Extended thromboprophylaxis with low-molecular-weight heparins after hospital discharge in high-risk surgical and medical patients: A review

Huo, Michael H.; Muntz, James E.

doi:10.1016/j.clinthera.2009.06.002

Cited by 70 publications

(45 citation statements)

References 50 publications

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“…121 Extended-duration prophylaxis with LMWH can reduce relative VTE risk by ~60%; however, there has often been concern that their subcutaneous administration could potentially reduce patients' overall satisfaction and adherence to treatment, and hence their ability to prevent VTE effectively. 75,76,122,123 Recent data suggests injection of treatment is not a barrier to patient compliance, particularly for injectable anticoagulants that are only administered once daily compared to multiple times a day. 124,125 Novel oral agents (NOA) on the other hand are convenient to administer and study data suggest they are at least as effective as LMWH against VTE, and in some cases up to 30% to 60% more effective.…”

Section: Anticoagulant Safety and Efficacymentioning

confidence: 99%

“…In particular, extending thromboprophylaxis beyond the first fourteen days after surgery can reduce relative VTE risk by approximately 50% to 70%, compared to employing thromboprophylaxis for fourteen days or less. 51,68,[75][76][77][78]93 …”

Section: Other Influencing Factorsmentioning

confidence: 99%

“…68 Several reviews have estimated that pharmacological prophylaxis reduces relative VTE incidence (symptomatic and asymptomatic) by 50% to 70%, and potentially up to 85%. [75][76][77][78] Extrapolating these two findings, we can estimate that the contemporary baseline VTE risk following arthroplasty is 2.9% within the first 7 to 14 days following surgery.…”

mentioning

confidence: 99%

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Thromboprophylaxis following hip and knee arthroplasty

Mirkazemi

Bereznicki

Peterson

2013

Internal Medicine Journal

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Aim To determine local thromboprophylaxis prescribing practices following arthroplasty. Methods A retrospective review was performed of 300 consecutive hip and knee arthroplasty patients (150 each) over a 2‐year period at Tasmania's major public hospital. The provision of thromboprophylaxis, the presence of bleeding/thrombotic risk factors and the prevalence of symptomatic venous thromboembolism (VTE) and major bleeding occurring within 90 days postoperatively were documented. Results The mean age of the 300 patients (169 females, 131 males) was 68.7 years (standard deviation 10.4). Only 11.3% of knee arthroplasty and 16.7% of hip arthroplasty inpatients had mechanical thromboprophylaxis documented during their stay. All inpatients received pharmacological thromboprophylaxis, predominantly injectable anticoagulants (98.4%). Only 36.5% continued to receive pharmacological thromboprophylaxis following discharge, predominantly an antiplatelet agent (55.5%). The 90‐day incidence of symptomatic VTE was 2.7% (95% confidence interval: 1.0–5.0%); 4.0% (95% confidence interval: 1.0–8.0%) for knees and 1.3% (95% confidence interval: 0–5.0%) for hips. The in‐hospital and post‐discharge VTE incidence was 0.7% and 2.0% respectively. All readmissions for VTE occurred within 1 month of surgery. Conclusions While inpatient thromboprophylaxis was routine, it generally was not continued on discharge, potentially leaving many patients exposed to a higher risk of VTE. Most cases of symptomatic VTE occurred after discharge, with the majority requiring readmission to hospital under medical units.Within the limitations of a retrospective study, these findings suggest a need for further research and discussion regarding what constitutes appropriate thromboprophylaxis (type, agent and duration) following hip or knee arthroplasty.

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Section: Anticoagulant Safety and Efficacymentioning

confidence: 99%

Section: Other Influencing Factorsmentioning

confidence: 99%

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Thromboprophylaxis following hip and knee arthroplasty

Mirkazemi

Bereznicki

Peterson

2013

Internal Medicine Journal

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“…Our previously published article showed that 34.6 % of patients with PE and 29.3 % of patients with DVT after colorectal surgery will be diagnosed after discharge [1]. Extension of VTE prophylaxis to the post-discharge period in high-risk patients has been suggested in previous studies as well as in American Society of Colon and Rectal Surgeons and the American Society of Clinical Oncology guidelines [1,[12][13][14][15]. A previously published article showed a reverse correlation between scores on DVT prophylaxis process measures and the identification of VTE [16].…”

Section: Introductionmentioning

confidence: 99%

Post‐Hospital Discharge Venous Thromboembolism in Colorectal Surgery

et al. 2016

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Background There are limited data regarding the criteria for prophylactic treatment of venous thromboembolism (VTE) after hospital discharge. We sought to identify risk factors of post-hospital discharge VTE events following colorectal surgery.Methods The NSQIP database was utilized to examine patients developed VTE after hospital discharge following colorectal surgery during [2005][2006][2007][2008][2009][2010][2011][2012][2013]. Multivariate analysis using logistic regression was performed to quantify risk factors of VTE after discharge.Results We evaluated a total of 219,477 patients underwent colorectal resections. The overall incidence of VTE was 2.1 % (4556). 33.8 % (1541) of all VTE events occurred after hospital discharge. The length of postoperative hospitalization had a strong association with post-discharge VTE, with the highest risk in patients who were hospitalized for more than 1 week after operation (AOR 9.08, P\0.01). Other factors associated with post-discharge VTE included chronic steroid use (AOR 1.81, P\0.01), stage 4 colorectal cancer (AOR 1.40, P = 0.03), obesity (AOR 1.37, P\0.01), age[70 (AOR 1.21, P = 0.04), and open surgery (AOR 1.36, P\0.01). Patients who were hospitalized for more than 1 week after an open colorectal resections had a 12 times higher risk of post-discharge VTE event compared to patients hospitalized less than 4 days after a laparoscopic resection (AOR 12.34, P\0.01).Conclusions VTE is uncommon following colorectal resections; however, a significant proportion occurs after patients are discharged from the hospital (33.8 %). The length of postoperative hospitalization appears to have a strong association with post-discharge VTE. High-risk patients may benefit from continued VTE prophylaxis after discharge.

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“…16 Furthermore, although analyses specific to abdominopelvic surgery are lacking, a review examining the cost-effectiveness of extended-duration thromboprophylaxis compared with standard-duration thromboprophylaxis among orthopedic patients notes prolonged thromboprophylaxis to be cost-effective with increased pharmacy costs being offset by reductions in venous thromboembolism and the associated costs of hospitalization. 17 Collectively, these data have prompted generalizations regarding the duration of thromboprophylaxis among all patients undergoing surgery for malignancy; however, until now, there have been insufficient data with regard to the true incidence of postoperative venous thromboembolism among patients undergoing laparoscopy for gynecologic malignancy. Furthermore, although our study was not established to determine the efficacy of various forms of thromboprophylaxis, the low postoperative incidence of venous thromboembolism in both cancer and noncancer populations suggests the use of intermittent pneumatic compression along with early ambulation is sufficient in preventing clinically overt venous thromboembolism among patients undergoing minimally invasive surgery of at least low or intermediate complexity.…”

Section: Discussionmentioning

confidence: 97%