A Randomized, Prospective Trial of Deep Venous Thrombosis Prophylaxis in Aortic Surgery

Killewich, Lois A.; Aswad, Margo A.; Sandager, Gail P.; Lilly, Michael; Flinn, William R.

doi:10.1001/archsurg.1997.01430290045007

Cited by 40 publications

(32 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Obesity and perioperative stasis and hypercoagulability place most bariatric surgery patients at high risk for 109,111,115 the pooled weighted risk of major bleeding in the control (no prophylaxis) groups was 0.3% (95% CI, 0.2%-2.4%). However, an observational study reported that the incidence of life-threatening hemorrhage among 973 patients undergoing complex major vascular procedures was 1.8%, with most episodes of bleeding occurring intraoperatively and only 0.4% of patients experiencing severe bleeding postoperatively.…”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtmentioning

confidence: 99%

“…[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%

See 1 more Smart Citation

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,857

744

View full text Add to dashboard Cite

(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

show abstract

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtmentioning

confidence: 99%

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

show abstract

“…22 In the absence of prophylaxis, the rate of DVT is Ϸ21% when routine contrast venography is obtained [23][24][25] and 15% when routine postoperative ultrasonography is performed. 22,26 Patients undergoing major vascular procedures who have additional thromboembolic risk factors should receive antithrombotic prophylaxis with LDUH or LMWH. Although the optimal time to start prophylaxis with antithrombotic agents in patients undergoing vascular surgery remains unclear, some practitioners prefer to administer the first dose after surgery.…”

Section: Vascular Surgerymentioning

confidence: 99%

Prevention of Venous Thromboembolism in Surgical Patients

2004

View full text Add to dashboard Cite

Abstract-Venous thromboembolism (VTE) is a common complication of surgical procedures. The risk for VTE in surgical patients is determined by the combination of individual predisposing factors and the specific type of surgery. Prophylaxis with mechanical and pharmacological methods has been shown to be effective and safe in most types of surgery and should be routinely implemented. For patients undergoing general, gynecologic, vascular, and major urologic surgery, low-dose unfractionated heparin or low-molecular-weight heparin (LMWH) are the options of choice. For low-risk urologic surgery, early postoperative mobilization of patients is the only intervention warranted. For higher-risk patients, including those undergoing elective hip or knee replacement and surgery for hip fracture, vitamin K antagonists, LMWH, or fondaparinux are recommended. For patients undergoing neurosurgery, graduated elastic stockings are effective and safe and may be combined with LMWH to further reduce the risk of VTE. The role of prophylaxis is less defined in patients undergoing elective spine surgery, as well as laparoscopic and arthroscopic surgery. A number of issues related to prophylaxis of VTE after surgery deserve further clarification, including the role of screening for asymptomatic deep vein thrombosis, the best timing for initiation of pharmacological prophylaxis, and the optimal duration of prophylaxis in high-risk patients. Key Words: venous thromboembolism Ⅲ deep vein thrombosis Ⅲ pulmonary embolism Ⅲ heparin Ⅲ low-molecular-weight heparin Ⅲ vitamin K antagonists

show abstract

“…The lowest frequency of thrombosis was observed by Killewich, at 2% in both study groups with and without pharmacological antithrombotic prophylaxis [18]. However, in his research he totally ignored the diagnostics of crural veins, which, according to our observations, constituted the most frequent location of thrombotic lesions.…”

Section: Discussionmentioning

confidence: 48%

“…In other studies the above ratio moved gradually in the proximal direction, amounting to, respectively, for the distal and proximal section, 78% and 22% [21], 67% and 33% [22], and 52% and 48% [29]. Fletcher and Batiste observed proximal thrombosis in as many as 80% of patients with TC [20], whereas Killewich detected the presence of thrombus only in proximal veins [18]. However, according to the examination report, during a DUS scan he did not assess the lower leg veins.…”

Section: Discussionmentioning

confidence: 91%

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

View full text Add to dashboard Cite

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.

show abstract

A Randomized, Prospective Trial of Deep Venous Thrombosis Prophylaxis in Aortic Surgery

Cited by 40 publications

References 20 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of Venous Thromboembolism in Surgical Patients

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

Contact Info

Product

Resources

About