Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

Akpınar, Evrim Eylem; Hoşgün, Derya; Akan, Burak; Ateş, Can; Gülhan, Meral

doi:10.1590/s1806-37132013000300004

Cited by 22 publications

(39 citation statements)

References 16 publications

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“…9 Accordingly, the benefits of prophylaxis in older adult orthopedic surgical populations have also been consistently noted. 30 Our results suggest that this effect of age on the risk of VTE also applies to the pediatric population, a finding which is also consistent with several previous reports. 3, 5, 6, 10 Interestingly, the 2012 recommendations from the American College of Chest Physicians on the prevention of VTE in orthopedic surgery patients state that even though increasing age is associated with VTE, in general, surgery-specific risks outweigh patient specific factors.…”

Section: Discussionsupporting

confidence: 93%

Incidence of Deep Vein Thrombosis and Pulmonary Embolism in the Elective Pediatric Orthopaedic Patient

Georgopoulos¹,

Hotchkiss

McNair

et al. 2016

Journal of Pediatric Orthopaedics

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Background Although venous thromboembolism has been well studied in the pediatric trauma population, rates of VTE associated with elective pediatric orthopaedic procedures have not been addressed in current literature. The purpose of this retrospective study was to identify the incidence of venous thromboembolism (VTE) in the elective pediatric orthopaedic surgical population and delineate subsets of this population at greatest risk. This study may provide valuable data to begin the process of resolving the controversy surrounding DVT prophylaxis in the pediatric orthopaedic population. Methods The Pediatric Health Information System (PHIS) was queried for patients admitted on an ambulatory or inpatient basis aged <18 years from 1/2006 to 3/2011 during which an elective orthopaedic surgery was the principal procedure performed. Patients with diagnoses or procedures related to infection, trauma, malignancy, or coagulopathies were excluded. Patients admitted through the emergency department (ED) or whose orthopedic procedure was not performed on the admission date were excluded. Age, gender, ethnicity, race, admission year, and all procedures/diagnoses were recorded. The presence of VTE at the index admission or any subsequent readmission within 90 days was recorded. All criteria were coded using ICD-9-CM codes. Generalized logistic regression analyses were used to identify factors related to VTE. Results 143,808 admissions (117,676 patients) matched the inclusion criteria. 33 had a VTE during the index admission with an additional 41 at subsequent readmissions, for a total incidence of 0.0515% by admission and 0.0629% by patient. In the multivariable model, variables significantly [p<0.05] related to VTE included increasing age, admission type, diagnosis of metabolic conditions, obesity, and/or syndromes, and complications of implanted devices and/or surgical procedures. No procedure variables were significantly related to VTE in the multivariable model. Conclusions The incidence of VTE in this cohort of pediatric patients undergoing elective orthopaedic surgery was 0.0515%. In children, underlying diagnosis appears to be a stronger predictor of VTE than procedures performed. Diagnosis with a metabolic condition, syndrome, and/or obesity, complications of implanted devices and/or surgical procedures, older age, and admission as an inpatient were significantly related to the development of a VTE. Level of Evidence Level II; Retrospective prognostic study

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Section: Discussionsupporting

confidence: 93%

Incidence of Deep Vein Thrombosis and Pulmonary Embolism in the Elective Pediatric Orthopaedic Patient

Georgopoulos¹,

Hotchkiss

McNair

et al. 2016

Journal of Pediatric Orthopaedics

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“…After screening title/abstract and full‐text information, 728 were excluded because of duplicated publications, and 1610 were excluded because the data they provided was not available or unrelated to our topic. Finally, 23 articles that met the inclusion criteria were included in this meta‐analysis . The flow chart of the search strategy is shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

“…All studies reported data on the incidence of VTE . The pooled estimates, using a random‐effect model, indicated that the incidence of VTE in patients who underwent surgery for fractures below the hip was 21% (95%CI: 17%, 24%; P = 0·000) (Figure ).…”

Section: Resultsmentioning

confidence: 99%

Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta‐analysis

Tan

et al. 2016

International Wound Journal

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Venous thromboembolism (VTE) is a common complication after surgical treatment of fractures, which is associated with significant morbidity and mortality. Identifying the risk factors for VTE is important for preventive strategies to reduce the incidence of VTE. Therefore, we conducted a meta-analysis to evaluate the incidence of VTE and the risk factors influencing the development of VTE in patients who underwent surgery for fractures below the hip. PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China) and CNKI (National Knowledge Infrastructure, China) databases were systematically searched to identify cohort or case-control studies that investigated the incidence and risk factors for VTE following surgical treatment of fractures below the hip. VTE risk ratios (RRs) were pooled by use of a fixed-effect model or a random-effect model, depending on the heterogeneity among the included studies. Heterogeneity between the studies was assessed by I statistics. Twenty-three studies with a total of 191 294 patients who met the inclusion criteria were included in this meta-analysis. Our results demonstrated that age (≥60 years) (RR = 1·85, 95% confidence interval (CI): 1·34, 2·55; P = 0·000), previous VTE(RR = 5·25, 95% CI: 2·77, 9·96; P = 0·000), heart failure (RR = 1·74, 95% CI: 1·34, 2·27; P = 0·000), current smoking status (RR = 1·23, 95% CI: 1·07, 1·41; P = 0·004), hypertension (RR = 1·62, 95% CI: 1·27, 2·06; P = 0·000), hyperlipidaemia (RR = 2·16, 95% CI: 1·79, 2·62; P = 0·000), diabetes mellitus (RR = 1·46, 95% CI: 1·27, 1·68; P = 0·000), obesity (RR = 1·58, 95% CI: 1·35,·1·85; P = 0·000), multiple fractures (RR = 2·14, 95% CI: 1·00, 4·60; P = 0·050), varicose veins (RR = 3·07, 95% CI: 1·12, 8·47; P = 0·030), prolonged operation time (weighted mean differences (WMD) = 1·22, 95% CI: 0·63, 1·81; P = 0·000) and prolonged bed rest time (WMD = 3·12, 95% CI: 2·96, 3·29; P = 0·000) were associated with an increased risk of developing VTE. The other variables, including age (<60 years), previous smoking, immobility, pregnancy, cancer, open fractures and combination with trauma were not identified as significant risk factors for VTE. Almost all the risk factors mentioned above are in line with the known risk factors for VTE following surgery for fractures below the hip. Thus, surgeons should pay close attention to patients with these medical conditions in order to reduce the incidence of VTE following surgical treatment of fractures below the hip.

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“…As a kind of mild thrombosis, thrombosis of calf muscular veins requires proper treatment during each section of the perioperative period. 4,5 As seen in our case, calf muscular venous thrombosis is not constant and might ascend to involve the thigh, even the common iliac vein with the increased duration of bed rest and performance of surgery. This may deteriorate the patient condition and cause life-threatening complications.…”

Section: Discussionmentioning

confidence: 46%

“…Besides, the coagulation function was regularly checked and the dose of warfarin was adjusted according to the international normalized ratio. [3][4][5] On the 11 th day after surgery, the edema of the left lower limb was alleviated, nevertheless, color Doppler ultrasonography indicated that thrombosis has ascended to the left common iliac vein and external iliac vein. Considering the elevation of the thrombosis level, a filter was placed in the inferior vena cava the same day (Fig.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Perioperative treatment of femoral neck fracture with deep venous thrombosis: A case report

Liu

Лю

Huang

et al. 2015

Chinese Journal of Traumatology

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Deep venous thrombosis (DVT) is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice. Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery. Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken. The condition of the patient was stable during the perioperative period and the surgery was successful. Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory. Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.

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Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

Cited by 22 publications

References 16 publications

Incidence of Deep Vein Thrombosis and Pulmonary Embolism in the Elective Pediatric Orthopaedic Patient

Incidence of Deep Vein Thrombosis and Pulmonary Embolism in the Elective Pediatric Orthopaedic Patient

Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta‐analysis

Perioperative treatment of femoral neck fracture with deep venous thrombosis: A case report

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