Prevention of Venous Thromboembolism in 2020 and Beyond

Nicholson, Matthew C.; Chan, Noel; Bhagirath, Vinai; Ginsberg, Jeffrey S.

doi:10.3390/jcm9082467

Cited by 128 publications

(134 citation statements)

References 199 publications

(250 reference statements)

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“…In studies that provided detailed patient characteristics, the majority of patients were at an advanced age and overweight. In addition to critical illness, immobility, advanced age and obesity have all previously been associated with increased VTE risk ( 76 ). VTE has thus long been recognized as a serious problem in critically ill patients ( 77 ).…”

Section: Discussionmentioning

confidence: 99%

Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Early during the course of the ongoing COVID-19 pandemic, reports suggested alarmingly high incidences for thromboembolic events in critically ill patients with COVID-19. However, the clinical relevance of these events was not reported in several studies. Additionally, more recent research showed contradictory results and suggested substantially lower rates of venous thromboembolism. Thus, the aim of the present study was to summarize evidence on the incidence of clinically relevant venous thromboembolism (VTE)—defined as VTE excluding isolated subsegmental pulmonary embolism (PE) and distal deep vein thrombosis (DVT)—in adult critically ill patients with COVID-19.Methods: We performed a systematic review of studies reporting the incidence of clinically relevant PE and/or DVT in critically ill patients with COVID-19. Scientific reports published in the English language between January and October 2020 were included. We conducted a random-effects model meta-analysis to calculate incidence estimates of clinically relevant VTE and bleeding events. We also performed exploratory meta-regression and subgroup analyses of different diagnostic approaches and additional factors that possibly influenced the incidence of these outcomes.Results: Fifty-four articles (5,400 patients) fulfilled the predefined inclusion criteria, of which 41 had a high risk of bias. The majority of included patients were male, > 60 years, and overweight. Twenty-one studies reported the use of prophylactic doses of heparin. Pooled incidences for clinically relevant PE were estimated at 8% (95% CI, 4–11%), for proximal DVT at 14% (95% CI, 9–20%), and—after exclusion of studies with a high risk of bias—for the composite outcome of VTE at 18% (95% CI, 13–24%). Clinically relevant bleeding occurred at a rate of 6% (95% CI, 2–9%).Conclusions: We summarized currently available data on the rate of clinically relevant VTE in critically ill patients with COVID-19. Pooled incidence estimates were lower than those reported by previous review articles. In the absence of evidence-based anticoagulation guidelines for critically ill patients with COVID-19, the results of our study provide clinically important information for an individual risk-benefit assessment in this context.Registration: The study protocol was prospectively registered in PROSPERO on June 22, 2020 (CRD42020193353; https://www.crd.york.ac.uk/prospero).

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Section: Discussionmentioning

confidence: 99%

Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis

et al. 2021

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“…This thrombotic event is related with a mortality rate of 7 to 65 percent in trauma patients, 25 to 33 percent in general surgical operations, and 41 to 85 percent following total hip arhroplasty, total knee arthroplasty, and other orthopedic surgeries (Jeong et al, 2014). Recent surgery was shown to be a provoking factor in up to 20% of all new instances of venous thromboembolism (Nicholson et al, 2020). The risk of venous thromboembolism after surgery was determined to be 0.3 percent in our research.…”

Section: Resultsmentioning

confidence: 62%

“…VTE, which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is the greatest cause of death after surgical treatments (Tadesse et al, 2020). Up to 20% of all new occurrences of venous thromboembolism are caused by recent surgery (Nicholson et al, 2020). Between 350 000 to 900 000 persons acquire VTE in the United States, with around 100,000 dying (Tadesse et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Application of the Caprini Risk Assessment Model for the Assessment of Risk Factors for Postoperative Venous Thromboembolism in the Surgery Department of Anosiala University Hospital

et al. 2021

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The purpose of this research is to ascertain the prevalence of postoperative venous thromboembolism in the Department of Surgery at Anosiala University Hospital and to identify risk factors for developing postoperative venous thromboembolism using the Caprini Risk Assessment Model. From December 2017 to October 2019, this was a 22-month prospective cohort research conducted at Anosiala University Hospital. It included all adult patients over the age of 18 who were operated on in an emergency or on a planned basis by the Department of Surgery. This research included 662 participants. Within 30 days after surgery, the risk of venous thromboembolism was 0.3 percent. According to the overall Caprini score, 25.2 percent of patients were classified as having a low risk of venous thromboembolism, 25.2 percent as having a moderate risk, 29.5 percent as having a high risk, and 20.1 percent as having the greatest risk. Patients in the highest risk category (scoring 5) had a substantially increased chance of having venous thromboembolism after surgery (p = 0.0007). Only major open surgery was related with a statistically significant increase in postoperative venous thromboembolism (p = 0.028). Age 75 years, elective arthroplasty, and hip, pelvic, or leg fractures were not linked with postoperative venous thromboembolism statistically significantly (p> 0.05). Our findings indicate that the Caprini risk assessment model might be used successfully to avoid postoperative venous thromboembolism in surgical patients in Madagascar, since patients in the highest risk category had a considerably increased chance of developing postoperative venous thromboembolism.

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“…Caprini score was used for individualized venous thromboembolism (VTE) prophylaxis after surgery [ 4 ]. This scoring system is able to risk-stratify patients for postoperative VTE [ 5 ]. LMWH was reintroduced at least 12 hours after surgery (if allowed by the patient comorbidities or clinical conditions) and taking surgical postoperative bleeding risk into account.…”

Section: Methodsmentioning

confidence: 99%

Awake Major Abdominal Surgeries in the COVID-19 Era

Romanzi

Boleso

Palma

et al. 2021

Pain Research and Management

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Background. During the outbreak of coronavirus disease 2019 (COVID-19), allocating intensive care beds to patients needing acute care surgery became a very difficult task. Moreover, since general anesthesia is an aerosol-generating procedure, its use became controversial. This strongly restricted therapeutic strategies. Here, we report a series of undeferrable surgical cases treated with awake surgery under neuraxial anesthesia. Contextual benefits of this approach are deepened. Methods. During the first pandemic surge, thirteen patients (5 men and 8 women) with a mean age of 80 years, needing undelayable surgery due to abdominal emergencies, underwent awake open surgery at our Hospital. Prior to surgery, all patients underwent nasopharyngeal swab tests for COVID-19 diagnosis. In all cases, regional anesthesia (spinal, epidural, or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain intensities have been monitored and regularly assessed. A distinct pathway has been set up to keep patients of uncertain COVID-19 diagnosis separated from all other patients. Postoperative course has been examined. Results. The mean operative time was 87 minutes (minimum 60 minutes; maximum 165 minutes). In one case, conversion to general anesthesia was necessary. Postoperative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien–Dindo ≥3) occurred. Early readmission after surgery never occurred. All nasopharyngeal swabs resulted negative. Conclusions. In our experience, awake laparotomy under regional anesthesia resulted feasible, safe, painless, and, in specific cases, was the only viable option. This approach allowed prevention of the need of postoperative intensive monitoring during the COVID-19 era. In such a peculiar time, we believe it could become part of an ICU-preserving strategy and could limit viral transmission inside theatres.

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Prevention of Venous Thromboembolism in 2020 and Beyond

Cited by 128 publications

References 199 publications

Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis

Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis

Application of the Caprini Risk Assessment Model for the Assessment of Risk Factors for Postoperative Venous Thromboembolism in the Surgery Department of Anosiala University Hospital

Awake Major Abdominal Surgeries in the COVID-19 Era

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