Thailand, we studied the outcomes after the implementation of a VTE prophylactic protocol in our hospital. MethodsA retrospective cohort single-center study was conducted from November 2019 to November 2020 in the Department of Surgery. We established the VTE prophylactic protocol using a multidisciplinary team approach and the Caprini score risk assessment model. The outcomes were the incidence of symptomatic VTE, VTE-related death, risk factors, and safety. ResultsIn total, 6983 patients were admitted to the surgical department during the study period. After excluding patients with current VTE and missing data, 4579 patients were enrolled in this study, and 1579 (34.5%) patients at high risk for VTE were identified. The use of pharmacological prophylaxis, mechanical prophylaxis, and early ambulation in the entire cohort was lower than that in high-risk patients (7.99%, 19.81%, and 21.56% vs. 15.77%, 31.10%, and 46.55%, respectively). In the comparison of before and after implementation, the prevalence of symptomatic VTE and 30-day mortality of VTE decreased from 1.20% to 0.37% and from 0.11% to 0.02%, respectively. No major bleeding occurred. ConclusionsAfter protocol implementation, the prevalence of symptomatic VTE and VTE-related death decreased. The VTE prophylaxis was safe. We highly recommended using a multidisciplinary team approach VTE prophylaxis in high-risk surgical patients.

Application of the Caprini Risk Assessment Model for the Assessment of Risk Factors for Postoperative Venous Thromboembolism in the Surgery Department of Anosiala University Hospital

The purpose of this research is to ascertain the prevalence of postoperative venous thromboembolism in the Department of Surgery at Anosiala University Hospital and to identify risk factors for developing postoperative venous thromboembolism using the Caprini Risk Assessment Model. From December 2017 to October 2019, this was a 22-month prospective cohort research conducted at Anosiala University Hospital. It included all adult patients over the age of 18 who were operated on in an emergency or on a planned basis by the Department of Surgery. This research included 662 participants. Within 30 days after surgery, the risk of venous thromboembolism was 0.3 percent. According to the overall Caprini score, 25.2 percent of patients were classified as having a low risk of venous thromboembolism, 25.2 percent as having a moderate risk, 29.5 percent as having a high risk, and 20.1 percent as having the greatest risk. Patients in the highest risk category (scoring 5) had a substantially increased chance of having venous thromboembolism after surgery (p = 0.0007). Only major open surgery was related with a statistically significant increase in postoperative venous thromboembolism (p = 0.028). Age 75 years, elective arthroplasty, and hip, pelvic, or leg fractures were not linked with postoperative venous thromboembolism statistically significantly (p> 0.05). Our findings indicate that the Caprini risk assessment model might be used successfully to avoid postoperative venous thromboembolism in surgical patients in Madagascar, since patients in the highest risk category had a considerably increased chance of developing postoperative venous thromboembolism.

Venous thromboembolism risk and adequacy of thromboprophylaxis in surgical patients

Venous thromboembolism (VTE) is the most prevalent potentially preventable complication amongst surgical patients. Appropriate prophylaxis is quite effective in its prevention. Mechanical and pharmacological thromboprophylaxis can be instituted based on risk categorisation. This study was undertaken to assess the risk for development of VTE in surgical patients and to assess the adequacy of thromboprophylaxis. A descriptive research design was used and was conducted in the general surgical wards of a tertiary hospital in South India. All 385 patients who were admitted in the surgical wards during the data collection period were included in the study, and the VTE Risk Assessment Tool by the Department of Health (2008b), UK, was used to assess the VTE risk in these patients. Eighty per cent of the patients were at high risk for developing VTE, and majority (62.7%) of them were not on any method of thromboprophylaxis. Only a minority (11.7%) of those who belonged to moderate or low risk were found to be on thromboprophylaxis. Majority of the patients who were found to be at high risk and were on prophylaxis for VTE were on anti-embolism stockings. More than half of the patients who were at low or moderate risk for VTE were found to be on injection heparin administered subcutaneously. There was a statistically significant association between age, type of occupation, the number of days of hospital stay, type of surgery, mobility level of patients and the VTE risk. Implementation of VTE risk assessment tool and a protocol for thromboprophylaxis helps in prevention of VTE and the complications associated with thromboprophylaxis. Incorporating this topic as a regular in-service education can ensure its mandatory learning and practice by nurses – the front line caregivers.

Low Anti-Factor Xa Level Predicts 90-Day Symptomatic Venous Thromboembolism in Surgical Patients Receiving Enoxaparin Prophylaxis: A Pooled Analysis of Eight Clinical Trials.

To examine the relationship between enoxaparin dose adequacy, quantified with anti-Factor Xa (aFXa) levels, and 90-day symptomatic venous thromboembolism (VTE) and postoperative bleeding. Surgical patients often develop "breakthrough" VTE events-those which occur despite receiving chemical anticoagulation. We hypothesize that surgical patients with low aFXa levels will be more likely to develop 90-day VTE, and those with high aFXa will be more likely to bleed. Pooled analysis of eight clinical trials (N = 985) from a single institution over a 4 year period. Patients had peak steady state aFXa levels in response to a known initial enoxaparin dose, and were followed for 90 days. Survival analysis log-rank test examined associations between aFXa level category and 90-day symptomatic VTE and bleeding. Among 985 patients, 2.3% (n = 23) had symptomatic 90-day VTE, 4.2% (n = 41) had 90-day clinically relevant bleeding, and 2.1% (n = 21) had major bleeding. Patients with initial low aFXa were significantly more likely to have 90-day VTE than patients with adequate or high aFXa (4.2% vs 1.3%, P = 0.007). In a stratified analysis, this relationship was significant for patients who received twice daily (6.2% vs 1.5%, P = 0.003), but not once daily (3.0% vs 0.7%, P = 0.10) enoxaparin. No association was seen between high aFXa and 90-day clinically relevant bleeding (4.8% vs 2.9%, P = 0.34) or major bleeding (3.6% vs 1.6%, P = 0.18). This manuscript establishes inadequate enoxaparin dosing as a plausible mechanism for breakthrough VTE in surgical patients, and identifies anticoagulant dose adequacy as a novel target for process improvement measures.

Effect of thromboprophylaxis on the incidence of venous thromboembolism in surgical patients with colorectal cancer: a meta-analysis.

This study evaluates the role of thromboprophylaxis in venous thromboembolism (VTE) incidence in colorectal cancer (CRC) surgical patients. Literature search was conducted in electronic databases and studies (randomized controlled trials, or prospective/retrospective cohorts) were selected if they reported the incidence of VTE in CRC patients who underwent any type of open or laparoscopic surgery. Random-effects meta-analyses were performed to obtain pooled incidence estimates; or odds ratios (OR) of incidence between prophylaxis and no-prophylaxis groups; or between VTE and non-VTE patients to identify risk factors. Twenty-four studies (804,003 patients) were included. Prophylaxis was performed mainly with low molecular weight heparins. Odds of VTE were significantly lower in prophylactic than in non-prophylactic patients (OR 0.42 [95% CI: 0.28, 0.63]; P<0.00001). Incidence of radiological and symptomatic VTE in patients with prophylaxis was 9.7% [95% CI: 8.6, 10.8] and 1.3% [95% CI: 0.7, 2.0] respectively. Odds of bleeding were higher in patients with prophylaxis (OR: 3.37 [95% CI: 1.05, 10.8]; P=0.04). Incidence of bleeding in patients with and without prophylaxis was 4.3% [95% CI: 3.2, 5.4] and 1.2% [95% CI: 0.02, 2.4] respectively. Operative time, anesthesia duration, and hospital stay were longer in patients with VTE. Obesity, disseminated cancer, chemotherapy, steroid use, emergency case status, advanced stage cancer, hypoalbuminemia, postoperative infection/sepsis, and history of VTE are identified as important risk factors for VTE incidence. Thromboprophylaxis reduces the incidence of VTE in CRC surgical patients but may increase the chances of bleeding. Several risk factors can influence VTE incidence.

Economic burden of venous thromboembolism in surgical patients: A propensity score analysis from the national claims database in Vietnam.

Venous thromboembolism (VTE) associated with surgery can cause serious comorbidities or death and imposes a substantial economic burden to society. The study examined VTE cases after surgery to determined how this condition imposed an economic burden on patients based on the national health insurance reimbursement database. Methods: This retrospective analysis adopted the public payer's perspective. The direct medical cost was estimated using data from the national claims database of Vietnam from Jan 1, 2017 to Sep 31, 2018. Adult patients who underwent surgeries were recruited for the study. Patients with a diagnostic code of up to 90 days after surgery were considered VTE cases with the outcome measure being the surgery-related costs within 90 days. The 90-day cost of VTE patients was found to be US$2,939. The rate of readmission increased by 5.4 times, the rate of outpatient visits increased by 1.8 times and total costs over 90 days in patients with VTE undergoing surgery increased by 2.2 times. Estimation using propensity score matching method showed that an increase of US$1,019 in the 90-day cost of VTE patients. The VTE-related costs can be used to assess the potential economic benefit and cost-savings from prevention efforts.

Venous thromboembolism an observational study to assess the risk of venous thromboembolism in surgical patients.

Objectives: The aim of this study is to assess the risk of venous thromboembolism (VTE) in surgical patients. Study Design: An Observational Study. Setting: 4 Tertiary Hospitals in Faisalabad city. Period: 6 months from July 2015 to December 2015. Material &amp; Methods: Clinical data sheets of surgical in patients of 4 teaching hospitals in Faisalabad city were retrospectively reviewed. Caprini assessment model (CAM) was used for VTE risk assessment and the patients were classified into very high risk (VHR), high risk (HR), moderate risk (MR) and low risk (LR) groups. The data was collected on an Excel spread sheet and statistical analysis was done using SPSS version 17. Chi square test was carried out to assess the association of VTE risk with age, gender, BMI and surgical units. Results: We identified a total of 256 patients from July 2015 to December 2015. The median age was 42 years. 118 (46%) patients were male and 138 (54%) were female. 106 (41.4%) patients were VHR and 124 (48.4%) patients were HR for VTE according to CAM. Nineteen (7.4%) patients were MR and only 7 (2.7%) patients were LR. Higher age and male gender were found to be significantly associated with the high risk for VTE (p&lt;0.001). Conclusion: Our study shows that the postoperative surgical patients are at higher risk of developing VTE. There is statistically significant association between increasing age and male gender with risk of VTE in this group of patients.

Генетические маркеры венозного тромбоэмболизма у хирургических пациентов

Генетические маркеры венозного тромбоэмболизма у хирургических пациентов

Use of Computerized Clinical Decision Support Systems to Prevent Venous Thromboembolism in Surgical Patients

ImportanceHealth care professionals do not adequately stratify risk or provide prophylaxis for venous thromboembolism (VTE) among surgical patients. Computerized clinical decision support systems (CCDSSs) have been implemented to assist clinicians and improve prophylaxis for VTE.ObjectiveTo evaluate the effect of implementing CCDSSs on the ordering of VTE prophylaxis and the rates of VTE.Data SourcesPubMed, MEDLINE via OVID, EMBASE via OVID, Scopus, Cochrane CENTRAL Register of Controlled Trials, and clinicaltrials.gov were searched in June 2016 for articles published in English from October 15, 1991, to February 16, 2016. A manual search of references from relevant articles was also performed.Study SelectionClinical trials and observational studies among surgical patients comparing CCDSSs with VTE risk stratification and assistance in ordering prophylaxis vs routine care without decision support were included. Of the 188 articles screened, 11 (5.9%) were eligible for meta-analysis.Data Extraction and SynthesisMeta-analysis of Observational Studies in Epidemiology guidelines were followed. Two reviewers extracted data and assessed quality independently. Main Outcomes and MeasuresRates of prophylaxis for VTE and VTE events. Random- and fixed-effects models were used to summarize odds ratios and risk ratios.ResultsEleven articles (9 prospective cohort trials and 2 retrospective cohort trials) comprising 156 366 individuals (104 241 in the intervention group and 52 125 in the control group) were included. The use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio, 2.35; 95% CI, 1.78-3.10; P < .001) and a significant decrease in the risk of VTE events (risk ratio, 0.78; 95% CI, 0.72-0.85; P < .001).Conclusions and RelevanceUse of CCDSSs increases the proportion of surgical patients who were prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients.

Venous thromboembolism (VTE) is one of the most common and feared complications in surgical patients, and its prevention has been the subject of a Call to Action from the Surgeon General of the United States. Here, we review the literature on the use of risk assessment models for the stratification of surgical patients into risk groups to guide the administration of pharmacoprophylaxis. Despite some disagreement in the literature and among various guidelines, there is good evidence that risk stratification identifies a 7- to 20-fold variation in postoperative VTE risk among the overall surgical population, including patients at both low and high risk. This information is useful to providers who are making decisions about mechanical prophylaxis and pharmacoprophylaxis.

Evidence-Based Recipes for Venous Thromboembolism Prophylaxis: A Practical Safety Guide.

After studying this article and viewing the videos, the participant should be able to: 1. Demonstrate an understanding of risk stratification for venous thromboembolism in surgical patients. 2. Calculate and interpret a 2005 Caprini score. 3. Give examples of modifiable risk factors for perioperative venous thromboembolism. 4. Propose a venous thromboembolism risk reduction strategy using mechanical and/or chemoprophylaxis and justify the risks and benefits of the proposed strategy. This CME article provides an evidence-based summary of venous thromboembolism in plastic and reconstructive surgery patients, with a focus on current knowledge surrounding risk stratification, risk modification, and risk reduction.

PP018 Clinical Risk Prediction Scores For Venous Thromboembolism In Hospitalized Patients

INTRODUCTION:Risk prediction scores have been devised to identify patients at increased risk for Venous Thromboembolism (VTE) in different patient populations and settings. Guideline recommendations for VTE risk assessment vary greatly. We performed a systematic review to synthesize evidence on clinical risk prediction scores for VTE in hospitalized medical and surgical patients.METHODS:We systematically searched Medline, EMBASE, Cochrane, National Institute of Health and Care Excellence (NICE), National Guidelines Clearinghouse (NGC), and Guidelines International Network (GIN) databases up to March 2016. We included studies validating risk prediction scores for adult hospitalized patients. We excluded studies for any of the following reasons: non-English publication, conducted in non-OECD (Organisation for Economic Co-operation and Development) countries, validation cohorts focused solely on critical care patients, or scores developed for specific surgical or medical sub-specialty populations. We plotted receiver operating characteristic (ROC) curves of included studies and performed summary ROC meta-analyses for scores in which &gt;1 external validation studies were combinable. Risk of bias was assessed qualitatively. We assessed the strength of the evidence base using Grading of Recommendations Assessment, Development and Evaluation (GRADE).RESULTS:We screened 110 primary studies and included 18 of those for analysis. There were seven studies of the Caprini score, three studies of the Padua score, two studies of the IMPROVE score; and one study each of the Arcelus, Geneva, Khorana, RAP, and Kucher scores . Strength of evidence was downgraded for study risk of bias because most studies disproportionately included patients at high risk of VTE. Our summary estimates of the performance of the three combinable scores at clinically-relevant thresholds are: Caprini score at a threshold of three in surgical patients – 96 percent sensitivity, 44 percent specificity; IMPROVE at a threshold of one in medical patients – 96 percent sensitivity, 20 percent specificity; and Padua at a threshold of 4–87 percent sensitivity and 58 percent specificity.CONCLUSIONS:There is moderate strength evidence for use of the Caprini score to predict VTE in surgical patients and for the Padua and IMPROVE scores in medical patients. Lower thresholds may be warranted to achieve sufficient sensitivity to identify low risk populations who may not require routine VTE prophylaxis. Studies making direct comparisons of risk prediction scores in similar patient populations are lacking and are necessary to ascertain which score is most effective.

The Prevention of Venous Thromboembolism in Surgical Patients.

Patients undergoing surgery are at an increased risk of VTE. Since the early 1990s the prevention of VTE has been dominated by the administration of low-molecular weight heparin during admission. New oral anticoagulants have been extensively researched and have increased in popularity. This chapter reviews why surgical patients are at increased risk of VTE and summaries both the pharmacological and mechanical methods of prophylaxis available.

Reduction of Venous Thromboembolism in Surgical Patients Using a Mandatory Risk-Scoring System: 5-Year Follow-Up of an American College of Surgeons National Surgical Quality Improvement Program.

Sheikh Khalifa Medical City's (SKMC) surgery institute was identified as a high outlier in the incidence of venous thromboembolism (VTE; deep vein thrombosis [DVT] and pulmonary embolism [PE]) based on the semiannual report of the American College of Surgeon's National Surgical Quality Improvement Program (ACS NSQIP) in June 2010. To report our rates of VTE at SKMC, the results, and 5-year follow-up after an ACS NSQIP quality improvement program. A multidisciplinary VTE task force was established in June 2010. We instituted a compulsory risk assessment for VTE and utilized the ACS NSQIP best practice guidelines to review cases of VTE. We prospectively evaluated the observed/expected (O/E) ratio for DVT/PE after implementing the action plan. The O/E ratio for PE/DVT in general and general/vascular (GV) surgery was 6.00 and 4.86 in June 2010. Our compliance with ordering antithrombotic prophylactic measures was as low and it improved to 100% and our O/E ratio decreased to 1.18 and 1.5 in July 2011 and stabilized for the next 4 years. Currently, our compliance with ordering antithrombotic prophylactic measures is 100%, and our last 2 O/E ratio for DVT/PE are 0.74 and 0.75 in GV surgery and 0.82 and 0.78 in the entire surgery institute, respectively, and we are considered an exemplary site of the ACS NSQIP in GV surgery. A compulsory risk assessment for VTE has led to an overall improvement in DVT/PE rates in the surgery institute and for GV surgery to become an exemplary site for the ACS NSQIP.

Improving prevention of venous thromboembolism in surgical patients

Improving prevention of venous thromboembolism in surgical patients

Sepsis in emergency surgical patients: Is management optimal?

Sepsis in emergency surgical patients: Is management optimal?