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Liu Z, Han N, Xu H, Fu Z, Zhang D, Wang T, Jiang B. Incidence of venous thromboembolism and hemorrhage related safety studies of preoperative anticoagulation therapy in hip fracture patients undergoing surgical treatment: a case-control study. BMC Musculoskelet Disord 2016; 17:76. [PMID: 26873584 PMCID: PMC4752756 DOI: 10.1186/s12891-016-0917-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/02/2016] [Indexed: 12/02/2022] Open
Abstract
Background Venous thromboembolism is a common postoperative complication following orthopedic surgeries, with morbid and potentially fatal consequences. Perioperative low-molecular-weight heparin (LMWH) therapy can reduce the incidence of venous thromboembolism, but may also increase the risk of bleeding complications. Current literature reflects the need to balance the improved efficacy of early initiating prophylaxis with increased risk of perioperative bleeding. The purpose of this study was to compare the effectiveness and hemorrhage related safety of preoperative versus postoperative LMWH therapy for prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in hip fracture patients. Methods We retrospectively evaluated 222 patients who underwent surgical treatment at Peking University People's Hospital between January 2009 and December 2010. Patients were allocated to two groups, receiving either preoperative or postoperative initiation of LMWH therapy for venous thromboembolism prophylaxis. Preoperative anticoagulation therapy was initiated 1–12 days prior to surgery (133 patients), and postoperative anticoagulation therapy was initiated 12 h after completion of surgery (89 patients). The preoperative group was further subdivided into four subgroups according to the time of initiation of therapy: 1–3 days before surgery (group A, 54 patients), 4–6 days before surgery (group B, 57 patients), 7–9 days before surgery (group C, 15 patients), and 10–12 days before surgery (group D, 7 patients). Occurrences of DVT, PE, adverse drug effects, intraoperative and postoperative bleeding were recorded, along with concentrations of preoperative and postoperative hemoglobin and length of hospital stay. The above parameters were compared between groups. Results Among recipients of preoperative anticoagulation therapy, two patients developed postoperative PE (1.5 %), one patient developed DVT (0.75 %). In the group receiving postoperative initiation of anticoagulation therapy, one patient each developed PE and DVT (1.1 %, 1.1 %). There was no difference in the occurrence of PE and DVT between the two groups (P>0.05, Chi-square tests). We identified the incidences of major bleeding, minor bleeding, and intraspinal hematoma after spinal anesthesia, which were 0 %/0 %, 3.76 %/3.37 %, and 0 %/0 %, respectively in preoperative and postoperative anticoagulation groups. There was no significant difference in the incidence of bleeding complications between patients receiving preoperatively initiated LMWH with patients receiving postoperatively initiated LMWH. Spinal anesthesia was administered to 168 patients, with no cases of postoperative intraspinal hematoma. Conclusions Preoperative anticoagulation therapy with LMWH may not increase intraoperative or postoperative blood loss, or the rate of intraspinal hematoma after spinal anesthesia, but also does not significantly reduce the risk of postoperative DVT or PE, compared to postoperative initiation.
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Affiliation(s)
- Zhongdi Liu
- Department of Trauma and Orthopedics, People's Hospital, Peking University, South Xizhimen Street No.11, Xicheng District, 100044, Beijing, China
| | - Na Han
- Department of Trauma and Orthopedics, People's Hospital, Peking University, South Xizhimen Street No.11, Xicheng District, 100044, Beijing, China
| | - Hailin Xu
- Department of Trauma and Orthopedics, People's Hospital, Peking University, South Xizhimen Street No.11, Xicheng District, 100044, Beijing, China.
| | - Zhongguo Fu
- Department of Trauma and Orthopedics, People's Hospital, Peking University, South Xizhimen Street No.11, Xicheng District, 100044, Beijing, China
| | - Dianying Zhang
- Department of Trauma and Orthopedics, People's Hospital, Peking University, South Xizhimen Street No.11, Xicheng District, 100044, Beijing, China
| | - Tianbing Wang
- Department of Trauma and Orthopedics, People's Hospital, Peking University, South Xizhimen Street No.11, Xicheng District, 100044, Beijing, China
| | - Baoguo Jiang
- Department of Trauma and Orthopedics, People's Hospital, Peking University, South Xizhimen Street No.11, Xicheng District, 100044, Beijing, China.
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Farquhar-Smith P, Chapman S. Neuraxial (epidural and intrathecal) opioids for intractable pain. Br J Pain 2012; 6:25-35. [PMID: 26516463 PMCID: PMC4590095 DOI: 10.1177/2049463712439256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
1. Neuraxial opioids are considered for use in patients who have resistant intractable pain that fails to respond to other treatment options or pain that responds to analgesia but for which the doses required result in unacceptable side-effects. 2. Neuraxial opiods can be considered for both chronic non-malignant pain and chronic cancer-related pain. 3. Effectiveness in chronic non-malignant pain and cancer pain is exerted through the use of either single-agent drugs (opioids) or a combination of drugs: opioids, local anaesthetics and other drugs such as clonodine and ziconotide. 4. Complications of long-term continuous infusion therapy are related to the insertion process (haematoma), the mechanical device (both pump and catheter) and the long-term effects of the drugs. 5. Patients will require ongoing ambulatory monitoring and supportive care.
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Bang SM, Jang MJ, Oh D, Kim YK, Kim IH, Yoon SS, Yoon HJ, Kim CS, Park S. Korean guidelines for the prevention of venous thromboembolism. J Korean Med Sci 2010; 25:1553-9. [PMID: 21060742 PMCID: PMC2966990 DOI: 10.3346/jkms.2010.25.11.1553] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/05/2010] [Indexed: 11/20/2022] Open
Abstract
This guideline focuses on the primary prevention of venous thromboembolism (VTE) in Korea. The guidelines should be individualized and aim at patients scheduled for major surgery, as well as patients with a history of trauma, high-risk pregnancy, cancer, or other severe medical illnesses. Currently, no nation-wide data on the incidence of VTE exist, and randomized controlled trials aiming at the prevention of VTE in Korea have yielded few results. Therefore, these guidelines were based on the second edition of the Japanese Guidelines for the Prevention of VTE and the eighth edition of the American College of Chest Physicians (ACCP) Evidenced-Based Clinical Practice Guidelines. These guidelines establish low-, moderate-, and high-risk groups, and recommend appropriate thromboprophylaxis for each group.
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Affiliation(s)
- Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon Ju Jang
- Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea
| | - Doyeun Oh
- Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea
| | - Yeo-Kyeoung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - In Ho Kim
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Hwi-Joong Yoon
- Department of Hematology-Oncology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chul-Soo Kim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seonyang Park
- Department of Internal Medicine, Seoul National University, Seoul, Korea
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Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of Venous Thromboembolism. Chest 2008; 133:381S-453S. [PMID: 18574271 DOI: 10.1378/chest.08-0656] [Citation(s) in RCA: 2868] [Impact Index Per Article: 179.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- William H Geerts
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Graham F Pineo
- Foothills Hospital, University of Calgary, Calgary, AB, Canada
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Pasero C, McCaffery M. Orthopaedic Postoperative Pain Management. J Perianesth Nurs 2007; 22:160-72; quiz 172-3. [PMID: 17543801 DOI: 10.1016/j.jopan.2007.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 02/23/2007] [Indexed: 10/23/2022]
Abstract
Severe postoperative pain is common following orthopaedic surgery, and its safe and effective management can be challenging for everyone on the health care team. There are a variety of methods used to address orthopaedic postoperative pain and all incorporate the principles of multimodal analgesia. The purpose of this article is to provide an overview of the primary methods used to manage orthopaedic pain and describe the perianesthesia nurse's role in the administration of them.
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Buckenmaier CC, Shields CH, Auton AA, Evans SL, Croll SM, Bleckner LL, Brown DS, Stojadinovic A. Continuous peripheral nerve block in combat casualties receiving low-molecular weight heparin. Br J Anaesth 2006; 97:874-7. [PMID: 17032662 DOI: 10.1093/bja/ael269] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Continuous peripheral nerve block (CPNB) is an important therapeutic tool in the anaesthetic and analgesic management of combat casualties at Walter Reed Army Medical Center (WRAMC). We describe our experience using CPNB techniques in combat trauma patients treated with low-molecular weight heparin (LMWH). Guidelines used at our institution for managing CPNB catheters in patients being treated with LMWH are introduced. METHODS From March 2003 to April 2005, 187 combat casualties treated by the WRAMC regional anaesthesia/acute pain section using CPNB were evaluated retrospectively by electronic chart review. Patient characteristic data, CPNB type, duration of CPNB, indication for LMWH [enoxaparin sodium injection (Lovenox-Sanofi Aventis, Bridgewater, NJ, USA)], enoxaparin dose (mg) before and after catheter insertion and removal, time from CPNB placement and removal to enoxaparin dose, and complications were recorded. RESULTS Median enoxaparin dose and time given before catheter insertion were 30 mg and 21 h, respectively. Median enoxaparin dose was also 30 mg given a median of 12 h after peripheral nerve catheter placement. Catheters remained in situ for a median of 8 days (range 1-33 days). Catheter specific complications were infrequent and identified in 7 (3.7%) patients (two catheter malfunction-kinking, catheter tip dislodgement in situ, two superficial catheter site infections and two catheter dislocations). There were no catheter-related bleeding complications evident in this study. CONCLUSIONS Information regarding the safety of CPNB in patients treated with LMWH for perioperative venous thromboembolism prevention is scarce. Our initial experience with CPNB and concurrent LMWH has not been complicated by catheter-related bleeding.
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Affiliation(s)
- C C Buckenmaier
- Army Regional Anesthesia and Pain Management Initiative, Anesthesia and Operative Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
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