ACOG Practice Bulletin No. 84: Prevention of Deep Vein Thrombosis and Pulmonary Embolism

doi:10.1097/01.aog.0000263919.23437.15

Cited by 118 publications

(21 citation statements)

References 46 publications

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“…The American College of Chest Physicians (ACCP) and the American College of Obstetricians & Gynecologists (ACOG) recommend unfractionated heparin, low molecular weight heparin, or unfractionated or low molecular weight heparin combined with pneumatic sequential compression devices (SCDs) for patients at moderate or high risk who undergo gynecologic surgery, with extended prophylaxis for 2-4 weeks after discharge [10]. …”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery

Corr¹,

Winter²,

Sammel³

et al. 2015

Gynecologic Oncology

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Objective To determine the effectiveness and safety of an expanded perioperative venous thromboembolism (VTE) prophylaxis strategy in women undergoing complex gynecologic surgery. Methods We performed a cohort study of 527 patients undergoing major surgery at a single institution over a thirty-month interval during which the gynecologic oncology service implemented an expanded approach to VTE prophylaxis. We compared rates of VTE pre- and post-intervention as well as bleeding and infectious complications. Results Prior to the intervention, there were 23 VTE events in 345 patients (rate of 6.67%): 8 deep vein thrombosis (DVTs) and 15 pulmonary emboli (PEs). Post intervention, there were 5 VTE events in 182 patients (2.7%): 3 DVTs and 2 PEs (RR=0.4 p=0.056). Time-to-event analysis showed a significantly higher incidence of VTE events in the pre-intervention time frame compared to the post-intervention period (p = 0.049). There were no significant differences in bleeding or infection complications between groups. Conclusions Implementation of a perioperative VTE prophylaxis protocol was safe, feasible and resulted in a clinically significant reduction in symptomatic VTE. Preoperative single-dose unfractionated heparin for all patients, combined with two weeks of thromboprophylaxis in gynecologic cancer patients, may decrease VTE events without increasing bleeding or infection.

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Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery

Corr¹,

Winter²,

Sammel³

et al. 2015

Gynecologic Oncology

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“…Of the two types of VTE, PAPE occurs suddenly and is not easy to diagnose promptly because the clinical presentation of PAPE is extremely variable in pregnancy and the signs and symptoms of a suspected PAPE such as dyspnea can frequently overlap with that of a normal pregnancy. Moreover, mortality by PAPE occurs within 30 minutes of the sentinel event, making timely intervention difficult [10]. Mortality from PAPE in pregnancy is related to challenges in targeting the right population for prevention, suspecting the diagnosis and adequately evaluating appropriate patients, and initiating timely and the best possible treatment when indicated [11].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy-associated pulmonary embolism during the peripartum period: An 8-year experience at a single center

et al. 2014

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ObjectiveThe purpose of this study was to estimate the incidence, timing of onset, risk factors, and mortality rate of pregnancy-associated pulmonary embolism (PAPE).MethodsWe analyzed PAPE cases that occurred between January 2005 and December 2012 at Cheil General Hospital & Women's Healthcare Center. Those cases that were not confirmed by computed tomography scan or were confirmed as amniotic fuid embolisms were excluded. We analyzed various risk factors such as previous surgery, mode of delivery, maternal age, and obesity in PAPE.ResultsThere were 57,092 deliveries over 8 years. Of them, 13 cases (0.023%) were diagnosed with PAPE. All cases occurred in the postpartum period after cesarean delivery. There were no cases of PAPE after vaginal deliveries. Of the total cases, 10 cases (76.9%) were diagnosed in the early postpartum period within 48 hours. Eight cases (61.5%) had a history of previous surgery. There were 3 cases (23.1%) of multiple pregnancy and 3 cases (23.1%) of preterm delivery. No cases had a history of venous thromboembolism. Among 13 cases, 10 cases improved with only anticoagulation, 2 cases received surgical thrombectomy, and one case was maternal death.ConclusionOur results indicated that the incidence of PAPE was very low (0.023%) and occurred mainly in the postpartum period after cesarean section. However, its maternal mortality rate was significantly high (7.7%). Therefore, we suggest that immediate diagnosis and prompt treatment should be prioritized for improvement of PAPE patients' survival rate.

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“…2 In addition, the diagnosis of EOC; having a personal history of VTE; age older than 60 years; surgical duration of more than 2 hours; bed rest of more than 4 days; prolonged hospital stay; and postoperative complications such as sepsis, urinary tract infection, transfusion, myocardial infarction, and pneumonia are associated with an increase in the risk for being diagnosed with a VTE. 2,10 Both perioperative prophylactic measures 10,11 and extended prophylaxis with lowYmolecular-weight heparin (LMWH) for 4 weeks after surgery for pelvic or abdominal malignancy 12 have been shown to decrease VTE. However, reimbursement for prolonged prophylaxis can be problematic.…”

mentioning

confidence: 99%

Incidence and Predictors of Venous Thromboembolism After Debulking Surgery for Epithelial Ovarian Cancer

Mokri¹,

Mariani²,

Heit³

et al. 2013

Int J Gynecol Cancer

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Objective The aim of this study was to determine the incidence and the risk factors of venous thromboembolism (VTE) within 30 days after primary surgery for epithelial ovarian cancer (EOC). Methods In a historical cohort study, we estimated the postoperative 30-day cumulative incidence of VTE among consecutive Mayo Clinic patients undergoing primary cytoreduction for EOC between January 2, 2003, and December 29, 2008. We tested perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program, >130 variables) as potential predictors of postoperative VTE using the Cox proportional hazards modeling. Results Among 569 cases of primary EOC cytoreduction and/or staging and no recent VTE, 35 developed symptomatic VTE within 30 days after surgery (cumulative incidence = 6.5%; 95% confidence interval, 4.4%–8.6%). Within the cohort, 95 (16.7%) received graduated compression stockings (GCSs), 367 (64.5%) had sequential compression devices + GCSs, and 69 (12.1%) had sequential compression devices + GCSs + postoperative heparin, with VTE rates of 1.1%, 7.4%, and 5.8%, respectively (P = 0.07, χ2 test). The remaining 38 (6.7%) received various other chemical and mechanical prophylaxis regimens. In the multivariate analysis, current or past tobacco smoking, longer hospital stay, and a remote history of VTE significantly increased the risk for postoperative VTE. Conclusions Venous thromboembolism is a substantial postoperative complication among women with EOC, and the high cumulative rate of VTE within 30 days after primary surgery suggests that a more aggressive strategy is needed for VTE prevention. In addition, because longer hospital stay is independently associated with a higher risk for VTE, methods to decrease length of stay and minimize factors that contribute to prolonged hospitalization are warranted.

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ACOG Practice Bulletin No. 84: Prevention of Deep Vein Thrombosis and Pulmonary Embolism

Cited by 118 publications

References 46 publications

Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery

Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery

Pregnancy-associated pulmonary embolism during the peripartum period: An 8-year experience at a single center

Incidence and Predictors of Venous Thromboembolism After Debulking Surgery for Epithelial Ovarian Cancer

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