Challenges in the prevention of venous thromboembolism in the elderly

Minno, G. Di; Tufano, Antonella

doi:10.1111/j.1538-7836.2004.00842.x

Cited by 37 publications

(29 citation statements)

References 61 publications

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“…[2][3][4]. Comparison between data waiting and mortality showed an increase of mortality in some way associated to the diagnostic data timing of supply, with an Data related to mortality and morbidity of TE linked to the specialty of the clinical departments where patients are treated were taken into consideration.…”

Section: Medical Treatment Before and After Surgerymentioning

confidence: 99%

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Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Franciscis¹,

Agus²,

Bisacci³

et al. 2008

Annals of Vascular Surgery

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Venous thromboembolism (VTE) is a common health problem for today's society, and considering the role that it plays in surgical patients (general surgery, gynecology, and orthopedics), new advances in our understanding of the procedures and trauma characteristics are relevant and necessary. The most important and recently published guidelines concerning this problem have been taken into consideration, leading to articulate investigations and data evaluation. This project has proposed a data-survey framework available as a questionnaire in order to investigate application of the guidelines for VTE throughout the national territory. Of the total 714 Italian centers, a random sample of 214 were contacted and asked to take part in this study; of these, 146 replied (20.4% of total and 68.2% of the sample): 48 departments of general surgery, 46 departments of gynecology, and 52 departments of orthopedics. About 70% of the centers has appropriate information about surgery as a risk factor for VTE. The answers have provided evidence of an adequate knowledge of the instrumental and laboratory diagnostic pathways, useful to confirm the diagnosis of TE (80%). Data waiting compared with morbidity and mortality rates related to deep vein thrombosis and pulmonary embolism showed an increase of mortality associated with the diagnostic data timing of supply, with an exponential trend linked to the data acquisition delay. Both risk stratification and adequate application of prophylaxis together with treatment devices represent a real tool to control morbidity and mortality for VTE. Moreover, diagnostic data waiting significantly influences adequate prophylaxis. In Italy, only 40% of the centers are ready to provide diagnostic data within 12 hr.

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Section: Medical Treatment Before and After Surgerymentioning

confidence: 99%

“…2 However, because of the variety of risk factors in these patients and their individual health problems (e.g., comorbidities, therapies), 3 the guidelines formulated for these cases are scarcely applied. The type of procedure as well as trauma are crucial for VTE in surgical patients (general surgery, gynecology, and orthopedics).…”

Section: Introductionmentioning

confidence: 99%

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Franciscis¹,

Agus²,

Bisacci³

et al. 2008

Annals of Vascular Surgery

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“…Evidence suggests that bleeding from antithrombotic agents is a strong predictor of mortality and reduces the overall benefits of VTE prophylaxis in hospitalized patients (14,(45)(46)(47)(48).…”

Section: Contraindications To Prophylaxismentioning

confidence: 99%

Thromboprophylaxis in Elderly Surgical Patients: Current State and Future Considerations

Delimpalta¹,

Ponchietti²

2017

chr

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RezumatTromboembolismul venos reprezintã cea mai frecventã cauzã evitabilã de deces în rândul pacienţilor spitalizaţi. Pacienţii vârstnici care suferã intervenţii operatorii în sfera Chirurgiei Generale prezintã o susceptibilitate crescutã pentru Tromboza Venoasã Profundã /Tromboembolism Pulmonar Acut (TVP/TEPA). Riscul de TVP/TEPA creşte de altfel adiţional în prezenţa comorbiditãţilor prevalente în grupul pacienţilor vârstnici. Cu toate acestea, TVP/TEPA este de multe ori subdiagnosticat şi subtratat în acest grup de pacienţi. În prezent existã o serie de scoruri de risc clinice care clasificã pacienţii în categorii de risc scãzut/moderat/crescut pentru TVP/TEPA. Ghidurile clinice de bunã practicã pentru tromboprofilaxie propun fie o combinaţie de procedee mecanice (ciorapi elastici sau compresie gambiera penumaticã intermitentã), fie agenţi farmacologici (ex. Heparina cu greutate molecularã redusã sau anticoagulante orale). Dat fiind faptul cã riscul de sângerare ca efect secundar al tratamentului reprezintã o cauzã semnificativã de îngrijorare în ceea ce priveşte populaţia vârstnicã, metodele de tromboprofilaxie trebuie ajustate astfel încât acest risc sa fie cât mai scãzut. Atât opţiunea pentru un anumit tromboprofilactic, cât şi doza acestuia pot fi, de asemenea, influenţate de o alterare a funcţiei renale. Durata necesarã tromboprofilaxiei este încã neclarã, ea putând varia între c. o sãptãmânã şi o lunã, în funcţie de patologia pacientului şi evaluarea riscului individual de TVP/TEPA. AbstractVenous thromboembolism is the number one cause of preventable death for hospital inpatients. Aging general surgical patients are especially susceptible to DVT/PE and this risk increases in the presence of other comorbidities prevalent in the elderly. However, it is often unrecognised and undertreated. Various risk scores classify patients in low, moderate and high risk categories. Current guidelines for thromboprophylaxis advocate combination of mechanical methods in the form of elastic stockings or intermittent pneumatic leg compression and pharmacological agents such as low molecular weight heparins and oral anticoagulants. Increased bleeding risk is a concern in this population and the method of prophylaxis needs to be adjusted as a result. Decreased renal function also influences the choice and dosage of medication. The required duration of prophylaxis is unclear but can range from one week to more than a month depending on the underlying pathology and individual risk assessment.

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“…We read with interest the articles by Minno and Tufano (2004) and Zakai et al (2004), which serve to highlight the need for prevention of venous thromboembolism (VTE) in at-risk patients. We recently audited our use of prophylactic low molecular weight heparin (LMWH) in hospitalized older adults (65 years or older) over a 6-week period.…”

mentioning

confidence: 99%

“…VAN The 2-year cumulative recurrence rate of deep venous thrombosis after suffering a single episode of thrombosis is approximately 10%-18% [1,2]. Recently, it was shown that the risk of recurrent venous thrombosis is higher among men than women, a difference that appeared not to be due to discontinuation of oral contraceptives or hormone replacement therapy, the presence of the factor V Leiden (FV Leiden) or the prothrombin mutation, or elevated levels of factor VIII or IX (FVIII or FIX) [3,4].…”

mentioning

confidence: 99%

Audit‐guided action can improve the compliance with thromboembolic prophylaxis prescribing to hospitalized, acutely ill older adults

Timmons

O’Callaghan

O’Connor

et al. 2005

Journal of Thrombosis and Haemostasis

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Challenges in the prevention of venous thromboembolism in the elderly

Cited by 37 publications

References 61 publications

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Thromboprophylaxis in Elderly Surgical Patients: Current State and Future Considerations

Audit‐guided action can improve the compliance with thromboembolic prophylaxis prescribing to hospitalized, acutely ill older adults

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