Reduction in Fatal Pulmonary Embolism and Venous Thrombosis by Perioperative Administration of Subcutaneous Heparin: Overview of Results of Randomized Trials in General, Orthopedic, and Urologic Surgery

Collins, Rory; Scrimgeour, Alison; Yusuf, Salim; Pető, Richárd

doi:10.1016/s0022-5347(17)40703-8

Cited by 295 publications

(425 citation statements)

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“…In recent years, different incidence rates of morbidity and mortality for TE related to the kind of patient, i.e., those attending general surgery, gynecology, and orthopedics units, have emerged in various studies. 5,6 Differences seem to be related to a different sensitivity to the problem and to varying cultural integration of single specialities.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 Appropriate use of the guidelines is thus an opportunity to decrease mortality and morbidity rates in this setting. 2,5,6 We have considered that, in addition to appropriate knowledge of the issue, the availability of specific technical resources in each health-care structure may affect dramatically the way guidelines are applied. We have evaluated the level of knowledge of VTE guidelines as well as the quantitative and qualitative information about diagnosis, prophylaxis, and treatment of a large number of Italian health departments that normally cope with patients at high risk of developing deep vein thrombosis (DVT) and PE.…”

Section: Introductionmentioning

confidence: 99%

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Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Franciscis¹,

Agus²,

Bisacci³

et al. 2008

Annals of Vascular Surgery

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Venous thromboembolism (VTE) is a common health problem for today's society, and considering the role that it plays in surgical patients (general surgery, gynecology, and orthopedics), new advances in our understanding of the procedures and trauma characteristics are relevant and necessary. The most important and recently published guidelines concerning this problem have been taken into consideration, leading to articulate investigations and data evaluation. This project has proposed a data-survey framework available as a questionnaire in order to investigate application of the guidelines for VTE throughout the national territory. Of the total 714 Italian centers, a random sample of 214 were contacted and asked to take part in this study; of these, 146 replied (20.4% of total and 68.2% of the sample): 48 departments of general surgery, 46 departments of gynecology, and 52 departments of orthopedics. About 70% of the centers has appropriate information about surgery as a risk factor for VTE. The answers have provided evidence of an adequate knowledge of the instrumental and laboratory diagnostic pathways, useful to confirm the diagnosis of TE (80%). Data waiting compared with morbidity and mortality rates related to deep vein thrombosis and pulmonary embolism showed an increase of mortality associated with the diagnostic data timing of supply, with an exponential trend linked to the data acquisition delay. Both risk stratification and adequate application of prophylaxis together with treatment devices represent a real tool to control morbidity and mortality for VTE. Moreover, diagnostic data waiting significantly influences adequate prophylaxis. In Italy, only 40% of the centers are ready to provide diagnostic data within 12 hr.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Franciscis¹,

Agus²,

Bisacci³

et al. 2008

Annals of Vascular Surgery

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“…In our country there is no tradition of using these physical measures. Finally, the low proportion of operated patients receiving a preoperative dose of heparin (36%), in spite of the evidence supporting its effectiveness [3,4,[15][16][17][18], is also notable. This suboptimal use may be related to surgeons' fear of haemorrhage, which seems to be largely unwarranted [19].…”

Section: Discussionmentioning

confidence: 99%

Multicentre hospital drug utilization study on the prophylaxis of venous thromboembolism. The Venous Thromboembolism Study Group of the Spanish Society of Clinical Pharmacology.

Vallès¹,

Vallano²,

Arnau³

et al. 1994

Brit J Clinical Pharma

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1 Thromboembolic disease (TED) is an important cause of in-hospital morbidity and mortality. Although different prophylactic approaches have been shown to be effective and cost-effective, surveys have suggested that they are underused. The aim of this study was to estimate the prevalence of use of TED prophylaxis in our hospitals. 2 All patients admitted on a specified day to the Internal Medicine and General Surgery wards of seven Spanish university hospitals were included in the study.

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“…One study with 49.7 months followup of 51 patients after THR or knee replacement was inconclusive on whether patients with asymptomatic DVT were more likely to have symptomatic DVTs [31]. Nevertheless, clinical trials and observational studies have shown that patients with asymptomatic venous thrombosis in proximal veins are clearly at higher risk to develop clinical VTE [26,[32][33][34][35][36][37].…”

Section: Methodsmentioning

confidence: 99%

“…have evaluated the role of Heparin and antiplatelet agents in preventing VTE after elective orthopedic surgery [35,36] and 30 randomized controlled trials have used low molecular weight heparin (LMWH) to prevent DVT after THR [30].…”

Section: Treatment Effect On Asymptomatic Dvt and Vte-two Systematic mentioning

confidence: 99%

The true treatment benefit is unpredictable in clinical trials using surrogate outcome measured with diagnostic tests

Kassaï

Shah

Leizorovicza

et al. 2005

Journal of Clinical Epidemiology

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Background and Objectives-Clinical trials increasingly use results of diagnostic tests as surrogate outcomes. Our objective was to answer the following questions: (1) is the parameter measured by the reference standard a valid surrogate? (2) How does the tests accuracy influence the estimate of the treatment benefit on surrogate? (3) Is it possible to correct the measured treatment effect given by results of inaccurate tests?Methods and Setting-We reviewed the literature on asymptomatic deep venous thrombosis (DVT), detected by the reference standard and other imaging techniques, as surrogate for venous thromboembolism. The influence of test inaccuracy on the measurement of treatment benefit was calculated as a function of the patient baseline risk, the treatment effect model, and test performances.Results-We show that: (1) asymptomatic DVT is correlated with clinical outcomes but is yet to be established as a surrogate; (2) inaccurate diagnostic test underestimates the treatment effect on surrogate; (3) the prevalence of the disease, the treatment effect model, and the accuracy of the test and the reference standard used to evaluate it need to be known to correct this underestimation.Conclusion-Even when the surrogate end point is valid, without a reliable study of the diagnostic test we cannot quantify the true treatment effect.

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Reduction in Fatal Pulmonary Embolism and Venous Thrombosis by Perioperative Administration of Subcutaneous Heparin: Overview of Results of Randomized Trials in General, Orthopedic, and Urologic Surgery

Cited by 295 publications

References 0 publications

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Multicentre hospital drug utilization study on the prophylaxis of venous thromboembolism. The Venous Thromboembolism Study Group of the Spanish Society of Clinical Pharmacology.

The true treatment benefit is unpredictable in clinical trials using surrogate outcome measured with diagnostic tests

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