Thromboembolism in patients undergoing thoracotomy

Ziomek, Stanley; Read, Raymond C.; Tobler, H.Gareth; Harrell, James E.; Gocio, John C.; Fink, Louis M.; Ranval, Timothy J.; Ferris, Ernest J.; Harshfield, David L.; McFarland, David R.; Schaefer, Robert F.; Purnell, Gary L.; Barnes, Robert W.

doi:10.1016/0003-4975(93)91151-c

Cited by 105 publications

(49 citation statements)

References 15 publications

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“…141 Other risk factors for VTE in thoracic surgery have not been rigorously evaluated, although individual studies have implicated malignancy, larger tumors, and pack-years of smoking as possible risk factors. 140,[142][143][144] In another study, age, sex, BMI, operation time, time to ambulation, operative method, and malignancy were not associated with VTE. 139 …”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,853

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,853

744

View full text Add to dashboard Cite

show abstract

“…[8][9][10][11] Typically they are smokers with some component of chronic obstructive pulmonary disease. Pulmonary embolism has been found to be a worthy cause of acute fatality after lung resection with 1.85% of patients in one study dying of acute cardiorespiratory failure, the majority because of pulmonary embolus.…”

Section: Discussionmentioning

confidence: 99%

Case of acute pulmonary embolism in post pneumonectomy-a rare clinical presentation and management

Manjunath

Thakre

et al. 2017

Int J Res Med Sci

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With a history of right pneumonectomy, pulmonary embolism affecting bilateral pulmonary artery is rare and needs to be meticulously managed to prevent pulmonary infarction of the normal lung with a clinical decision regarding thrombolysis. A 64 years male diabetic and hypertensive with a history of right pneumonectomy 10 years back, presented to ER with dyspnea and 2 episodes of syncope with right leg pain and swelling for 3 days. BP was 140/90mmHg and pulse rate of 100/min. SPO2 in room air was 95%. ECG suggested S1Q3T3 with sinus tachycardia. Echocardiogram revealed features of pulmonary embolism. Venous doppler of right leg showed DVT and CT Pulmonary angiogram was suggestive of pulmonary embolism. High-sensitive troponin I and NT-pro BNP were negative. Diagnosis of submassive pulmonary embolism was made. Protecting the normal lung from infarction was of paramount importance. There was no indication for thrombolysis. Treatment with LMWH was initiated and overlapped with the novel oral anticoagulant (NOAC) dabigatran. Symptomatically patient improved along with a reduction in pulmonary arterial hypertension and improved RV function. Post pneumonectomy of one lung, protecting the normal lung from infarction is utmost important in a setting of pulmonary embolism. It is a rare case scenario. Clinical decision regarding thrombolysis should be taken carefully. In this case thrombolysis was not indicated as per guidelines. LMWH, oral anticoagulation and broad-spectrum antibiotic to prevent secondary lung infection are the mainstay in the treatment of submassive pulmonary embolism where thrombolysis is not indicated.

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“…Moreover, almost patients had no major postoperative complications such as severe pulmonary infection and bronchopleural fistula, except one patient who underwent esophagectomy suffered anastomosis leakage and secondary pulmonary infection. Chest drainage tube duration (days) 4.22 [1][2][3][4][5][6][7][8][9][10] Treated with conservative therapies including mixed nutrition of enteral and parenteral alimentation, thoracic cavity drainage, anti-infection, electrolyte balance and other symptomatic treatments, the patient recovered well and discharged with stable vital signs and ability to have half-fluid food. Another one experienced right pneumothorax when the chest drainage tube was removed, then chest drainage tube was administrated again until the symptoms disappeared and the DR image of chest showed well.…”

Section: Resultsmentioning

confidence: 99%

The influence of heparin on coagulation function of patients undergoing video-assisted major thoracic surgery

Alai

Deng

et al. 2018

J. Thorac. Dis.

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Background: Venous thromboembolism (VTE) remains a common complication after major thoracic surgery, especially resection of lung or esophagus cancer. This trial aims to explore the influence of preoperative usage of heparin on coagulation function of patients treated with video-assisted major thoracic Conclusions: All patients underwent video-assisted major thoracic surgery with preoperative use of heparin, there were significant differences in coagulation function after operation. However, mean values of all coagulation parameters stayed normal range clinically. In a word, the method showed no influence on coagulation function clinically.

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Thromboembolism in patients undergoing thoracotomy

Cited by 105 publications

References 15 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Case of acute pulmonary embolism in post pneumonectomy-a rare clinical presentation and management

The influence of heparin on coagulation function of patients undergoing video-assisted major thoracic surgery

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