Prevention of Venous Thromboembolism

Geerts, William; Pineo, Graham F.; Heit, John A.; Bergqvist, David; Lassen, Michael R.; Colwell, Clifford W.; Ray, Joel G.

doi:10.1378/chest.126.3_suppl.338s

Cited by 4,855 publications

(915 citation statements)

References 651 publications

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“…The rate of 0.6% is comparable to the rate of 1% previously described with warfarin [36] and low-molecular-weight heparin in cohort studies. This literature cannot support the use of powerful anticoagulants to prevent PE, although they clearly reduce the risk of venographically evident deep vein thrombosis [19].…”

Section: Discussionmentioning

confidence: 89%

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Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Sharrock

Valle

et al. 2008

Clinical Orthopaedics &Amp; Related Research

163

116

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Section: Discussionmentioning

confidence: 89%

“…The recommendations from the Chest Physicians Consensus Statement advocate low-molecular-weight heparin or warfarin for prophylaxis after THA and TKA [19]. These recommendations often result in physicians feeling compelled to prescribe these anticoagulants to avoid potential litigation [30].…”

Section: Discussionmentioning

confidence: 99%

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Sharrock

Valle

et al. 2008

Clinical Orthopaedics &Amp; Related Research

163

116

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“…We included all patients age !18 years at moderate-tohigh risk of VTE according to the ACCP recommendations, 8 based on a principal diagnosis of pneumonia, septicemia or respiratory failure with pneumonia, heart failure, chronic obstructive pulmonary disease (COPD), stroke, and urinary tract infection. Diagnoses were assessed using ICD-9-CM codes.…”

Section: Setting and Patientsmentioning

confidence: 99%

Risk factor model to predict venous thromboembolism in hospitalized medical patients

Rothberg

Lindenauer

Lahti³

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:The Joint Commission requires that all medical inpatients be assessed for venous thromboembolism (VTE) risk, but available risk stratification tools have never been validated.METHODS:We conducted a retrospective cohort study of patients age ≥18 years, admitted to 374 US hospitals in 2004–2005, with a primary diagnosis of pneumonia, heart failure, chronic obstructive pulmonary disease (COPD), stroke, and urinary tract infection, and length of stay ≥3 days. Subjects were randomly assigned (80/20) to a derivation or validation set. We then assessed VTE (International Classification of Diseases, Ninth Revision [ICD‐9] code plus diagnostic test plus treatment), patient demographics, 21 potential risk factors, and other comorbidities. We created a VTE risk stratification tool using multivariable regression modeling and applied it to the validation sample.RESULTS:Of 242,738 patients, 612 (0.25%) patients fulfilled our criteria for VTE during hospitalization, and an additional 440 (0.18%) were readmitted for VTE within 30 days (overall incidence of 0.43%). In the multivariable model, age, sex, and 10 additional risk factors were associated with VTE. The strongest risk factors were inherited thrombophilia (OR 4.00), length of stay ≥6 days (OR 3.22), inflammatory bowel disease (OR 3.11), central venous catheter (OR 1.87), and cancer. In the validation set, the model had a c‐statistic of 0.75 (95% CI 0.71, 0.78). Deciles of predicted risk ranged from 0.11% to 1.46% with observed risk over the same deciles from 0.17% to 1.81%.CONCLUSIONS:The risk of symptomatic VTE in general medical patients is low. A risk factor model can identify those at sufficient risk to warrant pharmacologic prophylaxis. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.

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“…The maximum score yielded by any RCT was 10, with higher scores indicating better study quality. The following cut-points were used to categorize studies by quality: excellent (9-10); good (6)(7)(8); fair (4)(5); poor (<4). The Downs and Black tool consists of 27 questions that evaluate the quality of data reporting, external validity, and internal validity (both bias and confounding).…”

Section: Methodsmentioning

confidence: 99%

Venous Thromboembolism After Spinal Cord Injury

Teasell

Hsieh

Aubut

et al. 2009

Archives of Physical Medicine and Rehabilitation

102

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Objective-To systematically review the published literature on the treatment of deep venous thromboembolism post-spinal cord injury (SCI).Data Sources-MEDLINE/Pubmed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing the treatment of deep venous thromboembolism post-SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database Scale, while non-RCTs were assessed using the Downs and Black evaluation tool.Study Selection-Studies included RCTs, non-RCTS, cohort, case-control, case series, prepost, and postinterventional studies. Case studies were included only when no other studies were available.Data Extraction-Data extracted included demographics, the nature of the study intervention, and study results.Data Synthesis-Levels of evidence were assigned to the interventions using a modified Sackett scale.Conclusions-Twenty-three studies met inclusion criteria. Thirteen studies examined various pharmacologic interventions for the treatment or prevention of deep venous thrombosis in SCI patients. There was strong evidence to support the use of low molecular weight heparin in reducing venous thrombosis events, and a higher adjusted dose of unfractionated heparin was found to be more effective than 5000 units administered every 12 hours, although bleeding complication was more common. Nonpharmacologic treatments were also reviewed, but again limited evidence was found to support these treatments. Keywords Rehabilitation; Spinal cord injuries; Venous thrombosisDeep venous thrombosis and subsequent PE remain significant causes of morbidity and mortality in spinal cord injured patients. The incidence of DVT in patients with acute SCI was reported to be greater than 50% in early prospective studies-with the incidence of fatal PE estimated as high as 5%.,-The prevalence of DVT in acute SCI has been found to range from 14% to 100% and from 9% to 90%. Various test methods exist for diagnosing DVTs in individuals; however, venography has been considered the criterion standard.The clinical diagnosis of DVT and PE are often unrealiable and diagnostic testing is necessary to confirm the diagnosis. Diagnostic testing varies from center to center, but 3 The high risk of DVT in acute SCI patients is a consequence of the simultaneous presence of all 3 components of Virchow's triad: hypercoagulability, stasis, and intimal (venous inner wall) injury, with stasis being the greatest concern. VT most commonly begins with a calf DVT.-Although only 20% of DVTs extend into the proximal veins,-these result in over 80% of symptomatic DVTs. Distal calf DVTs which do not extend proximally rarely are a sources of PEs, so that they are much less worrisome. Nonetheless, even those who caution against over-treatment of distal DVTs concede that there is a need for randomized trials to assess the usefulness of diagnosing and treating distal DVTs.Proximal (ie, at the level of knee or above) DVTs continue to be the primary source of concern. PE is reported in 8%...

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Prevention of Venous Thromboembolism

Cited by 4,855 publications

References 651 publications

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Risk factor model to predict venous thromboembolism in hospitalized medical patients

Venous Thromboembolism After Spinal Cord Injury

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