Prophylaxis Against Postoperative Pulmonary Embolism and Deep-Vein Thrombosis by Low-Dose Heparin

Kiil, Jørgen; Axelsen, F; Kiil, J; Andersen, Ditte K.

doi:10.1016/s0140-6736(78)90297-0

Cited by 90 publications

(33 citation statements)

References 5 publications

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“…Venous thromboembolism is another frequent surgical complication. Studies dating back to the 1970s demonstrate that administration of heparin significantly reduces the incidence of both deep venous thrombosis and pulmonary embolism [43,44].…”

Section: Future Indicationsmentioning

confidence: 99%

The Inflammatory Reflex and Neural Tourniquet: Harnessing the Healing Power of the Vagus Nerve

Fritz

2017

Bioelectron. Med.

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The CNS helps protect against tissue injury. The most important priorities include limiting blood loss and systemic inflammation. We elucidated two endogenous neural pathways that rapidly and specifically improve hemostasis and decrease inflammation through vagus nerve signaling. Activation of the neural tourniquet or inflammatory reflex via electrical vagus nerve stimulation (VNS) significantly improves outcomes in preclinical disease models. Currently, VNS is clinically approved for the treatment of medically refractory epilepsy and depression. The growing field of bioelectronic medicine will help physicians harness the Neural Tourniquet™ and inflammatory reflex for clinical use as well. Considering the substantial harm caused by uncontrolled bleeding and inflammation, electrical VNS may dramatically improve the care of millions of patients.

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Section: Future Indicationsmentioning

confidence: 99%

The Inflammatory Reflex and Neural Tourniquet: Harnessing the Healing Power of the Vagus Nerve

Fritz

2017

Bioelectron. Med.

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“…How ever, most of the cases of TE listed in table 1 were confirmed by means of paraclinical diag nostic procedures. The total described inci dences of LTE were 48/3,926 (1.2%) [3][4][5][6][7][8][9][10][11][12][13] when the patients were examined at 30-90 days after surgery. Twenty-four of 11,397 pa tients (0.2%) [14,15] developed late fatal PE in two multicenter investigations comprising all kinds of surgery (table 1).…”

Section: Magnitude Of the Problemmentioning

confidence: 99%

Is There a Need for Long-Term Thromboprophylaxis following General Surgery?

Wille‐Jørgensen¹,

Lausen²,

Jørgensen³

1993

Pathophysiol Haemos Thromb

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Thromboprophylaxis to surgical patients is generally accepted, and used in the perioperative period by many surgeons as effective means of reducing postoperative thromboembolic complications. Often the prophylaxis is stopped at the time of mobilization or discharge of the patient, although late thromboembolic complications after cessation of the postoperative prophylaxis are known to occur up to 7 weeks after surgery. By scrutinizing thromboprophylactic studies performed in general surgery during the last 20 years, we found the incidence of late thromboembolic complications reported to be about 1 % when clinical diagnostics was applied. In studies where the patients were screened for late thromboembolic complications using paraclinical diagnostic methods the incidence is 10 times higher. The clinical relevance of these late postoperative thromboembolic complications is still uncertain, as is the value of long-term prophylaxis.

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“…Bilateral ascending venography in the 10 patients with suspected deep-vein thrombosis should confirm the diagnosis in 4, demonstrating thrombi as constant intraluminal filling defects, and ventilation-perfusion lung scanning in the 10 patients with suspected pulmonary embolism should yield high-probability findings in 4. The eight patients with confirmed venous thromboembolism would undergo full-dose anticoagulant therapy, with heparin given intravenously for 7 to 10 days and then warfarin given orally for 3 months, overlapping with the last 3 or 4 days of intravenous therapy.…”

Section: Subcutaneous Administration Of Heparin In Low Dosesmentioning

confidence: 99%

“…The results of multiple randomized trials indicate that in 1000 high-risk general surgery patients postoperative prophylaxis with intravenously administered dextran, 1 to 1.5 1 the first day and then 500 ml daily for 3 days, should reduce the frequency of clinically suspected deep-vein thrombosis to 2% and that of clinically suspected pulmonary embolism to 1%.26 Venography in the 20 patients with suspected deep-vein thrombosis should confirm the diagnosis in 9, and lung scanning in the 10 patients with suspected pulmonary embolism should yield high-probability findings in 4. The 13 patients with confirmed venous thromboembolism would undergo full-dose anticoagulant therapy as just de-scribed.…”

Section: Intravenous Administration Of Dextranmentioning

confidence: 99%

Cost-Effectiveness of Primary and Secondary Prevention of Fatal Pulmonary Embolism in High-Risk Surgical Patients

Hull

Hirsh

Sackett

et al. 1983

Survey of Anesthesiology

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Because death due to pulmonary embolism is relatively rare following general surgery, many question the need for prophylaxis. In addition, there has been reluctance to apply new interventions whose costeffectiveness has not been adequately evaluated. A cost-effectiveness analysis based on over 1000 highrisk patients undergoing abdominothoracic surgery, with effectiveness measured in terms of numbers of deaths from pulmonary embolism averted, has shown subcutaneous administration of heparin in low doses starting 2 hours before the operation to be the most cost-effective of several active approaches to prophylaxis. It averted seven of the eight deaths expected without active prophylaxis per 1000 such patients and cost half as much as the traditional approach of intervening only when venous thromboembolism becomes clinically apparent. Intravenous administration of dextran, although effective, was expensive, and leg scanning with iodine-1 25-labelled fibrinogen was extremely expensive. Intermittent pneumatic compression of the legs was inexpensive, but, as with leg scanning, its effectiveness has not been determined in randomized trials.

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Prophylaxis Against Postoperative Pulmonary Embolism and Deep-Vein Thrombosis by Low-Dose Heparin

Cited by 90 publications

References 5 publications

The Inflammatory Reflex and Neural Tourniquet: Harnessing the Healing Power of the Vagus Nerve

The Inflammatory Reflex and Neural Tourniquet: Harnessing the Healing Power of the Vagus Nerve

Is There a Need for Long-Term Thromboprophylaxis following General Surgery?

Cost-Effectiveness of Primary and Secondary Prevention of Fatal Pulmonary Embolism in High-Risk Surgical Patients

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