Prolonged prophylaxis against postoperative venous thromboembolism

Bergqvist, David

doi:10.1159/000217319

“…These data definitively demonstrate that in acute venous thrombosis the lymphatic system drain more interstitial fluid in order to reduce the local edema. The incidence of postthrombotic syndrome is nearly 35%-69% at three years after deep venous thrombosis and from 49% to 100% after five to ten years [28][29][30][31][32][33][34][35][36][37][38][39][40].…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

Cariati¹

2012

TOCVJ

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Lymphatic and venous systems work together to drain interstitial fluid and blood respectively. Data on lymphatic function in chronic venous insufficiency and in chronic venous ulcerations are discordant. Modification of lymphatic function in acute venous thrombosis have been never described. The aim of this study is to report the modifications of the function of the lymphatic system in acute venous thrombosis, chronic venous ulceration and post-thrombotic syndrome. Material and Methods: Patients were studied with qualitative and semi-quantitative lymphoscintigraphy. The transport index (TI 60) have been calculated for each patients. Data obtained in group a (13 patients with acute venous thrombosis) (TI 60 = 398); group b (12 limbs of 6 controls) (TI 60 = 203); group c (10 limbs with chronic venous ulcerations) (TI 60 = 114); group d (6 limbs with post-thrombotic syndrome in absence of ulcerations) (TI 60 = 148) were compared with Kruscall-Wallis statistic and Mann-Whitney test. Results: The TI 60 is different in the four groups. Differences are significant between: group a (TI 60 = 398) and group b (TI 60 = 203); group b (TI 60 = 203) and group c (TI 60 = 114); group b (TI 60 = 203) and group d (TI 60 = 148). Discussion: The compensatory function of lymphatic system in acute venous thrombosis is definitively demonstrated. The lymphatic drainage of the limb affected by chronic venous ulceration is reduced. After the healing of the ulceration the lymphatic flow of the limbs affected by post-thrombotic syndrome improves but it remains under the levels of normal subjects.

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“…The duration of prophylaxis is debated, with prolonged prophylaxis recommended for surgical (14)(15)(16) as well as medical and stroke patients (13,17,18). Primary prophylaxis for chronic or lifetime immobilization has never been studied in controlled trials (19,21).…”

Section: Discussionmentioning

confidence: 99%

“…In the setting of acute immobilization, guidelines advocate the administration of unfractionated or low molecular weight heparin (LMWH) prophylaxis during and after the hospitalization of surgical and medical patients. The duration of prophylaxis is much debated, with prolonged prophylaxis recommended for surgical (14)(15)(16) as well as medical and stroke patients (13,(17)(18)(19). However, the duration of prophylaxis is never defined when immobilization is prolonged, for instance, in the elderly population after trauma, stroke, prolonged hospitalization, or because of advancing dementia.…”

Section: Introductionmentioning

confidence: 99%

Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients?

Gatt¹,

Paltiel²,

Bursztyn³

2004

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Prolonged immobilization and advanced age are considered to be important risk factors for venous thromboembolism (VTE). Nevertheless, the need for VTE prophylaxis in long-term bedridden patients is not known. To assess whether very prolonged immobilization (i.e. over three months) carries an increased risk for clinically apparent VTE, we performed a historical-cohort study of nursing home residents during a ten-year period. Data concerning patient's mobility and incidence of overt deep vein thrombosis or pulmonary embolism were registered. The mean resident age was 85+/-8.4 years. Eighteen mobile and eight immobile patients were diagnosed with clinically significant thromboembolic events, during 1137 and 573 patient-years of follow up, respectively. The incidence of venous thromboembolic events was similar in both chronically immobilized and mobile patient groups, 13.9 and 15.8 per thousand patient years, respectively (p=0.77). The rate ratio for having a VTE event in the immobilized patient group as compared with the mobile group was 0.88 (95% Confidence Interval (CI) 0.33 to 2.13). When taking into account baseline characteristics, risk factors and death rates by various causes, no differences were found between the two groups. In conclusion, chronically immobile bedridden patients are no more prone to clinically overt venous thromboembolic events than institutionalized mobile patients. Until further studies are performed concerning the impact of very prolonged immobilization on the risk of VTE, there is no evidence to support primary prevention after the first three months of immobilization. Evidence for efficacy or cost effectiveness beyond this early period is not available.

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“…These data definitively demonstrate that in acute venous thrombosis the lymphatic system drain more interstitial fluid in order to reduce the local edema. The incidence of postthrombotic syndrome is nearly 35%-69% at three years after deep venous thrombosis and from 49% to 100% after five to ten years [28][29][30][31][32][33][34][35][36][37][38][39][40].…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

Cariati¹

2012

TOCVJ

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Lymphatic and venous systems work together to drain interstitial fluid and blood respectively. Data on lymphatic function in chronic venous insufficiency and in chronic venous ulcerations are discordant. Modification of lymphatic function in acute venous thrombosis have been never described. The aim of this study is to report the modifications of the function of the lymphatic system in acute venous thrombosis, chronic venous ulceration and post-thrombotic syndrome. Discussion: The compensatory function of lymphatic system in acute venous thrombosis is definitively demonstrated. The lymphatic drainage of the limb affected by chronic venous ulceration is reduced. After the healing of the ulceration the lymphatic flow of the limbs affected by post-thrombotic syndrome improves but it remains under the levels of normal subjects.

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Prolonged prophylaxis against postoperative venous thromboembolism

Cited by 5 publications

References 30 publications

Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients?

Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

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