A Multivariate Pattern Recognition Study of Risk-Factors Indicating Postoperative Thromboembolism Despite Low-Dose Heparin in Major Abdominal Surgery

Kjærgaard, J; Esbensen, Kim H.; Wille‐Jørgensen, Peer; Jørgensen, Torben; Thorup, Jørgen; Berning, H; Wold, Svante

doi:10.1055/s-0038-1657750

Cited by 9 publications

(4 citation statements)

References 5 publications

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“…Various methods of prophylaxis may be employed but no method completely protects against VTE [ 35 ]. LMWH is the current standard by which other chemical agents are compared.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery

Calder

Freeman

Domeij-Arverud

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Purpose To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and ankle surgery and propose guidelines for VTE prevention in this group of patients.MethodsFollowing a PRISMA compliant search, 372 papers were identified and meta-analysis performed on 22 papers using the Critical Appraisal Skills Programme and Centre for Evidence-Based Medicine level of evidence.Results 43,381 patients were clinically assessed for VTE and the incidence with and without chemoprophylaxis was 0.6 % (95 % CI 0.4–0.8 %) and 1 % (95 % CI 0.2–1.7 %), respectively. 1666 Patients were assessed radiologically and the incidence of VTE with and without chemoprophylaxis was 12.5 % (95 % CI 6.8–18.2 %) and 10.5 % (95 % CI 5.0–15.9 %), respectively. There was no significant difference in the rates of VTE with or without chemoprophylaxis whether assessed clinically or by radiological criteria. The risk of VTE in those patients with Achilles tendon rupture was greater with a clinical incidence of 7 % (95 % CI 5.5–8.5 %) and radiological incidence of 35.3 % (95 % CI 26.4–44.3 %).ConclusionIsolated foot and ankle surgery has a lower incidence of clinically apparent VTE when compared to general lower limb procedures, and this rate is not significantly reduced using low molecular weight heparin. The incidence of VTE following Achilles tendon rupture is high whether treated surgically or conservatively. With the exception of those with Achilles tendon rupture, routine use of chemical VTE prophylaxis is not justified in those undergoing isolated foot and ankle surgery, but patient-specific risk factors for VTE should be used to assess patients individually.Level of evidenceII.

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“…Various methods of prophylaxis may be employed but no method completely protects against VTE [ 35 ]. LMWH is the current standard by which other chemical agents are compared.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery

Calder

Freeman

Domeij-Arverud

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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“…Despite appropriate prophylaxis with low-dose heparin therapy, in the general surgical population there is an 8% to 10% risk of developing DVT. 19,20 This observation suggests that PCDs may be indicated in addition to giving pharmacologic therapy to increase the efficacy of prophylaxis. Current recommendations by the manufacturer for the placement of intermittent compression devices recommend placement only when no DVT is present.…”

Section: Discussionmentioning

confidence: 99%

Screening for asymptomatic deep vein thrombosis in surgical intensive care patients

Harris¹,

Curl²,

Booth³

et al. 1997

Journal of Vascular Surgery

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“…The incidence of VTE in patients following abdominopelvic surgery ranges from 3.1% to 3.6% [3,4]. Colorectal surgery carries a disproportionately higher risk of postoperative VTE compared with other general surgery specialities [5,6]. In patients with inflammatory bowel disease (IBD), the risk of VTE associated with colorectal surgery is increased by 1.5-to 3.5-fold [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Extended thromboprophylaxis following colorectal surgery in patients with inflammatory bowel disease: a comprehensive systematic clinical review

et al. 2019

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Aim Patients with inflammatory bowel disease (IBD) are at increased risk of postoperative venous thromboembolism (VTE) following major abdominal surgery. The pathogenesis is multifactorial and not fully understood. A combination of pathophysiology, patient and surgical risk factors increase the risk of postoperative VTE in these patients. Despite being at increased risk, IBD patients are not regularly prescribed extended pharmacological thromboprophylaxis following colorectal surgery. Currently, there is a paucity of evidence‐based guidelines. Thus, the aim of this review is to evaluate the role of extended pharmacological thromboprophylaxis in IBD patients undergoing colorectal surgery. Method A search of Ovid Medline, EMBASE and PubMed databases was performed. A qualitative analysis was performed using 10 clinical questions developed by colorectal surgeons and a thrombosis haematologist. The Newcastle–Ottawa Scale was utilized to assess the quality of evidence. Results A total of 1229 studies were identified, 38 of which met the final inclusion criteria (37 retrospective, one case–control). Rates of postoperative VTE ranged between 0.6% and 8.9%. Patient‐specific risk factors for postoperative VTE included ulcerative colitis, increased age and obesity. Surgery‐specific risk factors for postoperative VTE included open surgery, emergent surgery and ileostomy creation. Patients with IBD were more frequently at increased risk in the included studies for postoperative VTE than patients with colorectal cancer. The risk of bias assessment demonstrated low risk of bias in patient selection and comparability, with variable risk of bias in reported outcomes. Conclusion There is a lack of evidence regarding the use of extended pharmacological thromboprophylaxis in patients with IBD following colorectal surgery. As these patients are at heightened risk of postoperative VTE, future study and consideration of the use of extended pharmacological thromboprophylaxis is warranted.

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A Multivariate Pattern Recognition Study of Risk-Factors Indicating Postoperative Thromboembolism Despite Low-Dose Heparin in Major Abdominal Surgery

Cited by 9 publications

References 5 publications

Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery

Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery

Screening for asymptomatic deep vein thrombosis in surgical intensive care patients

Extended thromboprophylaxis following colorectal surgery in patients with inflammatory bowel disease: a comprehensive systematic clinical review

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