Frequency of deep venous thrombosis in asymptomatic patients with coronary artery bypass grafts

Reis, Steven E.; Polak, Joseph F.; Hirsch, Denise R.; Cohn, Lawrence H.; Creager, Mark A.; Donovan, Barbara C.; Goldhaber, Samuel Z.

doi:10.1016/0002-8703(91)91004-7

Cited by 67 publications

(31 citation statements)

References 9 publications

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“…There was a suggestion that the leg with the great saphenous vein harvested could have a higher risk of DVT compared to the contralateral leg (RR, 1.48; 95% CI, 0.96–2.26; P =0.07; I 2 =71%), but this result did not reach statistical significance and had substantial heterogeneity (Figure 7). Restricting the analysis to studies that used routine USS for both legs20, 25, 31, 36 did not change the results significantly (RR, 1.58; 95% CI, 0.96–2.61; P =0.07; I 2 =77%). Metaregression suggested that sample size was likely the main reason behind this heterogeneity (slope=0.004; 95% CI, 0.002–0.006; P =0.001; Figure 8), with large sample size studies more likely to show an increased risk of DVT in the leg with the great saphenous vein harvested than smaller studies.…”

Section: Resultsmentioning

confidence: 90%

“…The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta‐analyses (Tables 1 and 2). 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84 Of the 16 RCTs identified,1...…”

Section: Resultsmentioning

confidence: 99%

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Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Bham

Pavey

2015

JAHA

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BackgroundOptimal thromboprophylaxis after cardiac surgery is uncertain. This systematic review aimed to define the incidence and risk factors for deep vein thrombosis (DVT), fatal and nonfatal pulmonary embolism (PE), and assess whether venous thromboembolism (VTE) prophylaxis was effective in reducing VTE without complications after cardiac surgery.Methods and ResultsTwo reviewers independently searched and assessed the quality and outcomes of randomized, controlled trials (RCTs) and observational studies on VTE after cardiac surgery in the MEDLINE, EMBASE, and Cochrane controlled trial register (1966 to December 2014). Sixty‐eight studies provided data on VTE outcomes or complications related to thromboprophylaxis after cardiac surgery. The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta‐analyses. VTE prophylaxis was associated with a reduced risk of PE (relative risk [RR], 0.45; 95% confidence interval [CI], 0.28–0.72; P=0.0008) or symptomatic VTE (RR, 0.44; 95% CI, 0.28–0.71; P=0.0006) compared to the control without significant heterogeneity. Median incidence (interquartile range) of symptomatic DVT, PE, and fatal PE were 3.2% (0.6–8.1), 0.6% (0.3–2.9), and 0.3% (0.08–1.7), respectively. Previous history of VTE, obesity, left or right ventricular failure, and prolonged bed rest, mechanical ventilation, or use of a central venous catheter were common risk factors for VTE. Bleeding or cardiac tamponade requiring reoperation owing to pharmacological VTE prophylaxis alone, without systemic anticoagulation, was not observed.ConclusionsUnless proven otherwise by adequately powered RCTs, initiating pharmacological VTE prophylaxis as soon as possible after cardiac surgery for patients who have no active bleeding is highly recommended.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Bham

Pavey

2015

JAHA

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“…However, there are studies showing that sonographic examination can definitely be used as a screening test in asymptomatic patients. [8][9][10][11] These include studies of asymptomatic patients after coronary artery bypass graft surgery, 8 acute medical patients, 9 patients undergoing sonography as an initial examination for clinically suspected pulmonary embolism, 10 and healthy people after long-haul flights. 11 Finally, distal calf veins were not examined in our study.…”

Section: Discussionmentioning

confidence: 99%

Venous Sonography for the Diagnosis of Asymptomatic Deep Vein Thrombosis in Patients With Cancer Undergoing Chemotherapy

Bernstein

Haim

Brenner

et al. 2004

Journal of Ultrasound in Medicine

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Objective. Early detection of asymptomatic deep vein thrombosis by venous sonography may identify patients who may benefit from anticoagulant therapy and thus may prevent morbidity and mortality associated with deep vein thrombosis. The aim of this study was to examine the prevalence of deep vein thrombosis by venous sonography in asymptomatic ambulatory patients with cancer undergoing chemotherapy and to evaluate the correlation between procoagulant activity and asymptomatic deep vein thrombosis. Methods. The study population included 62 patients (32 with lung cancer and 30 with lymphoma) receiving chemotherapy with an ambulatory performance status and without clinical evidence of deep vein thrombosis. Bilateral venous sonographic studies of the lower extremities were performed, covering the femoropopliteal venous system. The D‐dimer level and acquired activated protein C resistance were determined in the patients and in 30 healthy control subjects. Results. Sonographic evidence of deep vein thrombosis on the femoropopliteal axis was found in 0 (0%) of 62 patients (1‐sided 95% confidence interval, 0%–4.8%). Acquired activated protein C resistance prevalence and D‐dimer levels were increased in study patients compared with control subjects (34% versus 0%; P < .003; median, 0.72 versus 0.25 mg/L; P < .0001, respectively). Conclusions. Despite the procoagulant tendency, venous sonography did not detect asymptomatic deep vein thrombosis in patients with cancer undergoing chemotherapy. Thus, screening by venous sonography is not justified in this patient population.

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“…It is estimated, based on extrapolated data, that 1,100 -1,300 deaths occur in the United States each year as a result of VTE after coronary artery bypass grafting. 27 Although asymptomatic VTE occurs frequently, 28 symptomatic VTE can also go undetected after cardiac surgery, because symptoms-such as shortness of breath and leg discomfort or swelling-may be attributed to the expected consequences of the preexisting conditions or surgery (i.e., saphenous vein harvest). 27 The overall risk of clinically important VTE may be relatively low after coronary artery bypass grafting, but patients often require anticoagulation because of unstable angina or the presence of other risk factors.…”

Section: Vte After Surgerymentioning

confidence: 99%

Novel Oral Anticoagulants

2010

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Patients undergoing surgery receive anticoagulation for perioperative thromboprophylaxis or ischemic cardiovascular disease. Because anticoagulants may also potentiate bleeding, clinicians need to understand the implications of anticoagulation in perioperative and postoperative patient management. Many newer anticoagulants that are now available or are in clinical development do not require routine coagulation monitoring, have more predictable dose responses, and have fewer interactions with other drugs and food. The most advanced oral anticoagulants in clinical development are the direct factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran etexilate. These agents have been evaluated in the postoperative setting in patients undergoing total hip-or knee-replacement surgery with promising results, and it remains to be seen whether these results will translate into other surgical settings. The impact of the new agents will be influenced by the balance between efficacy and safety, improved convenience, and potential cost-effectiveness benefits.

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Frequency of deep venous thrombosis in asymptomatic patients with coronary artery bypass grafts

Cited by 67 publications

References 9 publications

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Venous Sonography for the Diagnosis of Asymptomatic Deep Vein Thrombosis in Patients With Cancer Undergoing Chemotherapy

Novel Oral Anticoagulants

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