A randomised controlled trial of a low-molecular-weight heparin (Enoxaparin) to prevent deep-vein thrombosis in patients undergoing vascular surgery

Farkas, Jean-Christophe; Chapuis, C.; Combe, S.; Silsiguen, M.; Marzelle, J.; Laurian, Claude; Cormier, J M

doi:10.1016/s0950-821x(05)80369-x

Cited by 65 publications

(37 citation statements)

References 16 publications

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“…[109][110][111][112][113][114][115][116] Most enrolled patients undergoing diverse vascular procedures, but two studied patients undergoing aortic surgery, 109,115 and one enrolled patients undergoing lower-extremity amputation. 116 Three studies compared LDUH (with or without IPC) to no prophylaxis, one compared aspirin to no prophylaxis, and three compared LDUH to LMWH.…”

Section: Target Population: Vascular Surgerymentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,857

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Target Population: Vascular Surgerymentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,857

744

View full text Add to dashboard Cite

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“…As for the other research paper authors applying various forms of prophylaxis, Farkas determined the TC frequency as 4.2% and 10.6% depending on administration of, respectively, unfractionated heparin and low-molecular weight heparin [19], whereas in the case of Fletcher and Batiste, applying unfractionated heparin and compress therapy, the TC frequency was 11.5% [20].…”

Section: Discussionmentioning

confidence: 99%

“…Other authors reported similar observations. The frequency of this process is variously assessed, starting from 20% [21,33], through 33% [22] (based on phlebography), 36% [19] (based on DUS and phlebography), and up to 54.5% [20] (based on DUS scan).…”

Section: Tc -Thromboembolic Complicationsmentioning

confidence: 99%

Thromboembolic complications in patients using pharmacological antithrombotic prophylaxis and operated on for arterial occlusive disease in the aorto-iliac segment

Pawlaczyk-Gabriel¹,

Gabriel²,

Leszek³

et al. 2014

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Objectives: This prospective, non-randomised study was aimed at the assessment of prevalence of thromboembolic events in vascular patients routinely receiving antithrombotic prophylaxis following surgical revascularisation of the lower extremities. Material and methods: This study included 105 patients operated on for aortoiliac occlusive disease. Postoperatively all patients received pharmacological antithrombotic prophylaxis with low-molecular-weight heparin. Sonographic examination of the veins of low extremities was routinely performed three times: one day before the surgery, on the discharge day and 30 days after hospital discharge. Results: Thromboembolic complications were found in 21 patients (19.05%), including 18 patients with deep venous thrombosis and 3 with pulmonary embolism. Thromboembolic events were more prevalent in older patients (68.22 vs. 62.65 years), those with necrotic lesions of the limbs, with lower preoperative concentration of hemoglobin (7.89 vs. 8.61 mmol/l), higher of fibrinogen (455 vs. 357 mg/dl) and of platelet count (334 vs. 250 × 10 9 /l). Other risk factor comprised the number of transfused packed red blood cell units (3.39 vs. 1.45 units) and plasma units (1.61 vs. 0.39 units), and the length of stay in the intensive care unit (4.78 vs. 2.24 days). Conclusions: Vascular patients develop thromboembolism very often, despite pharmacological prophylaxis. Thus, routine scanning for deep vein thrombosis before hospital discharge in order to exclude thrombosis should be considered in this group. Also, an extended post-discharge thromboprophylaxis in these patients should be considered.

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“…Regarding late postoperative complications, deep venous thrombosis is reported to occur at a rate of 1.6 to 5% in these series and after surgery performed in the vicinity of major blood vessels in the abdomen at a rate 7 to 8% despite of use of LMWH (ref. 14,16,21 ). The reported incidence of sexual dysfunction varies from 0.5 to 24%.…”

Section: Discussionmentioning

confidence: 99%

Surgical complications of the anterior approach to the L5/S1 intervertebral disc

Hrabálek¹,

Adamus²,

Wanek³

et al. 2012

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. The aims of this study were to describe the incidence and type of perioperative complications that occur with minimally invasive anterior retroperitoneal spinal surgery performed at the level of the L5/S1 intervertebral disc. Methods. A retrospective review of 175 patients: 103 women and 72 men, average age 45, who had undergone anterior spinal surgery at level L5/S1 from January 2001 to February 2011. The preoperative diagnoses were: degenerative disc disease in 87 (50%), failed back surgery syndrome in 53 (30%) and spondylolisthesis in 35 patients (20%). The surgical steps in the minimally invasive anterior retroperitoneal approach from the right side to disc L5/S1 are described. All surgical intraoperative anatomical anomalies and complications directly related to the anterior spinal surgery were documented. Results. Intraoperative pathological-anatomical anomalies were found in 34 patients (19%) and intra -and postoperative minor complications in 24 patients (12%) but no serious complications. The main intraoperative complication was peritoneal opening without visceral injury (5%) and the main postoperative complication was weakness of the right abdominal wall (3%). Conclusion. Retroperitoneal access and surgery at level L5/S1 disc space is a safe procedure when performed by a knowledgeable and experienced spine team. During surgical planning for an anterior approach to the LS spine, the surgeon must carefully assess the neuroimaging results, such as MRI, to minimize potentially disastrous vascular complications.

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A randomised controlled trial of a low-molecular-weight heparin (Enoxaparin) to prevent deep-vein thrombosis in patients undergoing vascular surgery

Cited by 65 publications

References 16 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Thromboembolic complications in patients using pharmacological antithrombotic prophylaxis and operated on for arterial occlusive disease in the aorto-iliac segment

Surgical complications of the anterior approach to the L5/S1 intervertebral disc

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