Low Molecular Weight Heparins and External Pneumatic Compression as Options for Venous Thromboembolism Prophylaxis: A Surgeon's Perspective

Caprini, Joseph A.; Arcelus, Juan I.; Traverso, Clara I.; Hasty, J H

doi:10.1055/s-2007-1002635

Cited by 94 publications

(89 citation statements)

References 54 publications

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“…The AHRQ outlines methods for quality improvement, including the development of risk assessment tools; however, no such validated tool exists for EGS patients . For elective surgical patients, the Caprini and Rogers scores (Table 3) are 2 of the most commonly accepted risk assessment tools in medical and surgical patients. Attempting to apply these risk assessment tools is problematic in patients who are not undergoing elective surgery or who are admitted to a surgical service but treated nonoperatively.…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism Prevention in Emergency General Surgery

et al. 2018

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Despite the substantial number of annual EGS admissions, little is known about the risk of VTE or the use of mechanical and/or pharmacologic prophylaxis in EGS patients. Furthermore, although guidelines for VTE prophylaxis are available, 10,11 they are difficult to interpret in the context of admission to an EGS service for an acute condition, particularly when admissions to such services include as many as 70% of patients who do not require operative intervention. 9 The purpose of this narrative review is to apply the existing literature on VTE prophylaxis to this challenging group of EGS patients and offer recommendations using the best available evidence. MethodsWe performed an electronic literature search of MEDLINE, EMBASE, and the Cochrane Database of Collected Reviews from January 1, IMPORTANCE Venous thromboembolism (VTE) is the most preventable cause of morbidity and mortality in US hospitals, and approximately 2.5% of emergency general surgery (EGS) patients will be diagnosed with a VTE event. Emergency general surgery patients are at increased risk of morbidity and mortality because of the nature of acute surgical conditions and the challenges related to prophylaxis.OBSERVATIONS MEDLINE, Embase, and the Cochrane Database of Collected Reviews were searched from January 1, 1990, through December 31, 2015. Nearly all operatively and nonoperatively treated EGS patients have a moderate to high risk of developing a VTE, and individual risk should be assessed at admission. Pharmacologic prophylaxis in the form of unfractionated or low-molecular-weight heparin should be considered unless an absolute contraindication, such as bleeding, exists. Patients should receive the first dose at admission to the hospital, and administration should continue until discharge without missed doses. Certain patient populations, such as those with malignant tumors, may benefit from prolonged VTE prophylaxis after discharge. Mechanical prophylaxis should be considered in all patients, particularly if pharmacologic prophylaxis is contraindicated. Studies that specifically target improved adherence with VTE prophylaxis in EGS patients suggest that efficacy and quality improvement initiatives should be undertaken from a system and institutional perspective.CONCLUSIONS AND RELEVANCE Operatively and nonoperatively treated EGS patients are at a comparatively high risk of VTE. Despite gaps in existing literature with respect to this increasing patient population, successful best practices can be applied. Best practices include assessment of VTE risk, optimal prophylaxis, and physician, nurse, and patient education regarding the use of mechanical and pharmacologic VTE prophylaxis and institutional policies.

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Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism Prevention in Emergency General Surgery

et al. 2018

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“…1 ) based loosely on the Caprini model proposed for surgical patients. 23 The purpose of this study is to evaluate the effectiveness of this chemoprophylaxis protocol in a cohort of patients undergoing knee arthroscopy.…”

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confidence: 99%

Incidence of Venous Thromboembolism following Knee Arthroscopy: Effectiveness of a Risk-Based Stratified Chemoprophylaxis Protocol

et al. 2020

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The incidence of symptomatic venous thromboembolism (VTE) has been reported in up to 10.9% of patients undergoing knee arthroscopy without chemoprohylaxis. The purpose of this study was to evaluate the effectiveness of a chemoprophylaxis protocol in patients undergoing knee arthroscopy. A retrospective review of prospectively enrolled patients in a new institutional VTE prophylaxis protocol identified all patients undergoing knee arthroscopy during a 5-year period. This risk-based chemoprophylaxis protocol was instituted based on the Caprini model: patients at more than minimal risk were prescribed enoxaparin 40 mg daily for 3 weeks, while all others were instructed to take aspirin 325 mg twice daily. The primary outcome measure was incidence of VTE within 60 days postoperatively. Demographic characteristics and other risk factors for VTE were also recorded, as well as any postoperative complications. Among the 1,276 knee arthroscopies, there were 26 VTE events (2.0%), including 23 with deep vein thrombosis (DVT), two pulmonary emboli (PE), and one patient with both DVT and PE. There were no deaths or complications requiring hospitalization or reoperation. The VTE diagnosis occurred at, on average, 9 days postoperatively. Patients in the high-risk group treated with enoxaparin had a lower VTE incidence (1.49%) than those instructed to take aspirin (2.0%); p = 0.75. Those undergoing an anterior cruciate ligament (ACL) reconstruction had the highest VTE incidence (2.87%). This study found that a chemoprophylaxis protocol with preferential use of aspirin or low–molecular weight heparin based on risk factors reduced the VTE incidence below to 2.0%, which is lower than most historical controls.

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“…Studies using the Autoar scale showed that it was the most effective at warning the risk of perioperative DVT in patients with bone trauma and could reduce the incidence of VTE in patients with perioperative trauma[ 38 ]. The Caprini risk assessment model[ 39 ], originally released in 1991 for use in all inpatients as a weighted risk stratification tool, contains 39 indicators and is subject to constant updating. The Wells scoring system is a prediction system based on D-dimer level that can be better used for the early diagnosis of DVT[ 40 ] rather than the risk assessment of DVT.…”

Section: Discussionmentioning

confidence: 99%

Establishment of a risk assessment score for deep vein thrombosis after artificial liver support system treatment

Yun¹,

Li²,

Zhu³

et al. 2021

WJCC

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BACKGROUND The artificial liver support system (ALSS) is an effective treatment method for liver failure, but it requires deep venous intubation and long-term indwelling catheterization. However, the coagulation mechanism disorder of basic liver failure diseases, and deep venous thrombosis (DVT) often occur. AIM To evaluate the risk factors for DVT following use of an ALSS and establish a risk assessment score. METHODS This study was divided into three stages. In the first stage, the risk factors for DVT were screened and the patient data were collected, including ALSS treatment information; biochemical indices; coagulation and hematology indices; complications; procoagulant use therapy status; and a total of 24 indicators. In the second stage, a risk assessment score for DVT after ALSS treatment was developed. In the third stage, the DVT risk assessment score was validated. RESULTS A total of 232 patients with liver failure treated with ALSS were enrolled in the first stage, including 12 with lower limb DVT. Logistic regression analysis showed that age [odds ratio (OR), 1.734; P = 0.01], successful catheterization time (OR, 1.667; P = 0.005), activity status (strict bed rest) (OR, 3.049; P = 0.005), and D-dimer level (≥ 500 ng/mL) (OR, 5.532; P < 0.001) were independent risk factors for DVT. We then established a scoring system for risk factors. In the validation group, a total of 213 patients with liver failure were treated with ALSS, including 14 with lower limb DVT. When the cutoff value of risk assessment was 3, the specificity and sensitivity of the risk assessment score were 88.9% and 85.7%, respectively. CONCLUSION A simple risk assessment scoring system was established for DVT patients with liver failure treated with ALSS and was verified to have good sensitivity and specificity.

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Low Molecular Weight Heparins and External Pneumatic Compression as Options for Venous Thromboembolism Prophylaxis: A Surgeon's Perspective

Cited by 94 publications

References 54 publications

Venous Thromboembolism Prevention in Emergency General Surgery

Venous Thromboembolism Prevention in Emergency General Surgery

Incidence of Venous Thromboembolism following Knee Arthroscopy: Effectiveness of a Risk-Based Stratified Chemoprophylaxis Protocol

Establishment of a risk assessment score for deep vein thrombosis after artificial liver support system treatment

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