Incidence of venous thromboembolism among patients who underwent major surgery in a public hospital in Singapore

Abstract

Abstrak AbstractBackground: Venous thromboembolism (VTE) is a fatal yet potentially preventable complication of surgery. Routine thromboprophylaxis is still unequivocal prescription is problematic due to perception of low VTE incidence among Asian population. This study aims to investigate the incidence of VTE and thromboprophylaxis prescription among patients undergoing major surgery in a Singapore hospital.Methods: This was a cross-sectional study. Data were obtained from medical record of 1,103 patients who had underwent major orthopaedic or abdominal surgery in 2011-2012 at Khoo Teck Puat Hospital, Singapore. Incidence of VTE events either in the same admission or re-admission in less than one month time were noted as study parameters.Results: Incidence of VTE was 2.1% (95% CI: 1.67 -2.53) of which 1.3% and 0.8% were DVT and PE cases respectively. Age, gender, history of VTE, ischemic heart disease, and mechanical prophylaxis were associated with VTE incidence based on bivariate analysis. The prescription of pharmacological thromboprophylaxis was associated with prior anticoagulant medication, type of surgery, and incidence of new bleeding.Conclusion: Subsequent to major surgeries, VTE is as common in Asian patients as published data in other populations. Pharmacologic thromboprophylaxis should be considered as recommended in non-Asian guidelines.

Laboratory findings of postoperative venous thromboembolism (VTE) in Dr. Sardjito General Hospital, Yogyakarta

“…This result is consistent with a previous cross-sectional study that reported a VTE incidence of 2.1% among patients who underwent major orthopaedic or abdominal surgery, with DVT and PE accounting for 1.3% and 0.8% of cases, respectively. 5 On patients with acute medical illness in Indonesia, the rate of DVT was 37 -40%. 4 Another Asian study revealed that after total knee replacement and total hip replacement, the incidence of asymptomatic DVT was 17 and 24%, respectively, which is comparatively lower than the incidence rates of 36-84% in Western populations.…”

“…In their report, DVT and PE accounted for 1.3% and 0.8% of cases. 5 Virchow's triad, comprising venous stasis, blood hypercoagulability, and vascular wall injury, is the basis for venous thrombosis. There are some risk factors contribute for DVT, which can be provoked or unprovoked, transient or persistent.…”

Prevalence and risk factors of venous thromboembolism in postoperative patients: A retrospective study

“…Another study in India indicated that 16.3% of the operated patient group received thromboprophylaxis. Of the patients in a study conducted in England, 37% received thromboprophylaxis 8,19. The multicenter study conducted VTE risk and prophylaxis use among operated and internal disease patients in 32 countries; prophylaxis was used in 58.5% of the patients who were operated and had VTE risk 7…”

“…VTE causes pulmonary embolism, which accounts for the vast majority of hospital deaths. VTE causing death can also be prevented at the same time 1,2,19. However, we were unable to find a summary examining postoperative VTE prevalence in all Turkey.…”

“…In one study examining the VTE incidence following the vascular surgery in Turkey, the VTE incidence was found to be 1.75% 11. Studies related to VTE incidence following various operations were found in USA and in Asian countries, for example, Singapore and India;12-19 the VTE incidence rate ranged between 5/10,000 and 13% in these studies. In two studies conducted in Australia and Spain, postoperative VTE prevalence was found to be 1.8-2‰ 20,21.…”