Prevention of Venous Thromboembolism

Clagett, G. Patrick; Anderson, Frederick A.; Heit, John A.; Levine, Mark; Wheeler, H. Brownell

doi:10.1378/chest.108.4_supplement.312s

Cited by 337 publications

(167 citation statements)

References 252 publications

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“…Cancer patients who undergo surgery have an approximately 2-fold increase in risk for postoperative thrombosis compared with non-cancer patients undergoing surgery [22,23]. The risk of VTE in cancer patients undergoing specific types of surgery can be derived from the 'no-treatment' control arms of trials that evaluate prophylactic measures in surgery [24].…”

Section: Venous Thromboembolism In Cancer Patientsmentioning

confidence: 99%

Venous Thromboembolism in Malignancy and Malignancy in Venous Thromboembolism

Rickles

Levine

1998

Pathophysiol Haemos Thromb

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The activation of coagulation in patients with cancer contributes significantly to morbidity and mortality rates and may play a fundamental role in the host response to growing tumours. Patients with cancer are clearly at high risk for the development of venous thromboembolism (VTE), particularly during chemotherapy and surgery. This situation is aggravated by the use of venous access catheters and possibly growth factors. Data derived from large, randomized, controlled trials have been used to determine the true incidence of this complication of cancer and its treatment. The incidence based on the analyses of these randomized controlled trials varies from 1% for limited stage patients with breast cancer treated with tamoxifen to 60% for patients with any type of cancer who are subjected to orthopaedic surgery and do not receive prophylactic therapy. In view of the morbidity and mortality attributable to VTE in cancer, widespread utilization of prophylactic anticoagulation therapy, which has proven safe and effective in a variety of situations, should be considered. While migratory thrombophlebitis is a clear indicator of an underlying neoplasm, the risk of cancer in patients with the more typical form of VTE has been the subject of intense debate over recent years. Some investigators have suggested that the relative risk of being diagnosed with an occult cancer within 6 months of an episode of VTE (particularly recurrent VTE) could be up to 10-fold. However, the cost-effectiveness of aggressive screening for cancer in patients with VTE has not yet been defined adequately.

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Section: Venous Thromboembolism In Cancer Patientsmentioning

confidence: 99%

Venous Thromboembolism in Malignancy and Malignancy in Venous Thromboembolism

Rickles

Levine

1998

Pathophysiol Haemos Thromb

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“…The prevalence of objectively confirmed hospital-acquired deep vein thrombosis (DVT) in patients not receiving thromboprophylaxis is up to 20% in stroke and critical care patients, increasing the risk of pulmonary embolism (PE) [2,3,4,5]. After acute ischemic stroke, the administration of subcutaneous anticoagulants is recommended to prevent DVT among immobilized patients [1, 6, 7], the use of low molecular weight heparin (LMWH) being superior to unfractionated heparin [8]. …”

Section: Introductionmentioning

confidence: 99%

Early Administration of Low Molecular Weight Heparin after Spontaneous Intracerebral Hemorrhage

Kiphuth

Staykov²,

Köhrmann³

et al. 2008

Cerebrovasc Dis

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Background: Venous thromboembolism (VTE) is a common complication after stroke. Application of low molecular weight heparins (LMWH) has been proven to be beneficial for the prevention of VTE in ischemic stroke patients. However, there is no consensus whether and how to administer LMWH for prevention of thrombotic complications after acute spontaneous intracerebral hemorrhage (sICH), the main concern being possible hematoma growth. The objective of this study was to assess the safety of early subcutaneous LMWH in patients with sICH with respect to hemorrhage enlargement. Methods: A total of 97 patients with sICH were analyzed. LMWH (either enoxaparin-natrium or dalteparin-natrium) were initiated within 36 h after admission in all patients without clinical evidence of hemorrhage enlargement or an absence of evidence of hematoma growth on CT. Hematoma growth (significant when >33%, moderate when >20%) was assessed on follow-up CT between days 5 and 11. Results: None of the patients showed a significant hemorrhage growth. Between days 2 and 10, 2 patients experienced a moderate hematoma enlargement of 22.4 and 20.9%. None of the included patients developed a fatal lung embolism. Conclusions: Early application of subcutaneous LMWH for prevention of venous thromboembolism seems to be safe, and probably does not increase the risk of hematoma growth in patients with sICH.

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“…1 Number of thromboembolic events and complications according to the distribution of orthopaedic operations in Switzerland. 2 Summation of all outcomes based on the total number of operations in all of Switzerland. Mean duration of treatment in Switzerland is 4.5 months for DVT and 7.5 months for PE.…”

Section: Costs Of Dvt and Pe Occurring In Hospitalmentioning

confidence: 99%

“…Deep vein thrombosis (DVT) and pulmonary embolism (PE) are significant causes of morbidity and mortality in surgical patients [1][2][3][4]. Of the common surgical interventions, the risk of DVT and PE is particularly high in hip and knee replacement (KR), probably due to the traumatisation of the deep veins during surgery.…”

Section: Introductionmentioning

confidence: 99%

Thromboembolic Prophylaxis with Fondaparinux in Major Orthopaedic Surgery: Outcomes and Costs

et al. 2005

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Objective: To compare economic impacts of anti-thromboembolism prophylaxis with two medications – new pentasaccharide fondaparinux versus low molecular weight heparin (LMWH) – in major orthopaedic surgery, such as hip and knee replacement and hip fracture repair, in Switzerland. In order to meet this objective, three parameters were determined for an observation period of 5 years. (1) Outcomes: Frequency of deep vein thrombosis (DVT), pulmonary embolism (PE) and their complications. (2) Cost burden of disease: Determination of the costs of DVT, PE and complications not prevented despite prophylaxis. (3) Total costs of prophylaxis: Costs were calculated from the perspective of the health insurance scheme. Methods: In order to determine outcomes and cost burden of disease, a model was applied which generates the post-surgery course of thromboembolic events (TE) and their complications for individual cohorts of patients undergoing hip and knee replacement surgery and hip fracture repair. These findings were allocated to the Swiss standard diagnostic and therapeutic measures (resource consumption), which enabled subsequent calculation of the costs of TE, including complications not prevented in spite of prophylaxis (cost burden of disease) based on standard Swiss tariffs. Additionally, total costs of prophylaxis, including costs of medications and monitoring, were determined. Results: In Switzerland, the following outcomes (expressed as percentage of the number of patients undergoing surgery) can be expected for TE prophylaxis with LMWH and with fondaparinux: DVT 3.4 vs. 2.3%, PE 1.4 vs. 0.7%, recurrent DVT 0.2 vs. 0.1%, post-thrombotic syndrome 4.8 vs. 3.5%. The costs of non-prevented TE and their complications add up to CHF 437 vs. CHF 306 per patient undergoing major orthopaedic surgery; the total cost burden for Switzerland amounts to CHF 13.4 million vs. CHF 9.4 million (30% less). Thus, despite higher medication costs, the use of fondaparinux instead of LMWH saves a total of CHF 105 per operated patient from the perspective of the health insurer. Conclusion: Fondaparinux is superior to LMWH in regards to both clinical efficacy and financial costs. This statement is confirmed by sensitivity analysis with different parameters over a broad range.

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Prevention of Venous Thromboembolism

Cited by 337 publications

References 252 publications

Venous Thromboembolism in Malignancy and Malignancy in Venous Thromboembolism

Venous Thromboembolism in Malignancy and Malignancy in Venous Thromboembolism

Early Administration of Low Molecular Weight Heparin after Spontaneous Intracerebral Hemorrhage

Thromboembolic Prophylaxis with Fondaparinux in Major Orthopaedic Surgery: Outcomes and Costs

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