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Draganich C, Park A, Sevigny M, Charlifue S, Coons D, Makley M, Alvarez R, Fenton J, Berliner J. Venous thromboembolism: exploring incidence and utility of screening in individuals with dual diagnosis. Spinal Cord Ser Cases 2024; 10:58. [PMID: 39122690 PMCID: PMC11315684 DOI: 10.1038/s41394-024-00670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 07/08/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVES The development of venous thromboembolism (VTE) is a common complication following spinal cord injury (SCI) and brain injury (BI), leading to significant morbidity and mortality. The purpose of this study was to explore the incidence of VTE in patients with the dual diagnosis (DD) of SCI and concomitant BI using ultrasonography. DESIGN Retrospective study. SETTING Acute rehabilitation hospital. PARTICIPANTS Thirty-one individuals admitted for DD rehabilitation who were routinely screened for VTE with ultrasound on admission. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Retrospective chart review was performed to identify whether patients were found to have DVT or PE at the following three time points: in acute care prior to admission to rehabilitation, at time of admission diagnosed via screening examination, and after admission to rehabilitation during the inpatient stay via post screening examinations. Retrospective chart review was also performed to identify incidence of bleeding. RESULTS 67.7% of individuals were found to have DVTs at any timepoint. Of these DVTs, 22.6% were identified in acute care, 48.4% on admission to rehabilitation, and 16.1% during the course of rehabilitation stay. Of those who were placed on therapeutic anticoagulation due to admission diagnosis of VTE, 25% developed recurrent DVT and 12.5% had bleeding complications. No cases of PE were observed in this study population. CONCLUSIONS This study found a high incidence of DVT for the DD population at all three timepoints with a high proportion identified via screening ultrasonography on admission to rehabilitation. Further research is needed to investigate the incidence of VTE and utility of screening ultrasonography in this population.
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Affiliation(s)
- Christina Draganich
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO, USA.
- Craig Hospital, Englewood, CO, USA.
| | - Andrew Park
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
| | | | | | - David Coons
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO, USA
- VHA Spinal Cord Injury & Disorders, Aurora, CO, USA
| | - Michael Makley
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
| | - Raul Alvarez
- Colorado Blood and Cancer Care, LLC, Denver, CO, USA
| | - James Fenton
- Critical Care and Pulmonary Consultants, Englewood, CO, USA
| | - Jeffrey Berliner
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
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Elias A, Weber T, Green DA, Harris KM, Laws JM, Greaves DK, Kim DS, Mazzolai-Duchosal L, Roberts L, Petersen LG, Limper U, Bergauer A, Elias M, Winnard A, Goswami N. Systematic review of the use of ultrasound for venous assessment and venous thrombosis screening in spaceflight. NPJ Microgravity 2024; 10:14. [PMID: 38316814 PMCID: PMC10844233 DOI: 10.1038/s41526-024-00356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
The validity of venous ultrasound (V-US) for the diagnosis of deep vein thrombosis (DVT) during spaceflight is unknown and difficult to establish in diagnostic accuracy and diagnostic management studies in this context. We performed a systematic review of the use of V-US in the upper-body venous system in spaceflight to identify microgravity-related changes and the effect of venous interventions to reverse them, and to assess appropriateness of spaceflight V-US with terrestrial standards. An appropriateness tool was developed following expert panel discussions and review of terrestrial diagnostic studies, including criteria relevant to crew experience, in-flight equipment, assessment sites, ultrasound modalities, and DVT diagnosis. Microgravity-related findings reported as an increase in internal jugular vein (IJV) cross-sectional area and pressure were associated with reduced, stagnant, and retrograde flow. Changes were on average responsive to venous interventions using lower body negative pressure, Bracelets, Valsalva and Mueller manoeuvres, and contralateral IJV compression. In comparison with terrestrial standards, spaceflight V-US did not meet all appropriateness criteria. In DVT studies (n = 3), a single thrombosis was reported and only ultrasound modality criterion met the standards. In the other studies (n = 15), all the criteria were appropriate except crew experience criterion, which was appropriate in only four studies. Future practice and research should account for microgravity-related changes, evaluate individual effect of venous interventions, and adopt Earth-based V-US standards.
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Affiliation(s)
- Antoine Elias
- Cardiology and Vascular Medicine, Sainte Musse Hospital, Toulon Hospital Centre, Toulon, France.
- Clinical Research and Innovation, Sainte Musse Hospital, Toulon Hospital Centre, Toulon, France.
- Investigation Network On Venous Thrombo-Embolism | French Clinical Research Infrastructure Network (INNOVTE | F-CRIN), Toulon, France.
| | - Tobias Weber
- Space Medicine Team (HRE-OM), European Astronaut Center (EAC), European Space Agency (ESA), Cologne, Germany
- KBR, Cologne, Germany
| | - David A Green
- Space Medicine Team (HRE-OM), European Astronaut Center (EAC), European Space Agency (ESA), Cologne, Germany
- KBR, Cologne, Germany
- Centre of Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Katie M Harris
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jonathan M Laws
- University of Northumbria at Newcastle, Newcaslte-upon-Tyne, United Kingdom
- Space Biomedicine Systematic Review Methods Group, Wylam, United Kingdom
| | | | - David S Kim
- Space Medicine Team (HRE-OM), European Astronaut Center (EAC), European Space Agency (ESA), Cologne, Germany
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Lara Roberts
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Lonnie G Petersen
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ulrich Limper
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- University of Witten / Herdecke, Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Hospitals of Cologne, Cologne, Germany
| | - Andrej Bergauer
- Department of Surgery, LKH Südsteiermark, Wagna, Austria
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Michael Elias
- Critical Care Medicine, St. Vincent's Medical Center, Hartford Healthcare, Bridgeport, CT, USA
- The Frank H. Netter MD School of Medicine, North Haven, CT, USA
| | - Andrew Winnard
- Space Biomedicine Systematic Review Methods Group, Wylam, United Kingdom
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
- Mohammed Bin Rashid University of Medicine and Applied Health Sciences, Dubai, United Arab Emirates
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Draganich C, Park A, Sevigny M, Charlifue S, Coons D, Makley M, Fenton J, Alvarez R, Berliner J. Venous thromboembolism: Exploring incidence and utility of screening in spinal cord injury. J Spinal Cord Med 2023:1-8. [PMID: 37162305 DOI: 10.1080/10790268.2023.2207063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To assess the incidence and possible risk factors for venous thromboembolism (VTE) in patients admitted to a SCI rehabilitation center. DESIGN Retrospective review. SETTING Acute neurorehabilitation hospital specializing in SCI. METHODS Records of 228 consecutive admissions were reviewed. All patients received screening four limb ultrasounds on admission. Charts were reviewed to determine whether VTE was diagnosed at the acute care hospital or in the rehabilitation center; either on admission screening or later in the rehabilitation stay. Charts were reviewed to identify potential risk factors for VTE as well as the incidence of bleeding complications in patients on full anticoagulation. RESULTS In this cohort, 115 deep venous thromboses (DVTs) were identified in the following settings: 27% in acute care [n = 31], 70% on admission to rehabilitation [n = 80], and 24% during the rehabilitation stay [n = 28]. Of those on therapeutic anticoagulation due to admission diagnosis of VTE [n = 63], 12.7% developed recurrent DVT and 9.5% had bleeding complications. Of those who were initiated and continued on therapeutic anticoagulation, there was zero incidence of PE. Risk factors for the development of VTE included age, body mass index (BMI), rehabilitation length of stay, injury etiology, spinal cord-related surgery, and history of inferior vena cava filter. CONCLUSIONS DVT was identified in 70% of this cohort with screening ultrasound on admission to rehabilitation and of those initiated and continued on therapeutic anticoagulation, none developed PE, while 9.5% had bleeding complications. Given the findings of this study, prospective research in noninvasive vascular ultrasound screening for VTE should be considered.
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Affiliation(s)
- Christina Draganich
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Andrew Park
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
| | | | | | - David Coons
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- VHA Spinal Cord Injury & Disorders, Aurora, CO, USA
| | - Michael Makley
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
| | | | - Raul Alvarez
- Colorado Blood and Cancer Care, LLC, Denver, CO, USA
| | - Jeffrey Berliner
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
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4
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Draganich C, Park A, Sevigny M, Charlifue S, Coons D, Makley M, Alvarez R, Fenton J, Berliner J. Venous Thromboembolism: Exploring Incidence and Utility of Screening in Individuals With Brain Injury. Arch Phys Med Rehabil 2023:S0003-9993(23)00087-4. [PMID: 36736807 DOI: 10.1016/j.apmr.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/07/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the incidence of VTE in the population with brain injuries (BIs) using ultrasonography, and to assess the risk of pulmonary embolism (PE) development and/or bleeding complications related to anticoagulation. DESIGN Retrospective study. SETTING Acute rehabilitation hospital. PARTICIPANTS 238 individuals with moderate to severe BI who were routinely screened for VTE with ultrasonography on admission to rehabilitation (N=238). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Retrospective chart review was performed to identify individuals who were diagnosed with VTE at the following 3 time points: in acute care prior to admission to rehabilitation, at the time of admission diagnosed via screening examination, and after admission to rehabilitation. Additionally, risk factors for VTE, PE, and incidence of bleeding complications related to therapeutic anticoagulation were assessed. RESULTS 123 deep vein thromboses (DVTs) were identified with 38.2% in acute care (n=47), 69.1% on admission to rehabilitation (n=85), and 7.3% during the course of rehabilitation stay (n=9). Risk factors for development of VTE included age at injury, body mass index, injury etiology, history of neurosurgical procedure, and surgery during inpatient rehabilitation. Of those who were placed on therapeutic anticoagulation due to admission diagnosis of VTE (n=50), 2% developed recurrent DVT and 2% had bleeding complications. There was zero incidence of PE. CONCLUSION We demonstrated a high prevalence of VTEs identified on screening ultrasonography on admission to inpatient rehabilitation among individuals with moderate to severe BIs, and low complications related to anticoagulation. Given the findings of this study, prospective research in ultrasonography screening for VTE in moderate to severe BI is needed.
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Affiliation(s)
- Christina Draganich
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO.
| | - Andrew Park
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO; Craig Hospital, Englewood, CO
| | | | | | - David Coons
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO; VHA Spinal Cord Injury & Disorders, Aurora, CO
| | - Michael Makley
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO; Craig Hospital, Englewood, CO
| | | | | | - Jeffrey Berliner
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO; Craig Hospital, Englewood, CO
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5
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Phelan DM, Mayer SA, Stainback RF. Point-of-Care Ultrasonography. N Engl J Med 2022; 386:196. [PMID: 35020996 DOI: 10.1056/nejmc2118252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dermot M Phelan
- Atrium Health Sanger Heart and Vascular Institute, Charlotte, NC
| | - Susan A Mayer
- Saint Luke's Mid America Heart Institute, Kansas City, MO
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Park HJ, Kang SB, Park J, Chang MJ, Kim TW, Chang CB, Choi BS. Patterns and Distribution of Deep Vein Thrombosis and Its Effects on Clinical Outcomes After Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med 2021; 9:23259671211030883. [PMID: 34692875 PMCID: PMC8532235 DOI: 10.1177/23259671211030883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Although a few studies have reported the incidence of deep vein thrombosis (DVT) after opening-wedge high tibial osteotomy (OWHTO), previous studies focused only on symptomatic DVT. Information is lacking regarding the overall incidence of DVT after OWHTO, thrombus location, and the relationship between DVT and clinical outcome. Purpose: To determine the overall incidence of DVT and classify the location of DVT after OWHTO. We also determined whether significant differences in clinical improvement exist in patients with and without DVT at 6 months and at 2 years after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 46 patients (47 knees) who underwent OWHTO. All patients were instructed to perform knee range of motion exercises and partial weightbearing after drain removal. None of the patients received a chemoprophylaxis for DVT except intermittent pneumatic compression. DVT was diagnosed using 128-row multidetector computed tomography performed before discharge on the fourth postoperative day. The location was classified into 6 segments in the distal portion (muscular and axial veins) and proximal portion (popliteal, femoral, and common femoral veins and veins located above the iliac vein). International Knee Documentation Committee (IKDC) score was assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years using a linear mixed model. Results: Although the incidence of symptomatic DVT was 8.5% (n = 4), the overall incidence of early DVT was 44.7% (n = 21). All DVTs were located in the distal portion of the lower extremity vein, and 76.2% of the DVTs were located in an axial vein. The IKDC scores were 33.6 ± 7.2 and 35.3 ± 9.1 (P = .910) preoperatively, 38.1 ± 5.6 and 40.6 ± 8.4 (P = .531) at 6 months after surgery, and 44.8 ± 6.9 and 45.9 ± 11.4 (P = .786) at 2 years after surgery in patients without and those with DVT, respectively. Conclusion: The overall incidence of early DVT after OWHTO was 44.7%. DVT after OWHTO was found particularly around the osteotomy site (76.2%). Patients with DVT did not have inferior short-term clinical outcomes after surgery.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jisu Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Byung Sun Choi
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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Weidner N, Müller OJ, Hach-Wunderle V, Schwerdtfeger K, Krauspe R, Pauschert R, Waydhas C, Baumberger M, Göggelmann C, Wittgruber G, Wildburger R, Marcus O. Prevention of thromboembolism in spinal cord injury -S1 guideline. Neurol Res Pract 2020; 2:43. [PMID: 33324943 PMCID: PMC7727164 DOI: 10.1186/s42466-020-00089-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Traumatic and non-traumatic spinal cord injury bears a high risk for thromboembolism in the first few months after injury. So far, there is no consented guideline regarding diagnostic and prophylactic measures to prevent thromboembolic events in spinal cord injury. Based on a Pubmed research of related original papers and review articles, international guidelines and a survey conducted in German-speaking spinal cord injury centers about best practice prophylactic procedures at each site, a consensus process was initiated, which included spinal cord medicine experts and representatives from medical societies involved in the comprehensive care of spinal cord injury patients. The recommendations comply with the German S3 practice guidelines on prevention of venous thromboembolism. Recommendations Specific clinical or instrument-based screening methods are not recommended in asymptomatic SCI patients. Based on the severity of neurological dysfunction (motor completeness, ambulatory function) low dose low molecular weight heparins are recommended to be administered up to 24 weeks after injury. Besides, mechanical methods (compression stockings, intermittent pneumatic compression) can be applied. In chronic SCI patients admitted to the hospital, thromboembolism prophylactic measures need to be based on the reason for admission and the necessity for immobilization. Conclusions Recommendations for thromboembolism diagnostic and prophylactic measures follow best practice in most spinal cord injury centers. More research evidence needs to be generated to administer more individually tailored risk-adapted prophylactic strategies in the future, which may help to further prevent thromboembolic events without causing major side effects. The present article is a translation of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/179-015l_S1_Thromboembolieprophylaxe-bei-Querschnittlaehmung_2020-09.pdf).
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Affiliation(s)
- Norbert Weidner
- Klinik für Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Oliver J Müller
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Viola Hach-Wunderle
- Klinik für Gefäßchirurgie und Gefäßmedizin, Krankenhaus Nordwest, Frankfurt/M., Germany
| | - Karsten Schwerdtfeger
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg Saar, Germany
| | - Rüdiger Krauspe
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Rolf Pauschert
- Fachabteilung für Orthopädie/Unfallchirurgie, SRH Gesundheitszentrum Bad Wimpfen, Bad Wimpfen, Germany
| | - Christian Waydhas
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | | | - Christoph Göggelmann
- Klinik für Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.,Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
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8
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A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study). Ann Intensive Care 2020; 10:122. [PMID: 32926245 PMCID: PMC7490313 DOI: 10.1186/s13613-020-00739-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in high-risk trauma patients in ICU. Methods A prospective observational study was conducted at the ICU of Alfred Hospital, a major trauma center in Melbourne, Australia, between Feb and Nov 2015. All adult major trauma patients admitted with high risk for DVT were eligible for inclusion. IP-CUS was performed immediately before or after DUS for PLEDVT screening. The paired studies were repeated twice weekly until the DVT diagnosis, death or ICU discharge. Written informed consent from the patient, or person responsible, or procedural authorisation, was obtained. The individuals performing the scans were blinded to the others’ results. The agreement analysis was performed using Cohen’s Kappa statistics and intraclass correlation coefficient for repeated binary measurements. Results During the study period, 117 patients had 193 pairs of scans, and 45 (39%) patients had more than one pair of scans. The median age (IQR) was 47 (28–68) years with 77% males, mean (SD) injury severity score 27.5 (9.53), and a median (IQR) ICU length of stay 7 (3.2–11.6) days. There were 16 cases (13.6%) of PLEDVT with an incidence rate of 2.6 (1.6–4.2) cases per 100 patient-days in ICU. The overall agreement was 96.7% (95% CI 94.15–99.33). The Cohen’s Kappa between the IP-CUS and DUS was 0.77 (95% CI 0.59–0.95), and the intraclass correlation coefficient for repeated binary measures was 0.75 (95% CI 0.67–0.81). Conclusions There is a substantial agreement between IP-CUS and DUS for PLEDVT screening in trauma patients in ICU with high risk for DVT. Large multicentre studies are needed to confirm this finding.
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9
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Beswick AD, Dennis J, Gooberman-Hill R, Blom AW, Wylde V. Are perioperative interventions effective in preventing chronic pain after primary total knee replacement? A systematic review. BMJ Open 2019; 9:e028093. [PMID: 31494601 PMCID: PMC6731899 DOI: 10.1136/bmjopen-2018-028093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES For many people with advanced osteoarthritis, total knee replacement (TKR) is an effective treatment for relieving pain and improving function. Features of perioperative care may be associated with the adverse event of chronic pain 6 months or longer after surgery; effects may be direct, for example, through nerve damage or surgical complications, or indirect through adverse events. This systematic review aims to evaluate whether non-surgical perioperative interventions prevent long-term pain after TKR. METHODS We conducted a systematic review of perioperative interventions for adults with osteoarthritis receiving primary TKR evaluated in a randomised controlled trial (RCT). We searched The Cochrane Library, MEDLINE, Embase, PsycINFO and CINAHL until February 2018. After screening, two reviewers evaluated articles. Studies at low risk of bias according to the Cochrane tool were included. INTERVENTIONS Perioperative non-surgical interventions; control receiving no intervention or alternative treatment. PRIMARY AND SECONDARY OUTCOME MEASURES Pain or score with pain component assessed at 6 months or longer postoperative. RESULTS 44 RCTs at low risk of bias assessed long-term pain. Intervention heterogeneity precluded meta-analysis and definitive statements on effectiveness. Good-quality research provided generally weak evidence for small reductions in long-term pain with local infiltration analgesia (three studies), ketamine infusion (one study), pregabalin (one study) and supported early discharge (one study) compared with no intervention. For electric muscle stimulation (two studies), anabolic steroids (one study) and walking training (one study) there was a suggestion of more clinically important benefit. No concerns relating to long-term adverse events were reported. For a range of treatments there was no evidence linking them with unfavourable pain outcomes. CONCLUSIONS To prevent chronic pain after TKR, several perioperative interventions show benefits and merit further research. Good-quality studies assessing long-term pain after perioperative interventions are feasible and necessary to ensure that patients with osteoarthritis achieve good long-term outcomes after TKR.
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Affiliation(s)
- Andrew David Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Dennis
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Ashley William Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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10
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Serrano PE, Parpia S, Valencia M, Simunovic M, Bhandari M, Levine M. Incidence of delayed venous thromboembolic events in patients undergoing abdominal and pelvic surgery for cancer: a systematic review and meta‐analysis. ANZ J Surg 2019; 89:1217-1223. [DOI: 10.1111/ans.15290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Pablo E. Serrano
- Department of SurgeryMcMaster University Hamilton Ontario Canada
- Ontario Clinical Oncology Group Hamilton Ontario Canada
| | - Sameer Parpia
- Ontario Clinical Oncology Group Hamilton Ontario Canada
- Department of Health Research Methods, Evidence and ImpactMcMaster University Hamilton Ontario Canada
- Department of OncologyMcMaster University Hamilton Ontario Canada
| | - Marlie Valencia
- Department of SurgeryMcMaster University Hamilton Ontario Canada
| | - Marko Simunovic
- Department of SurgeryMcMaster University Hamilton Ontario Canada
- Ontario Clinical Oncology Group Hamilton Ontario Canada
- Department of Health Research Methods, Evidence and ImpactMcMaster University Hamilton Ontario Canada
| | - Mohit Bhandari
- Department of SurgeryMcMaster University Hamilton Ontario Canada
- Ontario Clinical Oncology Group Hamilton Ontario Canada
| | - Mark Levine
- Ontario Clinical Oncology Group Hamilton Ontario Canada
- Department of Health Research Methods, Evidence and ImpactMcMaster University Hamilton Ontario Canada
- Department of OncologyMcMaster University Hamilton Ontario Canada
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11
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Hon B, Botticello A, Kirshblum S. Duplex ultrasound surveillance for deep vein thrombosis after acute traumatic spinal cord injury at rehabilitation admission. J Spinal Cord Med 2019; 43:298-305. [PMID: 30939080 PMCID: PMC7241488 DOI: 10.1080/10790268.2019.1585134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Context/objective: To determine the prevalence of deep vein thrombosis (DVT) detected through routine duplex screening and factors associated with DVT in spinal cord injury (SCI) patients on admission to rehabilitation.Design: Retrospective chart review of medical records.Setting: Acute inpatient rehabilitation.Participants: One hundred and eighty-nine individuals admitted to rehabilitation within 2 weeks of initial traumatic SCI who underwent routine surveillance with duplex scan for DVT.Interventions: Duplex scan of lower extremities.Outcome measures: The dependent variable was positive duplex screening for either any DVT (distal and/or proximal) or proximal DVT.Results: Of the 189 patients, 31 patients (16.4%) had a positive scan for any (proximal and/or distal) DVT, with 9 (4.8%) positive for a proximal DVT and 22 (11.6%) positive for isolated distal DVT. Of those with isolated distal DVT, 31.8% later developed propagation with either proximal DVTs or pulmonary embolism (mean = 22 days). Factors significantly associated with positive duplex scans for any (proximal and/or distal) DVT include more severe neurological injury (AIS A, B or C versus AIS D: χ2 = 7.1791, df = 1, P = 0.007) and older age (age ≥50 years old: χ2 = 14.9410, df = 1, P = 0.000).Conclusion: In acute traumatic SCI, older age and more severe neurological impairment (AIS A, B, and C) are independent risk factors for positive duplex screening for any (proximal and/or distal) DVT detected on rehabilitation admission. Individuals with an acute distal DVT have a high likelihood for future thrombus progression. Routine surveillance for these patients may be warranted.
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Affiliation(s)
- Beverly Hon
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Correspondence to: Beverly Hon, JFK Johnson Rehabilitation Institute, 65 James Street, Edison, NJ 08820, USA.
| | - Amanda Botticello
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Kessler Foundation Research Center, West Orange, New Jersey, USA
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Kessler Foundation Research Center, West Orange, New Jersey, USA,Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
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The incidence of symptomatic in-hospital VTEs in Asian patients undergoing joint arthroplasty was low: a prospective, multicenter, 17,660-patient-enrolled cohort study. Knee Surg Sports Traumatol Arthrosc 2019; 27:1075-1082. [PMID: 30386998 DOI: 10.1007/s00167-018-5253-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to determine the real incidence of symptomatic in-hospital venous thromboembolism (VTE) and identify risk factors for VTEs in Asian patients undergoing total hip (THA) and total knee arthroplasty (TKA). METHODS A total of 17,660 patients (20,078 hips and knees) undergoing THA and TKA at 78 hospitals were enrolled. The composite incidence of symptomatic in-hospital DVT and PE was identified as the primary effectiveness outcomes. The primary safety outcomes were the incidences of postoperative complications, especially for major or minor bleeding. Secondary analyses were assessed to identify the risk factors for postoperative VTE. RESULTS The overall rates of symptomatic in-hospital DVT in patients undergoing THA and TKA were 0.21% (19/9022) and 0.36% (31/8638), respectively. Symptomatic PE was confirmed in one TKA patient. Safety analysis showed that the incidence of bleeding during hospital stays in patients undergoing THA and TKA was 0.10% (18/17,660). Increased VTE risks were associated with old age, high BMI index, hypertension, cerebrovascular disease, history of venous thromboembolism and no medical prophylaxis usage. CONCLUSIONS The incidence of symptomatic VTEs in Asian regions was low compared with that reported in studies targeting Western populations. Approximately 1 in 500 patients undergoing THA and approximately 1 in 300 patients undergoing TKA developed symptomatic VTEs prior to hospital discharge. Old age, high BMI, history of venous thromboembolism, hypertension, cerebrovascular disease, and no medication prophylaxis were risk factors identified in this study. LEVEL OF EVIDENCE Prospective cohort study; Level 2.
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Alvarez J, Santiveri FJ, Ramos MI, Gallart L, Aguilera L, Puig-Verdie L. Clinical trial on the effect of tranexamic acid on bleeding and fibrinolysis in primary hip and knee replacement. ACTA ACUST UNITED AC 2019; 66:299-306. [PMID: 30902396 DOI: 10.1016/j.redar.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/22/2018] [Accepted: 01/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tourniquet-induced ischaemia could increase fibrinolysis and enhance tranexamic acid (TXA) efficacy in total knee arthroplasty (TKA) compared to total hip arthroplasty (THA). The aims of this study are to compare the effect of TXA on bleeding and fibrinolysis in both types of surgery, and to record thromboembolic complications. METHODS A prospective double-blind study was conducted on patients scheduled for TKA or THA who received TXA (2 bolus of 10mg/kg) or placebo. Bleeding and fibrinolysis were evaluated. Doppler-ultrasound and computed tomography were performed in order to assess any thromboembolic complications. RESULTS A total of 44 patients were included (11 THA and 11 TKA treated with TXA; 11 THA and 11 TKA as controls). Blood losses were significantly lower in the TXA group (mean 921mL vs 1,383mL in THA and 969mL vs 1,223mL in TKA), and no transfusions were needed with TXA, whereas 5 blood units were transfused in controls. TXA was equally effecting in reducing bleeding in both surgeries (33% in THA and 21% in TKA). The significant mean increase in D-dimers from baseline to 6 hours after surgery (1,004 ug/L to 10,284 ug/L in THA and 571 ug/L to 6,480 ug/L in TKA) was attenuated by TXA (1,077 ug/L to 2,590 ug/L in THA and 655 ug/L to 2,535 ug/L in TKA). There were no differences in thromboembolic episodes. CONCLUSIONS Prophylactic use of tranexamic acid is equally effective in reducing bleeding in TKA and THA. Both surgeries have a similar effect on fibrinolysis.
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Affiliation(s)
- J Alvarez
- Servicio de Anestesia Reanimación y Terapia del Dolor, Parc de Salut MAR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, España.
| | - F J Santiveri
- Servicio de Anestesia Reanimación y Terapia del Dolor, Parc de Salut MAR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - M I Ramos
- Servicio de Anestesia Reanimación y Terapia del Dolor, Parc de Salut MAR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - L Gallart
- Servicio de Anestesia Reanimación y Terapia del Dolor, Parc de Salut MAR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - L Aguilera
- Servicio de Anestesia Reanimación y Terapia del Dolor, Parc de Salut MAR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - L Puig-Verdie
- Servicio de Cirugía Ortopédica y Traumatología, Parc de Salut MAR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, España
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Meftah M, White PB, Siddiqi A, Perake VS, Kirschenbaum IH. Routine Preoperative Venous Doppler Screening Is Not Effective in Preventing Thromboembolic Events After Total Joint Arthroplasty. Orthopedics 2018; 41:e202-e206. [PMID: 29309713 DOI: 10.3928/01477447-20180102-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/30/2017] [Indexed: 02/03/2023]
Abstract
Despite advances in thromboprophylaxis, the relationship between preexisting deep venous thromboses (DVTs) and postoperative thromboembolic complications is not fully established. The aim of this study was to assess the utility of selective and nonselective preoperative lower extremity venous Doppler screening protocols as tools in reducing the incidence of thromboembolic events (DVT/pulmonary embolism [PE]) after total joint arthroplasty. In the 2-year period from August 2013 to August 2015, a total of 455 consecutive elective primary total joint arthroplasties were identified from the authors' database. During the first year, a selective preoperative Doppler ultrasound screening protocol (only patients with a history of DVT/PE) was used for 182 patients, 31 of whom had preoperative ultrasound scans. The following year, a nonselective screening protocol was used for 273 consecutive patients, all of whom had preoperative Doppler ultrasound scans. All patients were followed for a minimum of 3 months postoperatively for postoperative Doppler ultrasound scans, emergency department visits, and readmissions related to DVT/PE. Preoperatively, there was no difference between the selective and nonselective cohorts regarding preoperative DVTs (3 and 1, respectively; P=.307); all patients were known to have prior DVT. Postoperative thromboembolic events were found in 4 (2.6%) of the patients in the selective cohort and 2 (0.7%) of the patients in the nonselective cohort (P=.196). Use of a nonselective preoperative Doppler ultrasound screening protocol did not improve the identification of preoperative DVTs or reduce postoperative thromboembolic complications. [Orthopedics. 2018; 41(2):e202-e206.].
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Buckner T, Leavitt A, Ragni M, Kempton C, Eyster M, Cuker A, Lentz S, Ducore J, Leissinger C, Wang M, Key N. Prospective, multicenter study of postoperative deep-vein thrombosis in patients with haemophilia undergoing major orthopaedic surgery. Thromb Haemost 2017; 116:42-9. [DOI: 10.1160/th15-10-0802] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/15/2016] [Indexed: 11/05/2022]
Abstract
SummaryPerioperative clotting factor replacement is administered to reverse the inherent haemostatic defect in persons with haemophilia (PWH), potentially increasing their risk for developing venous thromboembolism (VTE) postoperatively. It was our objective to determine the prevalence of VTE in PWH undergoing total hip or knee arthroplasty (THA, TKA). Patients with haemophilia A or B who underwent THA or TKA were enrolled in this prospective, multicentre observational cohort study. Lower extremity venous duplex ultrasound was performed prior to surgery and 4–6 weeks after surgery. Eleven centres enrolled 51 subjects, 46 of whom completed the study. Six subjects (13.0 %) were treated with bypass agents perioperatively; the remaining 40 subjects received factor VIII or IX replacement. Intermittent pneumatic compression devices were utilised postoperatively in 23 subjects (50 %), and four subjects (8.7 %) also received low-molecular-weight heparin prophylaxis. One subject (2.2 %) with moderate haemophilia A was diagnosed with symptomatic distal deep-vein thrombosis (DVT) on day 6 following TKA. One subject (2.2 %) with severe haemophilia A was diagnosed with pulmonary embolism on day 9 following bilateral TKA. No subjects had asymptomatic DVT. Eighteen subjects (39.1 %) had major bleeding, and three subjects (6.5 %) experienced minor bleeding. The observed prevalence of ultrasound-detectable, asymptomatic DVT in PWH following TKA or THA in this study was low, but the incidence of symptomatic VTE (4.3 %, 95 % CI, 0.5–14.8 %) appeared similar to the estimated incidence in the general population without thromboprophylaxis.
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Agnelli G, Bounameaux H. Symptoms and clinical relevance: A dilemma for clinical trials on prevention of venous thromboembolism. Thromb Haemost 2017; 109:585-8. [DOI: 10.1160/th12-08-0627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/23/2012] [Indexed: 11/05/2022]
Abstract
SummaryThe outcomes of thromboprophylactic trials have been debated for decades. Recently, the 9th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines based their strong recommendations only on patient-important outcomes. Practically, symptoms were considered the crucial element. Consequently, studies that primarily aimed at reducing venographic thrombi were considered less pertinent than studies that focused on symptomatic thrombosis. In the present viewpoint, we challenge the argument that “symptomatic” and “clinically relevant” are interchangeable. In particular, the case is made that asymptomatic events may be clinically relevant and that asymptomatic venographically detected thrombosis is a clinically relevant surrogate outcome for fatal pulmonary embolism.
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Ahmad J, Lynch MK, Maltenfort M. Incidence and Risk Factors of Venous Thromboembolism After Orthopaedic Foot and Ankle Surgery. Foot Ankle Spec 2017; 10:449-454. [PMID: 28413884 DOI: 10.1177/1938640017704944] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study examines the incidence and risk of postoperative symptomatic venous thromboembolism (VTE) after orthopaedic foot/ankle surgery. MATERIALS Patients that received foot/ankle surgery between 2006 and 2016 were reviewed. Inclusion criteria were surgical patients that were without coagulopathy, previous VTE, and/or using anticoagulation medications including aspirin. Age, sex, body mass index, medical comorbidities, and surgical diagnosis and procedure(s) were noted. Records were reviewed to see who developed a symptomatic VTE within 90 days from surgery. RESULTS This study involved 2774 patients that received foot/ankle surgery between 2006 and 2016. Of them, 22 (0.79%) developed a VTE within 90 days from surgery. The mean age of these patients was 49.5 years. Twelve patients were male and 10 were female. Sixteen patients were obese and 6 were nonobese. Postoperative VTEs were 14 infrapopliteal deep vein thrombosis (DVT), 1 suprapopliteal DVT, and 7 pulmonary emboli. The most common surgeries involved were ankle fracture repair in 8 (0.29%), Achilles tendon repair in 2 (0.07%), ankle ligament reconstruction in 2, and hammer-toe correction in 2 patients. Obesity was predictive of a postoperative VTE to a statistically significant degree (P = .04). Age, sex, medical comorbidities, diagnosis, and type of surgery were not significantly prognostic for a postsurgical VTE (P ≥ .05). DISCUSSION The incidence of VTE after foot/ankle surgery is low. However, obese patients are at significantly higher risk for VTE after such procedures. CLINICAL RELEVANCE These findings are important when educating patients as to their risks of developing a VTE after orthopaedic foot/ankle surgery. LEVELS OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- Jamal Ahmad
- Orthopaedic Foot and Ankle Surgery, NorthShore Orthopaedic Institute, NorthShore University Health System, Lincolnshire, Illinois (JA).,Rothman Institute Orthopaedics, Philadelphia, Pennsylvania (MKL, MM)
| | - Mary-Katherine Lynch
- Orthopaedic Foot and Ankle Surgery, NorthShore Orthopaedic Institute, NorthShore University Health System, Lincolnshire, Illinois (JA).,Rothman Institute Orthopaedics, Philadelphia, Pennsylvania (MKL, MM)
| | - Mitchell Maltenfort
- Orthopaedic Foot and Ankle Surgery, NorthShore Orthopaedic Institute, NorthShore University Health System, Lincolnshire, Illinois (JA).,Rothman Institute Orthopaedics, Philadelphia, Pennsylvania (MKL, MM)
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Managing hip fracture and lower limb surgery in the emergency setting. J Trauma Acute Care Surg 2017; 82:1112-1121. [DOI: 10.1097/ta.0000000000001453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 13:559-68. [PMID: 26513770 DOI: 10.2450/2015.0277-14] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/28/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Critically ill patients appear to be at high risk of developing deep vein thrombosis (DVT) and pulmonary embolism during their stay in the intensive care unit (ICU). However, little is known about the clinical course of venous thromboembolism in the ICU setting. We therefore evaluated, through a systematic review of the literature, the available data on the impact of a diagnosis of DVT on hospital and ICU stay, duration of mechanical ventilation and mortality in critically ill patients. We also tried to determine whether currently adopted prophylactic measures need to be revised and improved in the ICU setting. MATERIALS AND METHODS MEDLINE and EMBASE databases were searched up to week 4 of June 2012. Two reviewers selected studies and extracted data. Pooled results are reported as relative risks and weighted mean differences and are presented with 95% confidence intervals (CI). RESULTS Seven studies for a total of 1,783 patients were included. A diagnosis of DVT was frequent in these patients with a mean rate of 12.7% (95% CI: 8.7-17.5%). DVT patients had longer ICU and hospital stays compared to those without DVT (7.28 days; 95% CI: 1.4-13.15; and 11.2 days; 95% CI: 3.82-18.63 days, respectively). The duration of mechanical ventilation was significantly increased in DVT patients (weighted mean difference: 4.85 days; 95% CI: 2.07-7.63). DVT patients had a marginally significant increase in the risk of hospital mortality (relative risk 1.31; 95% CI: 0.99-1.74; p=0.06), and a not statistically significant increase in the risk of ICU mortality (RR 1.64; 95% CI: 0.91-2.93; p=0.10). CONCLUSIONS A diagnosis of DVT upon ICU admission appears to affect clinically important outcomes including duration of ICU and hospital stay and hospital mortality. Larger, prospective studies are warranted.
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Uchiyama H, Inoue Y, Uchimura I, Nakamura T, Kudo T, Muneta T, Kawano T. Prediction of Venous Thromboembolism after Total Knee Arthroplasty Using Dielectric Blood Coagulometry. Ann Vasc Surg 2016; 38:286-292. [PMID: 27522973 DOI: 10.1016/j.avsg.2016.05.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/11/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) frequently occurs in patients undergoing total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of dielectric blood coagulometry (DBCM) as a new technique for predicting postoperative VTE. METHODS Thirty patients undergoing TKA were enrolled. DVT was diagnosed by ultrasonography preoperatively and on the fourth or fifth postoperative day. Enhanced computed tomography was performed to detect PE on the fourth postoperative day. The day after surgery, a blood sample was measured by DBCM. All patients received fondaparinux or low-molecular-weight heparin for postoperative thromboprophylaxis. RESULTS Eighteen of the 30 patients had DVT postoperatively, and 10 had asymptomatic PE. Seven patients had both DVT and PE. The patterns of permittivity as a function of time and frequency from the DBCM measurement were different between patients with and without VTE. The sensitivity and specificity of the parameter constructed from a set of permittivities at the frequencies of 2.5 kHz, 1 MHz, and 10 MHz were 90% and 78%, respectively. CONCLUSIONS DBCM was effective and efficient for predicting VTE after TKA.
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Affiliation(s)
- Hidetoshi Uchiyama
- Department of Esophageal and General Surgery, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
| | - Yoshinori Inoue
- Department of Esophageal and General Surgery, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Isao Uchimura
- Department of Endocrinology and Metabolism, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Esophageal and General Surgery, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tatsuyuki Kawano
- Department of Esophageal and General Surgery, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Singh VA, Yong LM, Vijayananthan A. Is DVT prophylaxis necessary after oncology lower limb surgery? A pilot study. SPRINGERPLUS 2016; 5:943. [PMID: 27386387 PMCID: PMC4929109 DOI: 10.1186/s40064-016-2441-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/27/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Deep vein thrombosis (DVT) has been independently associated with both malignant diseases and orthopaedic surgery. Therefore, orthopaedic oncology patients may be at a high risk for thromboembolic events. However, less emphasis is given to this group of patients compared to the patients undergoing total hip and knee replacement. The objective of this study is to determine the incidence of DVT and their risk factors in patients undergoing orthopaedic oncology lower limb surgery without prophylaxis. QUESTIONS/PURPOSES (1) What is the incidence of DVT in patients who underwent orthopaedic oncology surgery for the lower limb? (2) What are the risk factors related to DVT in patients who underwent oncology surgery of the lower limb surgery? (3) This is a pilot study to determine if further trial is warranted. METHODS This is a prospective study. All sequential patients undergoing orthopaedic oncology operations from the period of 1st October 2013 till 30th September 2014 were recruited for the study with their consent. Their demographic data, diagnosis and surgery were documented. Thirty-eight patients who underwent lower limb surgeries for orthopaedic oncology indications were included in the study. No tourniquet was used in these lower limb surgeries. There were 24 men and 14 women with a mean age of 36 years (11-75). All potential risk factors were also identified and documented. All patients were not given any form of DVT prophylaxis (mechanical and chemical) before and after operation as this is a standard protocol in our center and a Medical Ethics Committee approval was taken for this study. DVT surveillance was performed 1 day before operation and 2 weeks after operation with ultrasound Doppler. Patients diagnosed with DVT via ultrasound Doppler were subsequently scheduled for CTPA to look for pulmonary embolism (PE). RESULTS DVT was detected in two patients (5 %). Both patients were asymptomatic and they both had proximal thrombosis. One patient (2.6 %) was diagnosed with non-fatal PE and was asymptomatic. PE was detected incidentally by staging computed tomography scan and the patient had negative ultrasound Doppler of the operated and non-operated limb for DVT. We did not carry out a statistical analysis as the study population with DVT and pulmonary embolism is small. CONCLUSIONS The incidence of DVT in patients after undergoing orthopaedic oncology lower limb surgery was low even without prophylaxis at our center. Further investigation with larger sample size is needed to validate our results and identify the risk factors. LEVEL OF EVIDENCE Level III descriptive study.
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Affiliation(s)
- Vivek Ajit Singh
- Department of Orthopaedic Surgery, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Lim Ming Yong
- Department of Orthopaedic Surgery, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Anushya Vijayananthan
- Department of Biomedical Imaging, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Fu D, Zhao Y, Shen J, Cai Z, Hua Y. Comparison of Venous Thromboembolism after Total Artificial Joint Replacement between Musculoskeletal Tumors and Osteoarthritis of the Knee by a Single Surgeon. PLoS One 2016; 11:e0158215. [PMID: 27352130 PMCID: PMC4924844 DOI: 10.1371/journal.pone.0158215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/13/2016] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study was to compare and evaluate the event of VTE (Venous Thromboembolism Event) after total artificial joint replacement between two groups diagnosed with either musculoskeletal tumors or osteoarthritis (OA) of the knee. From 2004 to 2014, a total of 1,402 patients (308 in tumor group, 1,094 in OA group) were involved in this study. The rate of asymptomatic DVT (Deep vein thrombosis) was significantly higher in tumor group when compared with OA group. Though both the incidence of symptomatic DVT and PE (Pulmonary embolism) were slightly higher in tumor group, no significant difference was detected. Tumor patients suffered an almost equal risk of VTE compared with OA patients except a higher rate of asymptomatic DVT after total artificial joint replacement. For patients with tumor, no significant association was observed between any potential risk factor and DVT.
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Affiliation(s)
- Dong Fu
- Department of Orthopedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, China
| | - Yiqiong Zhao
- The tenth People's Hospital affiliated with Tong Ji University, Shanghai 200072, China
| | - Jiakang Shen
- Department of Orthopedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, China
| | - Zhengdong Cai
- Department of Orthopedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, China
- * E-mail:
| | - Yingqi Hua
- Department of Orthopedics, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, China
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Luo C, Luo X, He Y, Li J, Huang B, Lin L, Li Q. Impact of postoperative drainage autologous blood re-transfusion on the coagulation parameters and D-dimer levels of patients after total hip arthroplasty. Transfus Apher Sci 2016; 55:109-13. [PMID: 27118495 DOI: 10.1016/j.transci.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/18/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative drainage autologous blood re-transfusion (ABT) is an important treatment method that maintains a high haemoglobin (HGB) content and obviates the need for allogeneic blood transfusion in patients after surgery. However, the safety of ABT remains controversial. OBJECTIVES AND METHODS This study aimed to investigate the safety of postoperative drainage ABT in primary total hip arthroplasty (THA). In this randomized, controlled study, patients undergoing THA were selected and randomly divided into two groups. A device for postoperative ABT was used for the 49 patients in the ABT group, whereas conventional postoperative vacuum drainage was used for the 42 patients in the drainage blood (Drain) group without ABT. The coagulation parameters and D-dimer (DD) levels of the two groups of patients were recorded before surgery (T0) and on postoperative days one (T1), three (T2), seven (T3), and 14 (T4). RESULTS A within-group comparison after THA showed that the postoperative fibrinogen (FIB) and DD levels were higher than those before surgery in both groups (P < 0.01). A between-group comparison showed that, at different time points, the postoperative drainage blood amount and the coagulation parameters were not significantly different between the two groups. Compared with the Drain group, the DD levels in the ABT group were significantly higher at T1, T2, and T3 (P < 0.05). CONCLUSION Postoperative drainage ABT did not significantly impact the coagulation parameters of patients after THA. However, the DD levels after ABT significantly increased, which may affect the risk of thrombosis.
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Affiliation(s)
- Cheng Luo
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China; Department of Joint Surgery, Panyu Central Hospital, Guangzhou 511400, China
| | - Xiangping Luo
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Yingyi He
- Department of Anesthesiology, Panyu Central Hospital, Guangzhou 511400, China
| | - Jiewen Li
- Department of Joint Surgery, Panyu Central Hospital, Guangzhou 511400, China
| | - Bingsheng Huang
- Department of Joint Surgery, Panyu Central Hospital, Guangzhou 511400, China
| | - Lijun Lin
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Qi Li
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China.
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Boddi M, Peris A. Deep Vein Thrombosis in Intensive Care. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:167-181. [DOI: 10.1007/5584_2016_114] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.: Consortium for Spinal Cord Medicine. Top Spinal Cord Inj Rehabil 2016; 22:209-240. [PMID: 29339863 PMCID: PMC4981016 DOI: 10.1310/sci2203-209] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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26
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Incidence of deep venous thrombosis in Chinese patients undergoing arthroscopic knee surgery for cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:3540-4. [PMID: 25362246 DOI: 10.1007/s00167-014-3216-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 07/28/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE This study investigated the incidence of deep venous thrombosis (DVT) in patients undergoing arthroscopic cruciate ligament surgery. METHODS A total of 282 patients were examined by color Doppler ultrasound preoperatively and 3 and 7 days postoperatively. RESULTS DVT was present in 34 of 282 patients (12.1 %); of these, 11 (32.6 %) underwent reconstruction of the anterior cruciate ligament (ACL), alone or in conjunction with the medial or lateral collateral ligament (MCL or LCL, respectively; 17.6 %); eight (23.5 %) of the posterior cruciate ligament (PCL); four (11.8 %) of the PCL-MCL/LCL; and five (14.7 %) of the ACL-MCL. In patients with tourniquets applied for <90, 90-120, and >120 min, the incidence of DVT was 5.6, 12.8, and 17.4 %, respectively. CONCLUSION The incidence of DVT in normal patients undergoing ACL surgery was 12.1 %. A higher incidence was observed among cases of multiligament reconstruction, especially those involving the PCL, as well as in patients with tourniquets applied for more than 2 h. Based on these findings, prophylactic measures for DVT may be considered after arthroscopic knee surgery in order to decrease the incidence of DVT if specific risk factors are present. LEVELS OF EVIDENCE IV.
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Izumi M, Ikeuchi M, Aso K, Sugimura N, Kamimoto Y, Mitani T, Ueta T, Sato T, Yokoyama M, Sugiura T, Tani T. Less deep vein thrombosis due to transcutaneous fibular nerve stimulation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2015; 23:3317-23. [PMID: 24957913 DOI: 10.1007/s00167-014-3141-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 06/12/2014] [Indexed: 01/29/2023]
Abstract
PURPOSE It has been known for years that deep vein thrombi (DVT) start to develop during total joint arthroplasty. Previously, we reported effective prevention of venous stasis by transcutaneous electrical nerve stimulation (TENS). It is hypothesized that TENS might be a thromboprophylactic tool for the limb undergoing surgery. The purpose of this study is to clarify the clinical efficacy and safety of TENS in patients during total knee arthroplasty (TKA). METHODS Ninety patients undergoing primary TKA were involved and randomly allocated to the TENS or control group. In the TENS group, electrical stimulation of the common fibular nerve, which produced a brisk dorsiflexion of the ankle, was performed for the operated leg during surgery. In the control group, no electrical stimulation was applied. Serum D-dimer and soluble fibrin monomer complex (SFMC) levels were measured before surgery, immediately after surgery, and post-operative day (POD) 1. Ultrasonography was performed on POD 1. RESULTS Immediately after surgery, D-dimer and SFMC levels of each group were significantly lower in the TENS group compared with control (p < 0.05). The incidence of DVT was 11 % (five cases) in the TENS group while 31 % (14 cases) in control (p = 0.02). There were no adverse effects related to TENS. CONCLUSIONS TENS during TKA showed significant effects on preventing DVT. Sustaining muscle pump activation during surgery prevented not only venous stasis, but also hypercoagulability of blood. Intraoperative TENS is a safe and novel strategy against early post-operative thromboembolism, which is difficult to be completed through existing prophylaxis after total joint arthroplasty. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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Affiliation(s)
- Masashi Izumi
- Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan.
| | - Koji Aso
- Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan
| | - Natsuki Sugimura
- Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan
| | - Yuko Kamimoto
- Department of Anesthesiology, Kochi University, Nankoku, Japan
| | - Tetsuya Mitani
- Department of Clinical Laboratory, Kochi University, Nankoku, Japan
| | - Tadashi Ueta
- Department of Clinical Laboratory, Kochi University, Nankoku, Japan
| | - Takayuki Sato
- Department of Cardiovascular Control, Kochi University, Nankoku, Japan
| | | | - Tetsuro Sugiura
- Department of Clinical Laboratory, Kochi University, Nankoku, Japan
| | - Toshikazu Tani
- Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan
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Izumi M, Migita K, Nakamura M, Jiuchi Y, Sakai T, Yamaguchi T, Asahara T, Nishino Y, Bito S, Miyata S, Kumagai K, Osaki M, Mawatari M, Motokawa S. Risk of venous thromboembolism after total knee arthroplasty in patients with rheumatoid arthritis. J Rheumatol 2015; 42:928-34. [PMID: 25877506 DOI: 10.3899/jrheum.140768] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the incidence of venous thromboembolism (VTE) following total knee arthroplasty (TKA) between patients with rheumatoid arthritis (RA) and those with osteoarthritis (OA). METHODS The subjects were composed of 1084 Japanese patients with OA and 204 with RA. Primary effectiveness outcomes were any deep vein thrombosis (DVT) as detected by bilateral ultrasonography up to postoperative Day 10 (POD10) and pulmonary embolism (PE) up to POD28. The main safety outcomes were bleeding and death from any cause up to POD28. Plasma D-dimer levels were measured before and at POD10 after TKA. RESULTS The study cohort was composed of 1288 patients from 34 hospitals. There was no death up to POD28. PE occurred in 2 patients with OA and in no patients with RA. The incidence of primary effectiveness outcome was 24.3% and 24.0% in patients with OA and RA, respectively. The incidence of major bleeding up to POD28 was 1.3% and 0.5% in patients with OA and RA, respectively. No differences in the incidence of VTE (symptomatic/asymptomatic DVT plus PE) or bleeding were noted between patients with RA and OA. D-dimer levels on POD10 were significantly higher in patients with OA compared with those with RA. Also, D-dimer levels on POD10 were significantly lower in patients receiving fondaparinux than in patients without pharmacological prophylaxis. CONCLUSION Despite some differences in demographic data, patients with RA and OA have equivalent risks of VTE and bleeding following TKA.
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Affiliation(s)
- Masahiro Izumi
- Japanese NHO-EBM study group and J-PSVT, Nagasaki University Graduate School of Biomedical Sciences
| | - Kiyoshi Migita
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
| | - Mashio Nakamura
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Yuka Jiuchi
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Tatsuya Sakai
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Takayuki Yamaguchi
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Tomihiko Asahara
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Yuichiro Nishino
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Seiji Bito
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Shigeki Miyata
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Kenji Kumagai
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Makoto Osaki
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Masaaki Mawatari
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
| | - Satoru Motokawa
- From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT
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Le Gal G, Robert-Ebadi H, Carrier M, Kearon C, Bounameaux H, Righini M. Is it useful to also image the asymptomatic leg in patients with suspected deep vein thrombosis? J Thromb Haemost 2015; 13:563-6. [PMID: 25604398 DOI: 10.1111/jth.12851] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Venous ultrasonography is the cornerstone of the diagnostic work-up in patients with suspected deep vein thrombosis (DVT). Significant variations exist in clinical practice between centers and/or countries, e.g. proximal vs. whole-leg ultrasound, serial tests vs. single test, and combination with clinical probability and D-dimer testing. Fewer data exist on the need for bilateral leg imaging. OBJECTIVES To assess the yield of bilateral leg ultrasonography in patients with suspected DVT. PATIENTS AND METHODS This was a retrospective cohort study of consecutive patients with clinically suspected DVT. A single whole-leg ultrasound scan was performed in all patients. We extracted information on demographics, risk factors, clinical signs, pretest probability, side of clinical suspicion, and ultrasound results. RESULTS AND CONCLUSIONS Among the 2804 included patients, 609 (21.8%) patients had a positive ultrasound finding. A total of 20 patients (0.8%; 95% confidence interval [CI] 0.5-1.2%) had a thrombus diagnosed in both the symptomatic leg and asymptomatic leg. Moreover, five patients (0.2%; 95% CI 0.1-0.5%) did not have a thrombus in the symptomatic leg but had a thrombus in the asymptomatic leg. Two of 2540 patients with unilateral symptoms had no proximal DVT in the symptomatic leg and a proximal DVT in the asymptomatic leg (0.08%; 95% CI 0.0-0.3%). In summary, systematic imaging of both legs in patients with suspected DVT has a very low yield, and therefore does not appear to be justified.
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Affiliation(s)
- G Le Gal
- Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada; Centre d'Investigation Clinique, Université de Brest, Brest, France
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Reply to Letter: "A Randomized Study on 1-Week Versus 4-Week Prophylaxis for Venous Thromboembolism After Laparoscopic Surgery for Colorectal Cancer". Ann Surg 2014; 263:e63. [PMID: 25502469 DOI: 10.1097/sla.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Migita K, Bito S, Nakamura M, Miyata S, Saito M, Kakizaki H, Nakayama Y, Matsusita T, Furuichi I, Sasazaki Y, Tanaka T, Yoshida M, Kaneko H, Abe I, Mine T, Ihara K, Kuratsu S, Saisho K, Miyahara H, Segata T, Nakagawa Y, Kamei M, Torigoshi T, Motokawa S. Venous thromboembolism after total joint arthroplasty: results from a Japanese multicenter cohort study. Arthritis Res Ther 2014; 16:R154. [PMID: 25047862 PMCID: PMC4223565 DOI: 10.1186/ar4616] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/27/2014] [Indexed: 01/13/2023] Open
Abstract
Introduction Real-world evidence of the effectiveness of pharmacological thromboprophylaxis for venous thromboembolism (VTE) is limited. Our objective was to assess the effectiveness and safety of thromboprophylactic regimens in Japanese patients undergoing joint replacement in a real-world setting. Method Overall, 1,294 patients (1,073 females and 221 males) who underwent total knee arthroplasty (TKA) and 868 patients (740 females and 128 males) who underwent total hip arthroplasty (THA) in 34 Japanese national hospital organization (NHO) hospitals were enrolled. The primary efficacy outcome was the incidence of deep vein thrombosis (DVT) detected by mandatory bilateral ultrasonography up to post-operative day (POD) 10 and pulmonary embolism (PE) up to POD28. The main safety outcomes were bleeding (major or minor) and death from any cause up to POD28. Results Patients undergoing TKA (n = 1,294) received fondaparinux (n = 360), enoxaparin (n = 223), unfractionated heparin (n = 72), anti-platelet agents (n = 45), or no medication (n = 594). Patients undergoing THA (n = 868) received fondaparinux (n = 261), enoxaparin (n = 148), unfractionated heparin (n = 32), anti-platelet agents (n = 44), or no medication (n = 383). The incidence rates of sonographically diagnosed DVTs up to POD10 were 24.3% in patients undergoing TKA and 12.6% in patients undergoing THA, and the incidence rates of major bleeding up to POD28 were 1.2% and 2.3%, respectively. Neither fatal bleeding nor fatal pulmonary embolism occurred. Significant risk factors for postoperative VTE identified by multivariate analysis included gender (female) in both TKA and THA groups and use of a foot pump in the TKA group. Only prophylaxis with fondaparinux reduced the occurrence of VTE significantly in both groups. Propensity score matching analysis (fondaparinux versus enoxaparin) showed that the incidence of DVT was lower (relative risk 0.70, 95% confidence interval (CI) 0.58 to 0.85, P = 0.002 in TKA and relative risk 0.73, 95% CI 0.53 to 0.99, P = 0.134 in THA) but that the incidence of major bleeding was higher in the fondaparinux than in the enoxaparin group (3.4% versus 0.5%, P = 0.062 in TKA and 4.9% versus 0%, P = 0.022 in THA). Conclusions These findings indicate that prophylaxis with fondaparinux, not enoxaparin, reduces the risk of DVT but increases bleeding tendency in patients undergoing TKA and THA. Trial registration University Hospital Medical Information Network Clinical Trials Registry: UMIN000001366. Registered 11 September 2008.
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Samama CM, Lecoules N, Kierzek G, Claessens YE, Riou B, Rosencher N, Mismetti P, Sautet A, Barrellier MT, Apartsin K, Jonas M, Caeiro JR, Van der veen AH, Roy PM. Étude comparant le fondaparinux à une héparine de bas poids moléculaire dans la prévention de la maladie thromboembolique veineuse en cas d’immobilisation rigide ou semi-rigide après traumatisme isolé non chirurgical du membre inférieur au-dessous du genou. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sun Y, Chen D, Xu Z, Shi D, Dai J, Qin J, Qin J, Jiang Q. Deep venous thrombosis after knee arthroscopy: a systematic review and meta-analysis. Arthroscopy 2014; 30:406-12. [PMID: 24581264 DOI: 10.1016/j.arthro.2013.12.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 12/20/2013] [Accepted: 12/31/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish a contemporary literature-based estimate of the incidence of deep venous thrombosis (DVT) after knee arthroscopic surgery. METHODS We performed a systematic review and meta-analysis of the English language literature to assess the efficacy of prophylaxis to prevent DVT after knee arthroscopic surgery. Only randomized controlled trials (RCTs) or prospective studies were considered. Studies were excluded if they were not original prospective studies concerning DVT detected by imaging after knee arthroscopic surgery. We calculated pooled proportions of postoperative DVT and proximal DVT. RESULTS Nine prospective uncontrolled studies and 4 RCTs were retrieved. Within them, the populations given low-molecular-weight heparin (LMWH) to prevent DVT had a 0.1% to 11.9% incidence of DVT, with an overall 36 DVTs identified (4 proximal), averaging 1.8%. One hundred thirty-six DVTs (29 proximal) were indicated in the populations without prophylaxis, and the DVT incidence varied from 1.8% to 41.2%, averaging 6.8%. Of the RCTs, the pooled risk ratio for DVT to develop was 0.180 (range, 0.065 to 0.499) for those who had LMWH as prophylaxis. An absolute risk reduction of 1.2%--from 1.5% to 0.3%--for the development of proximal DVT was observed. CONCLUSIONS Compared with patients who did not receive prophylaxis, the pooled risk ratio for the development of DVT was 0.18 for those who had LMWH prophylaxis. The incidence of proximal DVT is very low after arthroscopic surgery regardless of receiving prophylaxis (4 of 2,184) or not (29 of 1,814). The rate of proximal DVT in total DVT occurrence can be markedly reduced from 21.3% (29 of 136) to 11.1% (4 of 36). LEVEL OF EVIDENCE Level IV. This study is a meta-analysis of RCTs and a systematic review of Level IV studies.
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Affiliation(s)
- Ye Sun
- The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Dongyang Chen
- The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhihong Xu
- The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Dongquan Shi
- The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jin Dai
- The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jianghui Qin
- The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jizhen Qin
- The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qing Jiang
- The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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Lundin ES, Johansson T, Zachrisson H, Leandersson U, Bäckman F, Falknäs L, Kjølhede P. Single-dose tranexamic acid in advanced ovarian cancer surgery reduces blood loss and transfusions: double-blind placebo-controlled randomized multicenter study. Acta Obstet Gynecol Scand 2014; 93:335-44. [PMID: 24428857 DOI: 10.1111/aogs.12333] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 01/03/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether single-dose tranexamic acid given intravenously immediately before surgery for presumed advanced ovarian cancer reduces perioperative blood loss and blood transfusions. DESIGN A randomized double-blind, placebo-controlled multicenter study. SETTING Two university hospitals and two central hospitals in the southeast health region of Sweden. POPULATION One hundred women with presumed advanced ovarian cancer scheduled for radical debulking surgery between March 2008 and May 2012 who complied with inclusion/exclusion criteria were randomized; 50 were allocated to receive tranexamic acid and 50 to receive placebo. Analysis was performed according to intention-to-treat principles. METHODS The volume of tranexamic acid (15 mg/kg body weight, 100 mg/mL tranexamic acid) or the same volume of placebo (0.9% NaCl) was added to a 100-mL saline solution plastic bag. The study medication was given immediately before the start of surgery. Data were analyzed by means of non-parametric statistics and multivariate models adjusted for confounding factors. MAIN OUTCOME MEASURES Blood loss and red blood cell transfusions. RESULTS The total blood loss volume and transfusion rate were significantly lower in the tranexamic acid group compared with the placebo group. Median total blood loss was 520 and 730 mL, respectively (p = 0.03). Fifteen (30%) and 22 (44%), respectively received transfusions (odds ratio 0.44; upper 95% CI 0.97; p = 0.02). CONCLUSION A single dose of tranexamic acid given immediately before surgery reduces blood loss and transfusion rates significantly in advanced ovarian cancer surgery. Tranexamic acid may be recommended as standard prophylactic treatment in advanced ovarian cancer surgery.
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Affiliation(s)
- Evelyn S Lundin
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Obstetrics and Gynecology, County Council of Östergötland, Linköping, Sweden
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Zhao Z, Wang S, Ma W, Kong G, Zhang S, Tang Y, Zhao Y. Diabetes mellitus increases the incidence of deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg 2014; 134:79-83. [PMID: 24276361 DOI: 10.1007/s00402-013-1894-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Many patients undergoing total knee arthroplasty (TKA) have diabetes mellitus, which may increase the risk of deep vein thrombosis (DVT) after TKA. We therefore assessed whether diabetes mellitus increased the incidence of DVT within 14 days after TKA. MATERIALS AND METHODS The incidence of DVT within 14 days of surgery was compared in diabetic and non-diabetic patients undergoing TKA in our hospital between June 2011 and February 2013. The relationships between diabetes mellitus and DVT were analyzed. RESULTS Of the 358 enrolled patients, 70 (19.6%) had diabetes and 288 (80.4%) did not. DVT occurred within 14 days in 198 patients, 52 of 70 (74.3%) in the diabetes group and 146 of 288 (50.7%) in the non-diabetes group (p = 0.012). DVT of the contralateral leg was observed in 16 and 50 patients, respectively (p = 0.452). Logistic regression analysis showed that the risk of DVT was 2.71-fold higher in patients with than without diabetes mellitus (95% CI 1.183-6.212, p = 0.018). There were no significant differences in age, gender, hypertension, BMI, duration of surgery, intra-operative blood loss, and duration of tourniquet between the two groups. CONCLUSIONS The incidence of DVT 14 days after TKA was significantly higher in patients with than without diabetes.
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Affiliation(s)
- Zhongyuan Zhao
- Department of the Joint and Bone Surgery, Yantaishan Hospital, No. 91, Jiefang Road, Yantai, 264001, Shandong, China,
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Yamaguchi T, Matsumine A, Niimi R, Nakamura T, Matsubara T, Asanuma K, Hasegawa M, Sudo A. Deep-vein thrombosis after resection of musculoskeletal tumours of the lower limb. Bone Joint J 2013; 95-B:1280-4. [PMID: 23997146 DOI: 10.1302/0301-620x.95b9.30905] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to define the incidence of venous thromboembolism (VTE) and risk factors for the development of deep-vein thrombosis (DVT) after the resection of a musculoskeletal tumour. A total of 94 patients who underwent resection of a musculoskeletal tumour between January 2003 and December 2005 were prospectively studied. There were 42 men and 52 women with a mean age of 54.4 years (18 to 86). All patients wore intermittent pneumatic compression devices and graduated compression stockings. Ultrasound examination of the lower limbs was conducted to screen for DVT between the fifth and ninth post-operative days. DVT was detected in 21 patients (22%). Of these, two were symptomatic (2%). One patient (1%) had a fatal pulmonary embolism. Patients aged ≥ 70 years had an increased risk of DVT (p = 0.004). The overall incidence of DVT (both symptomatic and asymptomatic) after resection of a musculoskeletal tumour with mechanical prophylaxis was high. It seems that both mechanical and anticoagulant prophylaxis is needed to prevent VTE in patients who have undergone the resection of a musculoskeletal tumour.
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Affiliation(s)
- T Yamaguchi
- Mie University Graduate School of Medicine, Department of Orthopedic Surgery, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
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Samama CM, Lecoules N, Kierzek G, Claessens YE, Riou B, Rosencher N, Mismetti P, Sautet A, Barrellier MT, Apartsin K, Jonas M, Caeiro JR, van der Veen AH, Roy PM. Comparison of fondaparinux with low molecular weight heparin for venous thromboembolism prevention in patients requiring rigid or semi-rigid immobilization for isolated non-surgical below-knee injury. J Thromb Haemost 2013; 11:1833-43. [PMID: 23965181 DOI: 10.1111/jth.12395] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND In several small studies, anticoagulant therapy reduced the incidence of venous thromboembolism (VTE) in patients with isolated lower-limb injuries. OBJECTIVES To compare the efficacy and safety of fondaparinux 2.5 mg (1.5 mg in patients with a creatinine clearance between 30 and 50 mL min(-1) ) over nadroparin 2850 anti-factor Xa IU. PATIENTS AND METHODS In this international, multicenter, randomized, open-label study, patients with an isolated non-surgical unilateral below-knee injury having at least one additional major risk factor for VTE and requiring, in the Investigator's opinion, rigid or semi-rigid immobilization for 21-45 days with thromboprophylaxis up to complete mobilization received subcutaneously once-daily either fondaparinux or nadroparin. The primary efficacy outcome was the composite of VTE (symptomatic or ultrasonographically detected asymptomatic deep vein thrombosis of the lower limb or symptomatic pulmonary embolism) and death up to complete mobilization. The main safety outcome was major bleeding. RESULTS We randomized 1349 patients (mean age 46 years): 88.7% had a bone fracture, and 83.8% had a plaster cast fitted (mean duration of immobilization, 34 days). The primary efficacy outcome occurred in 15 of 584 patients (2.6%) in the fondaparinux group and 48 of 586 patients (8.2%) in the nadroparin group (odds ratio, 0.30; 95% confidence interval [CI], 0.15-0.54; P < 0.001). A single major bleed was experienced by fondaparinux-treated patients and none by nadroparin-treated patients. These results were maintained up to the end of follow-up. CONCLUSIONS Fondaparinux 2.5 mg day(-1) may be a valuable therapeutic option over nadroparin 2850 anti-FXa IU day(-1) for preventing VTE after below-knee injury requiring prolonged immobilization in patients with additional risk factors.
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Affiliation(s)
- C M Samama
- Department of Anesthesia and Intensive Care Medicine, Hôtel Dieu and Cochin University Hospitals, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France
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Wexels F, Haslund A, Dahl OE, Pripp AH, Gudmundsen TE, Laszlo F, Seljeflot I, Borris LC, Lassen MR. Thrombin split products (prothrombin fragment 1+2) in urine in patients with suspected deep vein thrombosis admitted for radiological verification. Thromb Res 2013; 131:560-3. [DOI: 10.1016/j.thromres.2013.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/25/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
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Shibata M, Hanzawa K, Ueda S, Yambe T. Deep venous thrombosis among disaster shelter inhabitants following the March 2011 earthquake and tsunami in Japan: a descriptive study. Phlebology 2013; 29:257-66. [DOI: 10.1177/0268355512474252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives A retrospective analysis of data collected during subject screening following Japan's March 2011 earthquake and tsunami was performed. We aimed to determine the incidence of deep venous thrombosis (DVT) among screened subjects and to identify risk factors associated with the development of DVT as independent variables. Methods Calf ultrasonography was undertaken in 269 subjects living in 21 shelters in Miyagi prefecture during the one-month period immediately following the March 2011 disaster. Information regarding the health and risk factors of subjects was collected by questionnaire and assessment of physical signs. Results Of the 269 evacuees screened, 65 (24%) met the criteria for calf DVT. We found lower limb trauma, reduced frequency of urination and sleeping in a vehicle to be independent positive predictors of DVT. Conclusions Evacuees had an increased risk of developing DVT, associated with tsunami-related lower limb injury, immobility and dehydration.
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Affiliation(s)
- M Shibata
- Department of Cardiology, Miyagi Cardiovascular and Respiratory Center, Kurihara
| | - K Hanzawa
- Division of Thoracic and Cardiovascular Surgery, Niigata University, Niigata
| | - S Ueda
- Department of Thoracic Surgery, Japanese Red Cross Ishinomaki Hospital, Ishinomaki
| | - T Yambe
- Department of Medical Engineering and Cardiology, Tohoku University, Sendai, Japan
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Wang S, Zhao Y. Diabetes mellitus and the incidence of deep vein thrombosis after total knee arthroplasty: a retrospective study. J Arthroplasty 2013; 28:595-7. [PMID: 23153599 DOI: 10.1016/j.arth.2012.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 06/04/2012] [Accepted: 07/18/2012] [Indexed: 02/01/2023] Open
Abstract
We explored if there was an increased risk of DVT in patients with diabetes mellitus undergoing total knee arthroplasty within 14days followup. We reviewed 245 patients undergoing total knee arthroplasty in our hospital between 2003 and 2011. The incidence of DVT within 14days after operations was compared between diabetic patients and non-diabetic patients. There were 37 patients with DVT in the diabetes group and 88 in the non-diabetes group within 14days followup (p=0.002). The risk of DVT in patients with diabetes mellitus was 2.76 times the risk in patients without diabetes mellitus using logistic regression modeling (OR=2.76, p=0.003). Although it is still controversial, patients with diabetes had a higher incidence rate of DVT after total knee arthroplasty in our study.
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Affiliation(s)
- Shijun Wang
- Department of the Joint and Bone Surgery, Yantaishan Hospital, Yantai, Shandong Province, China
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Ye S, Dongyang C, Zhihong X, Dongquan S, Jin D, Jianghui Q, Jizhen Q, Pu Y, Huacheng H, Wei S, Qing J. The incidence of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction. Arthroscopy 2013; 29:742-7. [PMID: 23527593 DOI: 10.1016/j.arthro.2013.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 01/16/2013] [Accepted: 01/16/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to retrospectively assess and analyze the incidence of deep venous thrombosis (DVT) after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR) at our institution. METHODS We conducted a retrospective analysis of 249 arthroscopic ACLRs performed in our hospital between February 2009 and February 2012. The surgical procedure was standardized in all the patients and was conducted by the same 2 surgeons. Quadrupled hamstring autograft was used in all the patients. No patient was given nonsteroidal anti-inflammatory drugs for the first 2 weeks after surgery. A unilateral contrast venography examination was performed on the third postoperative day. Patients were confined to bed once DVT was confirmed, followed by therapeutic doses of batroxobin. The proportion of patients with DVT was calculated. The significance of the association between clinical factors and postoperative DVT was determined. RESULTS This study included 171 patients (123 men and 48 women), with a mean age (±SD) of 30.1 ± 10.0 years. DVT was detected in 24 patients (14.0%; 95% confidence interval, 8.8% to 19.3%). Body mass index (BMI), operative time, operator, and duration of tourniquet application were not significant risk factors for DVT. The risk of DVT was significantly higher in patients aged 35 years or older (P < .01). Higher risk for DVT was also identified in female patients (P < .05). Pulmonary embolism did not develop after thrombolytic therapy in any of the 24 patients with DVT after ACLR. CONCLUSIONS The incidence of DVT in patients who underwent arthroscopic ACLR was 14% in this study. Female patients and those aged 35 years or older have a significantly higher risk of DVT developing after ACLR; thus thromboprophylaxis is advocated in these patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Sun Ye
- Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Giorgi Pierfranceschi M, Donadini MP, Dentali F, Ageno W, Marazzi M, Bocchi R, Imberti D. The short- and long-term risk of venous thromboembolism in patients with acute spinal cord injury: a prospective cohort study. Thromb Haemost 2012; 109:34-8. [PMID: 23223906 DOI: 10.1160/th12-06-0390] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/28/2012] [Indexed: 11/05/2022]
Abstract
Venous thromboembolism (VTE) is a frequent complication in the acute setting after spinal cord injury (SCI). Less is known about the long-term risk of VTE in these patients. It was the aim of this study to prospectively evaluate the short- and long-term risk of VTE in a cohort of patients after acute SCI and during rehabilitation and post-rehabilitation follow-up period. From January 2003 to November 2007 all consecutive adult patients admitted to a Spinal Rehabilitation Unit (RU) after surgical treatment in three Neurosurgical Units for SCI, were enrolled. After an accurate evaluation of their neurosurgical medical records the patients were prospectively evaluated for VTE occurrence. Ninety-four patients (80 males; mean age 40.3 years, SD 15.9) were recruited. All the patients received thromboprophylaxis with low-molecular-weight heparin combined with compressive stockings during hospitalization (median duration 7 months, IQR 4.5-8.8). Over a median follow-up period of 36.3 months (IQR 4.4-48) after SCI, VTE was diagnosed in 22 patients (23.4%) The majority of VTE events were recorded during the first three months of follow-up (34.4 VTE events/100 patient-years in the first 3 months and 0.3 VTE events/100 patient-years thereafter); age over 45 years (HR 8.4, 95% CI 3-23.5), previous VTE (HR 6.0, 95% CI 1.6-23.3) and paraplegia (HR 4.7, 95% CI 1.6-13.7) were independently associated with the occurrence of VTE. In conclusion, the risk of VTE in patients suffering from SCI is high despite the use of thromboprophylaxis, in particular in some patients categories. However, this risk appears to be limited to the first 3 months after the index event.
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Schellong SM, Encke A, Weber AA, Bramlage P, Paar WD, Haas S. Benefits and Risks of Preventing Thromboembolism With Enoxaparin in Patients With General Surgery in Real World—The CLEVER Study. Clin Appl Thromb Hemost 2012; 19:282-8. [DOI: 10.1177/1076029612461067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: We aimed to document enoxaparin use in real world and identify the risk factors for bleeding complications. Methods: Postauthorization study in 448 surgical patients receiving enoxaparin prophylaxis. Complete compression ultrasound (CCUS) was performed at day 10 ± 3. Results: During treatment, 11 of 448 patients had suspected deep venous thrombosis (DVT) but none confirmed. One patient had symptoms of pulmonary embolism ([PE] 0.22%; 95% confidence interval [CI] −0.21-0.66). There were no asymptomatic cases detected upon CCUS. At the 90-day follow-up, 4 (0.9%) of the 440 patients had DVT symptoms (95% CI 0.02-1.80) and none had PE; 5.4% had major and 11.6% any type of bleeding complications. Major bleeding was more frequent in those with kidney disease (odds ratio [OR] 5.53), those who are bedridden (OR 5.49), those with peridural indwelling catheters (OR 4.01), and those on nonsteroidal anti-inflammatory drugs (OR 3.33). Conclusions: Enoxaparin is effective and safe in surgical patients to prevent venous thromboembolism.
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Affiliation(s)
| | - Albrecht Encke
- Chirurgische Universitätsklinik Frankfurt/Main, Frankfurt, Germany
| | - Artur-Aaron Weber
- Universitätsklinikum Düsseldorf, Klinik für Allgemeine Pädiatrie und Neonatologie, Düsseldorf, Germany
| | - Peter Bramlage
- Institut für Pharmakologie und präventive Medizin, Mahlow, Germany
| | | | - Sylvia Haas
- Institut für Experimentelle Onkologie und Therapieforschung, Technische Universität München, Germany
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Abstract
INTRODUCTION Hip fractures are the most common cause of acute admissions to orthopaedics and in the UK approximately 70,000–75,000 hip fractures occur annually. Hip fractures carry a significant risk of developing a venous thromboembolism. The National Institute for Health and Clinical Excellence (NICE) estimated that the risk of developing a venous thromboembolism in patients with hip fractures who do not receive thromboprophylaxis is 43%. In their recent guidelines, NICE recommended that combined mechanical and pharmacological thromboprophylaxis should be offered to patients undergoing hip fracture surgery and mechanical prophylaxis should be commenced at admission. The aim of this review was to search for available evidence that could support using graduated compression stockings combined with low molecular weight heparin (LMWH) in hip fracture patients. METHODS NICE guidelines and the reference list of the guidance were reviewed and a thorough literature search was performed on main electronic databases (MEDLINE®, Embase™ and the Cochrane Library). RESULTS A literature search was unable to find sufficient evidence to support the use of graduated compression stockings combined with LMWH in hip fracture settings. The guidelines are critically reviewed and the available evidence discussed. CONCLUSIONS The evidence supporting these recommendations is very limited and there is considerable concern regarding the safety and efficacy of the mechanical devices used in thromboprophylaxis. Further studies are needed urgently before specific guidelines can be agreed confidently for patients with hip fractures.
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Affiliation(s)
- A Alsawadi
- Colchester Hospital University NHS Foundation Trust, Essex, UK.
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Ciuti G, Grifoni E, Pavellini A, Righi D, Livi R, Perfetto F, Abbate R, Prisco D, Pignone AM. Incidence and characteristics of asymptomatic distal deep vein thrombosis unexpectedly found at admission in an Internal Medicine setting. Thromb Res 2012; 130:591-5. [DOI: 10.1016/j.thromres.2012.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/25/2012] [Accepted: 05/19/2012] [Indexed: 11/15/2022]
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Shimoyama Y, Sawai T, Tatsumi S, Nakahira J, Oka M, Nakajima M, Jotoku T, Minami T. Perioperative risk factors for deep vein thrombosis after total hip arthroplasty or total knee arthroplasty. J Clin Anesth 2012; 24:531-6. [PMID: 23006595 DOI: 10.1016/j.jclinane.2012.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 01/06/2012] [Accepted: 02/25/2012] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To determine the perioperative frequency of deep vein thrombosis (DVT) after lower limb joint prosthesis surgery using Doppler ultrasonography (US). DESIGN Prospective cohort study. SETTING Operating room and hospital ward. PATIENTS 144 consecutive ASA physical status 1 and 2 patients who underwent elective total hip arthroplasty (THA; n=64) or total knee arthroplasty (TKA; n= 80). INTERVENTIONS Patients were allocated to two groups, those who developed DVT (DVT group) postoperatively and those who did not (no-DVT group). To examine the perioperative risk factors for DVT after THA or TKA, comparative analysis of the two groups was done. MEASUREMENTS Doppler US was performed on all patients from the bilateral femoral to lower limb to detect the existence of DVT postoperatively. MAIN RESULTS DVT was detected in 61 patients (42%), including three proximal DVT patients (2%). Preoperative elevated plasma D-dimer value [P = 0.0131, odds ratio (OR) 1.54, 95% CI 1.10-2.17] and history of hyperlipidemia (P = 0.0453, OR 6.92, 95% CI 1.04-46.00] were significant risk factors for the onset of DVT. A preoperative plasma D-dimer cutoff value as a diagnostic test was obtained as 0.85 μg/mL. CONCLUSIONS A high preoperative plasma D-dimer value and/or history of hyperlipidemia were risk factors for DVT after THA or TKA.
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Affiliation(s)
- Yuichiro Shimoyama
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
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Sequential duplex ultrasound screening for proximal deep venous thrombosis in asymptomatic patients with acetabular and pelvic fractures treated operatively. J Trauma Acute Care Surg 2012; 72:443-7. [PMID: 22327985 DOI: 10.1097/ta.0b013e318241090d] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent evidence-based practice guidelines recommend against routine ultrasound screening for proximal deep vein thrombosis (DVT) in asymptomatic pelvic fracture patients. However, the majority of trauma surgeons favor this practice. Furthermore, the timing of screening has been inconsistently described. The purpose of this study was to examine the utility of sequential scans in asymptomatic acetabular and pelvic fracture patients treated operatively. METHODS In 2003, a screening protocol for DVT was begun for asymptomatic patients with these fractures treated operatively. Duplex ultrasound screening was used to evaluate the lower extremities for proximal DVT. Scans were to be obtained preoperatively and then postoperatively on the day before planned discharge from the hospital. A DVT prophylaxis protocol was also instituted. Between 2003 and 2007, 343 patients were identified for study. Patients were followed for thromboembolic complications for a minimum of 3 months. RESULTS Two hundred twenty-nine patients received both preoperative and postoperative scans. Of these, 35 patients (15%) had an asymptomatic DVT: 16 (7%) preoperatively and 19 (8%) postoperatively. Two patients (1%) with negative scans had a postoperative symptomatic pulmonary embolism (PE) diagnosed the day after surgery, but fatal PE did not occur. In the remaining 114 patients, 27 received a prophylactic inferior vena cava filter, 6 had a preoperative symptomatic DVT or PE before scanning, 25 received only the postoperative scan (3 being positive), and 56 were not scanned postoperatively. Of the 56 not scanned postoperatively, 2 (4%) were readmitted with a symptomatic proximal DVT but none for PE, and a fatal PE did not occur. CONCLUSIONS Despite the possible diagnostic utility of sequential duplex ultrasound screening, it does not decrease the risk of PE in acetabular and pelvic fracture patients. LEVEL OF EVIDENCE IV.
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Le Gal G, Kercret G, Ben Yahmed K, Bressollette L, Robert-Ebadi H, Riberdy L, Louis P, Delluc A, Labalette ML, Baba-Ahmed M, Bounameaux H, Mottier D, Righini M. Diagnostic value of single complete compression ultrasonography in pregnant and postpartum women with suspected deep vein thrombosis: prospective study. BMJ 2012; 344:e2635. [PMID: 22531869 PMCID: PMC3339806 DOI: 10.1136/bmj.e2635] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the safety of using single complete compression ultrasonography in pregnant and postpartum women to rule out deep vein thrombosis. DESIGN Prospective outcome study. SETTING Two tertiary care centres and 18 private practices specialising in vascular medicine in France and Switzerland. PARTICIPANTS 226 pregnant and postpartum women referred for suspected deep vein thrombosis. METHODS A single proximal and distal compression ultrasonography was performed. All women with a negative complete compression ultrasonography result did not receive anticoagulant therapy and were followed up for a three month period. MAIN OUTCOME MEASURES Symptoms of venous thromboembolism, second compression ultrasonography or chest imaging, a thromboembolic event, and anticoagulant treatment. RESULTS 16 women were excluded, mainly because of associated suspected pulmonary embolism. Deep vein thrombosis was diagnosed in 22 out of the 210 included women (10.5%). 10 patients received full dose anticoagulation despite a negative test result during follow-up. Of the 177 patients without deep vein thrombosis and who did not receive full dose anticoagulant therapy, two (1.1%, 95% confidence interval 0.3% to 4.0%) had an objectively confirmed deep vein thrombosis during follow-up. CONCLUSIONS The rate of venous thromboembolic events after single complete compression ultrasonography in pregnant and postpartum women seems to be within the range of that observed in studies in the non-pregnant population. These data suggest that a negative single complete compression ultrasonography result may safely exclude the diagnosis of deep vein thrombosis in this setting. TRIAL REGISTRATION clinicaltrials.gov NCT00740454.
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Affiliation(s)
- Grégoire Le Gal
- INSERM CIC 05-02, Centre Hospitalier Universitaire de la Cavale Blanche, Brest, France.
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Using the Risk Assessment and Predictor Tool (RAPT) for patients after total knee replacement surgery. Ann Phys Rehabil Med 2011; 55:4-15. [PMID: 22177789 DOI: 10.1016/j.rehab.2011.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 10/26/2011] [Accepted: 10/27/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to use the Risk Assessment and Predictor Tool (RAPT) to evaluate the risk of complications in patients hospitalized after total knee replacement (TKR) surgery. METHOD The medical charts of 272 patients who had TKR surgery for knee osteoarthritis (OA) were included in the study. The presurgical RAPT score and Lequesne functional pain index score were determined based on a thorough analysis of the medical charts. Complications that had an impact on the vital prognosis or knee prosthesis outcomes were reported. Patients were compared according to the RAPT and a relative risk of complications was established. RESULTS Only 12.2% of patients hospitalized in a Physical Medicine and Rehabilitation (PM&R) center after their surgery could have been discharged home directly after their initial hospital stay for TKR surgery (score RAPT more than 9). These patients were mostly men and significantly younger. Their Lequesne score was significantly lower by an average of at least two points. Their relative risk of complications was 0.45 vs. 2.16 for patients who had a RAPT score less than 6. CONCLUSION Patients with a RAPT score more than 9 have a low risk of complications. They should not systematically be admitted to a PM&R unit after surgery. On the other hand, for patients with a RAPT score less than 6 a hospital stay in a PM&R care center is justified after TKR surgery.
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