Prevention of Venous Thromboembolism in Surgical Patients

Abstract

Abstract-Venous thromboembolism (VTE) is a common complication of surgical procedures. The risk for VTE in surgical patients is determined by the combination of individual predisposing factors and the specific type of surgery. Prophylaxis with mechanical and pharmacological methods has been shown to be effective and safe in most types of surgery and should be routinely implemented. For patients undergoing general, gynecologic, vascular, and major urologic surgery, low-dose unfractionated heparin or low-molecular-weight heparin (LMWH) are the options of choice. For low-risk urologic surgery, early postoperative mobilization of patients is the only intervention warranted. For higher-risk patients, including those undergoing elective hip or knee replacement and surgery for hip fracture, vitamin K antagonists, LMWH, or fondaparinux are recommended. For patients undergoing neurosurgery, graduated elastic stockings are effective and safe and may be combined with LMWH to further reduce the risk of VTE. The role of prophylaxis is less defined in patients undergoing elective spine surgery, as well as laparoscopic and arthroscopic surgery. A number of issues related to prophylaxis of VTE after surgery deserve further clarification, including the role of screening for asymptomatic deep vein thrombosis, the best timing for initiation of pharmacological prophylaxis, and the optimal duration of prophylaxis in high-risk patients. Key Words: venous thromboembolism Ⅲ deep vein thrombosis Ⅲ pulmonary embolism Ⅲ heparin Ⅲ low-molecular-weight heparin Ⅲ vitamin K antagonists

Venous Thromboembolism in Brain Tumor Patients: A Review of Literature

“…Although VTE is relatively common in the general population, it is far more common during the post-operative period [25,27,[39][40][41][42][51][52][53]. Proposed explanations for this phenomenon include limited post-operative mobility, which can promote venous stasis, and damage to endothelial tissue, as discussed above.…”

“…Studies have shown that other risk factors for VTE include age, sex, ethnicity, blood type, length of hospital stay, operative duration, and coagulation status [3,6,[8][9][10]14,[25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Standard prophylactic measures for VTE include chemical anticoagulation, mechanical prophylaxis, and increased ambulation during the post-operative period [36,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]. This paper seeks to review the relevant and current literature on VTE in brain tumor patients, with particular focus on the risk factors and presenting symptoms of VTE, treatment options for those with VTE, and a review of current prophylactic measures for VTE.…”

Vena cava filters are not superior to low molecular weight heparin in venous thromboembolism prophylaxis: a study on long term immobilized neurosurgical patients

“…There seems to be a lack of consensus on the use of pharmacological prophylaxis. Some authors suggest pharmacological prophylaxis to be safe (12,17) while there are reports that indicate the risk of hemorrhage is higher (1,6,7,14).…”

“…Given the possibility of a surgical intervention, it is questionable to use an antiaggregant and anticoagulant agent for DVT and PE prophylaxis due to high risk of bleeding. Pharmacological agents might result in catastrophic complications in the peri-and postoperative period and their use is therefore not considered to be beneficial (1,6,7,23,18,19). Although absolute and relative indications of vena cava filters are still debatable, their prophylactic use in patients with neurosurgical problems has not been reported thoroughly in the literature (8,10,20,22,24,26,28).…”

“…Pharmacological prophylaxis with lowered dose low molecular weight heparin is reported to be a safer alternative but the use of these agents might also be hazardous (1,6,7,23). Vena cava filters (VCF) offer an alternative-adjuvant treatment option for prevention of the pulmonary embolism in high risk patient groups where pharmacological prophylaxis is risky or contraindicated (1,4,26). The PREPIC study showed that VCF is effective in preventing PE (26).…”