The impact of risk assessment on the implementation of venous thromboembolism prophylaxis in foot and ankle surgery

Saragas, Nikiforos Pandelis; Ferrao, Paulo N. F.; Saragas, E; Jacobson, Barry

doi:10.1016/j.fas.2013.11.002

Cited by 49 publications

(67 citation statements)

References 39 publications

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“…Tourniquet time, procedure groups and smoking were included as possible risk factors. The above risk factors were identified so that the present study would be comparable with our previous study, [37] in which no patient had received any ven ous thromboprophylaxis postoperatively.…”

Section: Methodssupporting

confidence: 57%

“…The average risk factor score in these three patients was 7 (range 6 -8) v. 7.7 (range 4 -13) in the VTE group in our previous study, [37] in which the average BMI was 34 (range 32 -36). The average tourniquet time in the previous study was 92 minutes (range 55 -120).…”

Section: Resultsmentioning

confidence: 99%

“…[26] In a more recent prospective study, we found an 8.5% incidence of VTE in patients who required immobilisation in a below-knee cast and non-weightbearing for ≥4 weeks after foot and ankle surgery. [37] Two patients developed a PE. Neither of them had shown any clinical evidence of DVT.…”

Section: Researchmentioning

confidence: 99%

“…To determine whether prophylactic chemoprophylaxis had any impact on the prevention of VTE in a cohort of foot and ankle surgical patients requiring the combination of below-knee cast immobilisation and nonweightbearing for ≥4 weeks, identified by us as a risk factor for VTE in a previous study, [37] and therefore whether its routine administration is justified in these selected patients.…”

Section: Objectivementioning

confidence: 99%

“…[6,[8][9][10][11][12][13][14][15][16][17][18][19][20]26,37,41] A difficulty of long-term follow-up of patients is that many DVT events occur several weeks or longer after discharge. [37,42] …”

Section: Researchmentioning

confidence: 99%

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The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

et al. 2017

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Section: Methodssupporting

confidence: 57%

Section: Resultsmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

Section: Objectivementioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

See 3 more Smart Citations

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

et al. 2017

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Association of Prolonged-Duration Chemoprophylaxis With Venous Thromboembolism in High-risk Patients With Head and Neck Cancer

Tipirneni

Bauter

Arnold

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Venous thromboembolism (VTE) is associated with substantial morbidity and is the most common factor associated with preventable death among hospitalized patients. Data from otolaryngologic studies suggest that the risk of VTE may be underestimated among high-risk patients, particularly among those undergoing oncologic procedures. The incorporation of prolonged-duration chemoprophylaxis (PDC) into preventive therapy has been associated with substantial decreases in VTE incidence among patients undergoing oncologic surgery. However, bleeding remains a major concern among otolaryngologists, and substantial variation exists in the use of thromboprophylaxis.OBJECTIVE To assess the association between PDC and VTE in high-risk patients with head and neck cancer undergoing oncologic procedures. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study identified 750 patients with biopsy-confirmed head and neck cancer and a Caprini risk score of 8 or higher who underwent inpatient oncologic surgery at a tertiary care referral center between January 1, 2014, and February 1, 2020. After exclusions, 247 patients were included in the study; patients were divided into 2 cohorts, traditional and PDC, based on the duration of prophylaxis. Univariate and multivariate analyses were performed to examine the development of VTE and bleeding-associated complications during the 30-day postoperative period. Data were analyzed from April 1 to April 30, 2020.EXPOSURES PDC, defined as 7 or more postoperative days of chemoprophylaxis.MAIN OUTCOMES AND MEASURES VTE and bleeding events during the 30-day postoperative period.RESULTS Among 247 patients (mean [SD] age, 63.1 [11.1] years; 180 men [72.9%]) included in the study, 106 patients (42.9%) received traditional prophylaxis, and 141 patients (57.1%) received PDC. The incidence of VTE was 5 of 106 patients (4.7%) in the traditional cohort and 1 of 141 patients (0.7%) in the PDC cohort (odds ratio [OR], 0.15; 95% CI, 0.003-1.33). In the multivariate logistic regression analysis, PDC was independently associated with reductions in the risk of VTE (OR, 0.04; 95% CI, 0.001-0.46). The incidence of bleeding events was 1 of 106 patients (0.9%) in the traditional cohort and 6 of 141 patients (4.3%) in the PDC cohort (OR, 4.64; 95% CI,. CONCLUSIONS AND RELEVANCEThe use of chemoprophylaxis for high-risk patients with head and neck cancer remains a high-priority topic. The results of this study suggest that PDC may be associated with reductions in VTE among this patient population. However, the associated increase in nonfatal bleeding events warrants careful consideration and further highlights the need to determine an optimal duration for chemoprophylaxis among this distinct cohort.

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Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization

Zee

Lieshout

Heide

et al. 2017

Cochrane Database of Systematic Reviews

105

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Moderate-quality evidence showed that the use of LMWH in outpatients reduced DVT when immobilization of the lower limb was required, when compared with no prophylaxis or placebo. The quality of the evidence was reduced to moderate because of risk of selection and attrition bias in the included studies. Low-quality evidence showed no clear differences in PE between the LMWH and control groups, but less symptomatic VTE in the LMWH groups. The quality of the evidence was downgraded due to risk of bias and imprecision.

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The impact of risk assessment on the implementation of venous thromboembolism prophylaxis in foot and ankle surgery

Cited by 49 publications

References 39 publications

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

Association of Prolonged-Duration Chemoprophylaxis With Venous Thromboembolism in High-risk Patients With Head and Neck Cancer

Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization

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