Prevention of postoperative deep-vein thrombosis by low-dose heparin in urological surgery

Kutnowski, M; Vandendris, Michel; Steinberger, R; Kraytman, M

doi:10.1007/bf00256865

Cited by 20 publications

(11 citation statements)

References 10 publications

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“…This study verifies the findings of several other authors that LDH reduces the postoperative frequen- [3][4][5][6], and only Sebeseri et al [5] and Kutnowski et al [6] have observed a prophylactic effect. The frequency of DVT was similar in males and females, but since the females had a higher frequency of DVT in the control group, there appears to be a relatively better protective effect of LDH in female patients.…”

Section: Discussionsupporting

confidence: 94%

Prophylaxis of postoperative venous thrombosis in a controlled trial comparing dextran 70 and low‐dose heparin

Bergqvist

Hallböök

1980

World j. surg.

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A controlled, randomized trial comparing dextran 70 and low-dose heparin with no treatment for prophylaxis of postoperative deep vein thrombosis is reported. A total of 168 patients who underwent general and urologic surgical operations participated in the trial. The 125I-fibrinogen test was used for diagnosis. The frequency of deep venous thrombosis was 27% in controls, 29% in patients who also received dextran 70, and 13% in patients treated with low-dose heparin. Only heparin therapy reduced the incidence of thrombosis. Epidural analgesia did not reduce the frequency of thrombosis. In patients with malilgnant diseases, the thrombotic process always extended proximally, at least to the knee. The highest frequency of thrombosis was seen after urologic surgery. Complications did not differ between the groups.

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Section: Discussionsupporting

confidence: 94%

Prophylaxis of postoperative venous thrombosis in a controlled trial comparing dextran 70 and low‐dose heparin

Bergqvist

Hallböök

1980

World j. surg.

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“…In the study reported by Coe et al [51], 36% of the patients had malignancy and a 3-fold increase in positive leg scans was reported in this group in comparison to the group without a malignant surgical diagnosis. In the smaller study reported by Kutnowski and colleagues, 2 of the 3 control patients with malignancy developed TED [52]. Pooling all of the data from control patients in the 7 series reveals that 53 of 129 patients (41%) developed DVT, a best estimate of risk in this patient group (Table 2).…”

Section: Cancer Patients Undergoing Surgerymentioning

confidence: 85%

Hemostatic alterations in cancer patients

1992

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Nearly all patients with cancer manifest laboratory evidence of hypercoagulability and some develop clinical thromboembolic disease (TED). Routine laboratory studies of blood coagulation have been performed in several large, prospective trials of the use of anticoagulant drugs in cancer treatment. The results of these studies, as well as data from several smaller studies of more sensitive tests of hypercoagulability [e.g. fibrinopeptide A (FPA); thrombin-antithrombin (TAT) complexes; prothrombin fragment F1 + 2)], indicate that the levels of some clotting proteins parallel disease activity. However, no studies of sound methodologic design have yet been performed to indicate that any of these tests of blood coagulation can serve as adequate predictors of TED in patients with cancer. In addition to the important role played by tumor-related procoagulants, several other mechanisms may be involved in the pathogenesis of thromboembolic events in patients with cancer, including stasis and endothelial damage. Considerable variability in the relative importance of these mechanisms in the pathogenesis of TED may exist among patients with different types of cancer. The risk for TED associated with surgical procedures in cancer patients is substantial and prophylactic antithrombotic therapy should be considered for most of these patients. Chemotherapy and hormonal therapy of cancer probably increases the likelihood of TED, particularly in those subjects with indwelling venous catheters. This risk has been particularly well-studied in patients with breast cancer treated with tamoxifen plus cytotoxic drugs. The pathogenic mechanisms may be complex but vascular injury is likely as a proximate cause of venous access catheter thrombosis and can be prevented with low dose coumadin therapy. The utility of low dose coumadin anticoagulation in reducing the risk for TED during breast cancer treatment is unknown but is currently being tested in a large, multiinstitutional study. Since chronic coumadin anticoagulation of cancer patients, and single pulse dose heparin prior to intravenous chemotherapy, both prevent thrombin generation, these agents may be of use in reducing the risk of chemotherapy-associated thrombosis. Prophylactic anticoagulation should be considered for high risk patients.

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“…Six studies 38,280,[353][354][355][356] were conducted on patients undergoing urological surgery. Eighteen studies 122,125,[274][275][276][277][278]284,285,291,293,296,297,299,300,302,353,354 reported the effect of pharmacological prophylaxis vs no pharmacological prophylaxis on risk of mortality, 16 studies 38,118,125,273,[276][277][278][279]285,286,289,293,295,[354][355][356] reported the effect on risk of symptomatic PEs, 6 studies 49,125,278,285,287,290 reported the effect on risk of screening-detected proximal DVTs, and 7 studies 66,…”

Section: Recommendation 18mentioning

confidence: 99%

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

et al. 2019

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Background:Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality.Objective:These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery.Methods:ASH formed a multidisciplinary guideline panel balanced to minimize bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic reviews. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.Results:The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gynecological surgery (n = 2).Conclusions:For patients undergoing major surgery in general, the panel made conditional recommendations for mechanical prophylaxis over no prophylaxis, for pneumatic compression prophylaxis over graduated compression stockings, and against inferior vena cava filters. In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH). For major general surgery, the panel suggested pharmacological prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For major neurosurgery, transurethral resection of the prostate, or radical prostatectomy, the panel suggested against pharmacological prophylaxis. For major trauma surgery or major gynecological surgery, the panel suggested pharmacological prophylaxis over no prophylaxis.

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Prevention of postoperative deep-vein thrombosis by low-dose heparin in urological surgery

Cited by 20 publications

References 10 publications

Prophylaxis of postoperative venous thrombosis in a controlled trial comparing dextran 70 and low‐dose heparin

Prophylaxis of postoperative venous thrombosis in a controlled trial comparing dextran 70 and low‐dose heparin

Hemostatic alterations in cancer patients

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

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