Challenges of extended venous thromboembolism prophylaxis in medical and surgical patients

Chindamo, Maria Chiara; Paiva, Edison F.; Carmo, Plínio Resende do; Rocha, Ana Thereza; Marques, Marcos Arêas

doi:10.1590/1677-5449.202101952

Cited by 12 publications

(19 citation statements)

References 40 publications

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Section: Discussionmentioning

confidence: 99%

“…Saint et al underlined that IDUCs are known to negatively affect patient mobility and participation in daily activities (Saint et al, 2018). Moreover, by reducing the time to ambulation a broad range of complications including thrombosis and embolisms could be prevented (Chindamo & Marques, 2019). Early ambulation is stated to be of great importance after surgical interventions due to the positive effect on patient recovery, that results in a reduced length of hospital stay and which in turn as has as substantial societal impact by limiting costs (Adogwa et al, 2017; Fleming et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

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Impact of early postoperative indwelling urinary catheter removal: A systematic review

Nollen

Pijnappel

Schoones

et al. 2022

Journal of Clinical Nursing

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Background Indwelling urinary catheters (IDUCs) are associated with complications and early removal is therefore essential. Currently, it is unknown what the effect of a specific removal time is and what the consequences of this removal time are. Research question To present an overview of the available evidence to determine the effects of three postoperative IDUC removal times (after a certain number of hours, at a specific time of day and flexible removal time) on the development of complications in hospital. Methods PubMed, Medline, Embase, Emcare and Cochrane Central Register of Controlled Trials were searched till 6 June, 2021. Studies were included that described the effect of the removal time in relation to re‐catheterisation, urinary tract infections (UTIs), ambulation time, time of first voiding and hospital stay. The quality of the studies was assessed with the Newcastle‐Ottawa Scale and the Cochrane Effective Practice and Organisation of Care. A narrative descriptive analysis was performed. PRISMA guidelines were followed in reporting this review. Results Twenty studies were included from which 18 compared removal after a number of hours, 1 reported on a specific removal time and 1 reported on both topics. The results were contradicting regarding the hypothesis that later removal increases the incidence of UTIs. Earlier removal does not lead to a higher re‐catheterisation rate while immediate removal is beneficial for reducing the time to first ambulation and shortening the hospital stay. Studies reporting on specific removal times did not find differences in outcomes. No study addressed flexible removal time. Conclusions There is inconclusive evidence that earlier removal results in less UTIs, despite the incidence of UTIs increasing if the IDUC is removed ≥24 h. Immediate or after 1–2 day(s) removal does not lead to higher re‐catheterisation rates while immediate removal results in earlier ambulation and shorter length of hospital stay. Implications of key findings Nurses should focus on early IDUC removal while being aware of urinary retention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of early postoperative indwelling urinary catheter removal: A systematic review

Nollen

Pijnappel

Schoones

et al. 2022

Journal of Clinical Nursing

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“…[3][4][5] However, VTE chemoprophylaxis is associated with a small but significant increased risk of bleeding. [6][7][8] For this reason, VTE chemoprophylaxis is often halted in advance of a planned surgical procedure, or initiation is delayed until after a surgical procedure is performed.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, the median (IQR) time to initiate VTE chemoprophylaxis was 25 (10-38) hours, and the median number of doses received was 5. [4][5][6][7][8] Most patients (93%) received LMWH for chemoprophylaxis, 3% received UFH, and 5% received both LMWH and UFH.…”

Section: Vte Chemoprophylaxismentioning

confidence: 99%

Timing of venous thromboembolism chemoprophylaxis with major surgery of lower-extremity long bone fractures

Salottolo

Carrick

Nwafo

et al. 2022

J Trauma Acute Care Surg

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BACKGROUNDThere is debate on the need to withhold chemical venous thromboembolism (VTE) prophylaxis in patients requiring major orthopedic surgery. We hypothesized that the incidence of clinically significant hemorrhage (CSH) does not differ by the timing of prophylaxis in such patients.METHODSThis was a multicenter, retrospective cohort study conducted at five US trauma centers that included trauma patients admitted between January 1, 2018, to March 1, 2020, requiring surgical fixation of the femoral shaft, hip, or tibia and received VTE chemoprophylaxis during the hospitalization. Exclusions were major and moderate head or spinal injuries, chronic anticoagulant use, or multiple long bone surgeries. Timing of VTE chemoprophylaxis was examined as four groups: (1) initiated preoperatively without interruption for surgery; (2) initiated preoperatively but held perioperatively; (3) initiated within 12 hours postoperatively; and (4) initiated >12 hours postoperatively. The primary outcome was incidence of CSH (%), defined as overt hemorrhage within 24 hours postoperative that was actionable. Multivariate logistic regression evaluated differences in CSH based on timing of VTE chemoprophylaxis.RESULTSThere were 786 patients, and 65 (8.3%) developed a CSH within 24 hours postoperatively. Nineteen percent of patients received chemoprophylaxis preoperatively without interruption for surgery, 13% had preoperative initiation but dose(s) were held for surgery, 21% initiated within 12 hours postoperatively, and 47% initiated more than 12 hours postoperatively. The incidence and adjusted odds of CSH were similar across groups (11.3%, 9.1%, 7.1%, and 7.3% respectively; overall p = 0.60). The incidence of VTE was 0.9% and similar across groups (p = 0.47); however, six of seven VTEs occurred when chemoprophylaxis was delayed or interrupted.CONCLUSIONThis study suggests that early and uninterrupted VTE chemoprophylaxis is safe and effective in patients undergoing major orthopedic surgery for long bone fractures.LEVEL OF EVIDENCETherapeutic/Care Management; Level IV.

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“…84,118,119 The role of early mobilisation in preventing VTE and in particular post-sclerotherapy DVT is yet to be conclusively demonstrated. 153 Patients who are permanently bedridden are usually not suitable for routine sclerotherapy. However, patients with lesser degrees of immobility may be present with chronic venous hypertensive changes requiring venous interventions.…”

Section: Relative Contraindicationmentioning

confidence: 99%

Sclerotherapy of lower limb veins: Indications, contraindications and treatment strategies to prevent complications – A consensus document of the International Union of Phlebology-2023

Wong

Parsi

Myers³

et al. 2023

Phlebology

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Background Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous disease, vascular malformations and other ectatic vascular lesions. While extremely rare, sclerotherapy may be complicated by serious adverse events. Objectives To categorise contraindications to sclerotherapy based on the available scientific evidence. Methods An international, multi-disciplinary panel of phlebologists reviewed the available scientific evidence and developed consensus where evidence was lacking or limited. Results Absolute Contraindications to sclerotherapy where the risk of harm would outweigh any benefits include known hypersensitivity to sclerosing agents; acute venous thromboembolism (VTE); severe neurological or cardiac adverse events complicating a previous sclerotherapy treatment; severe acute systemic illness or infection; and critical limb ischaemia. Relative Contraindications to sclerotherapy where the potential benefits of the proposed treatment would outweigh the risk of harm or the risks may be mitigated by other measures include pregnancy, postpartum and breastfeeding; hypercoagulable states with risk of VTE; risk of neurological adverse events; risk of cardiac adverse events and poorly controlled chronic systemic illness. Conditions and circumstances where Warnings and Precautions should be considered before proceeding with sclerotherapy include risk of cutaneous necrosis or cosmetic complications such as pigmentation and telangiectatic matting; intake of medications such as the oral contraceptive and other exogenous oestrogens, disulfiram and minocycline; and psychosocial factors and psychiatric comorbidities that may increase the risk of adverse events or compromise optimal treatment outcomes. Conclusions Sclerotherapy can achieve safe clinical outcomes provided that (1) patient-related risk factors and in particular all material risks are (1a) adequately identified and the risk benefit ratio is clearly and openly discussed with treatment candidates within a reasonable timeframe prior to the actual procedure; (1b) when an individual is not a suitable candidate for the proposed intervention, conservative treatment options including the option of ‘ no intervention as a treatment option’ are discussed; (1c) complex cases are referred for treatment in controlled and standardised settings and by practitioners with more expertise in the field; (1d) only suitable individuals with no absolute contraindications or those with relative contraindications where the benefits outweigh the risks are offered intervention; (1e) if proceeding with intervention, appropriate prophylactic measures and other risk-mitigating strategies are adopted and appropriate follow-up is organised; and (2) procedure-related risk factors are minimised by ensuring the treating physicians (2a) have adequate training in general phlebology with additional training in duplex ultrasound, procedural phlebology and in particular sclerotherapy; (2b) maintain their knowledge and competency over time and (2c) review and optimise their treatment strategies and techniques on a regular basis to keep up with the ongoing progress in medical technology and contemporary scientific evidence.

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Challenges of extended venous thromboembolism prophylaxis in medical and surgical patients

Cited by 12 publications

References 40 publications

Impact of early postoperative indwelling urinary catheter removal: A systematic review

Impact of early postoperative indwelling urinary catheter removal: A systematic review

Timing of venous thromboembolism chemoprophylaxis with major surgery of lower-extremity long bone fractures

Sclerotherapy of lower limb veins: Indications, contraindications and treatment strategies to prevent complications – A consensus document of the International Union of Phlebology-2023

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