Pulmonary embolism after cardiac surgery

Josa, Miguel; Siouffi, Samer Y.; Silverman, Andrew; Barsamian, Ernest M.; Khuri, Shukri F.; Sharma, Gaurav

doi:10.1016/0735-1097(93)90358-8

Cited by 80 publications

(53 citation statements)

References 25 publications

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“…The results of this study are in agreement with those of previous studies [15,16] which indicated a relatively high rate of DVT after CABG in most cases without clinically significant symptoms. Goldhaber et al [17] reported an incidence of approximately 22% DVT post-CABG.…”

Section: Discussionsupporting

confidence: 83%

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Comparison of aspirin plus heparin with heparin alone on asymptomatic perioperative deep vein thrombosis in candidates for elective off-pump coronary artery bypass graft: A randomized clinical trial

Mirhosseini¹,

Forouzannia²,

Mostafavi-Pour-Manshadi³

et al. 2013

Cardiol J.

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Section: Discussionsupporting

confidence: 83%

“…Venous thromboembolism (VTE), which consists of DVT and PE, is a major cause of morbidity and mortality in patients undergoing open heart surgery [15,16].…”

Section: Discussionmentioning

confidence: 99%

Comparison of aspirin plus heparin with heparin alone on asymptomatic perioperative deep vein thrombosis in candidates for elective off-pump coronary artery bypass graft: A randomized clinical trial

Mirhosseini¹,

Forouzannia²,

Mostafavi-Pour-Manshadi³

et al. 2013

Cardiol J.

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“…The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta‐analyses (Tables 1 and 2). 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84 Of the 16 RCTs identified,1...…”

Section: Resultsmentioning

confidence: 99%

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Bham

Pavey

2015

JAHA

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BackgroundOptimal thromboprophylaxis after cardiac surgery is uncertain. This systematic review aimed to define the incidence and risk factors for deep vein thrombosis (DVT), fatal and nonfatal pulmonary embolism (PE), and assess whether venous thromboembolism (VTE) prophylaxis was effective in reducing VTE without complications after cardiac surgery.Methods and ResultsTwo reviewers independently searched and assessed the quality and outcomes of randomized, controlled trials (RCTs) and observational studies on VTE after cardiac surgery in the MEDLINE, EMBASE, and Cochrane controlled trial register (1966 to December 2014). Sixty‐eight studies provided data on VTE outcomes or complications related to thromboprophylaxis after cardiac surgery. The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta‐analyses. VTE prophylaxis was associated with a reduced risk of PE (relative risk [RR], 0.45; 95% confidence interval [CI], 0.28–0.72; P=0.0008) or symptomatic VTE (RR, 0.44; 95% CI, 0.28–0.71; P=0.0006) compared to the control without significant heterogeneity. Median incidence (interquartile range) of symptomatic DVT, PE, and fatal PE were 3.2% (0.6–8.1), 0.6% (0.3–2.9), and 0.3% (0.08–1.7), respectively. Previous history of VTE, obesity, left or right ventricular failure, and prolonged bed rest, mechanical ventilation, or use of a central venous catheter were common risk factors for VTE. Bleeding or cardiac tamponade requiring reoperation owing to pharmacological VTE prophylaxis alone, without systemic anticoagulation, was not observed.ConclusionsUnless proven otherwise by adequately powered RCTs, initiating pharmacological VTE prophylaxis as soon as possible after cardiac surgery for patients who have no active bleeding is highly recommended.

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“…1 After cardiac surgery, VTE has been reported as a common cause of postoperative death, [2][3][4] and it is the fifth most common reason for hospital readmission after coronary artery bypass graft surgery (CABG). 5 Recent reports in the cardiac surgery literature have documented rates of clinically apparent VTE ranging from 0.5% to 1.3%, [5][6][7][8] although higher rates have been seen in studies using routine postoperative ultrasound surveillance.…”

mentioning

confidence: 99%

Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

Kulik

Rassen

Myers

et al. 2012

Circ: Cardiovascular Interventions

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Background-Controversy exists regarding the optimal preventative therapy for venous thromboembolism (VTE) after coronary artery bypass graft (CABG) surgery. We sought to compare the effectiveness and safety of the most commonly used regimens. Methods and Results-We assembled a cohort of 92 699 patients who underwent CABG between 2004 and 2008, using the Premier database. Patients were categorized by method of VTE prevention initiated within 48 hours of surgery, including no preventative therapy (n=55 400), mechanical preventative therapy (n=21 162), subcutaneous unfractionated or low-molecular-weight heparin (n=10 718), subcutaneous fondaparinux (n=88), and concurrent mechanicalchemical therapy (n=5331). The incidence of VTE and major bleeding events within 6 weeks of CABG were compared, using multivariable and propensity score adjustment. The overall incidence of VTE for the entire cohort was 0.74%, and the incidence of major bleeding was 1.43%. VTE and bleeding events occurred with similar incidence in each of the patient categories (VTE: 0.70%, 0.79%, 0.81%, 1.14%, and 0.73%; major bleeding: 1.36%, 1.45%, 1.69%, 3.41%, 1.50%; no prevention, mechanical prevention, subcutaneous heparin, subcutaneous fondaparinux, concurrent mechanical-chemical prevention, respectively). Compared with receiving no prevention, the use of mechanical prevention or subcutaneous heparin did not significantly reduce the risk of VTE or change the risk of major bleeding (P=NS). Conclusions-Venous thromboembolism occurs infrequently after CABG. Compared with the use of no prevention, the administration of chemical or mechanical preventative therapies to CABG patients does not appreciably lower the risk of VTE. These data provide support for the common practice of administering no VTE preventative therapy after CABG, used for nearly 60% of patients within this cohort. (Circ Cardiovasc Interv. 2012;5:590-596.)

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Pulmonary embolism after cardiac surgery

Abstract: Although pulmonary embolism is rare after isolated valve replacement, it is not an uncommon complication after coronary bypass surgery.

Cited by 80 publications

References 25 publications

Comparison of aspirin plus heparin with heparin alone on asymptomatic perioperative deep vein thrombosis in candidates for elective off-pump coronary artery bypass graft: A randomized clinical trial

Comparison of aspirin plus heparin with heparin alone on asymptomatic perioperative deep vein thrombosis in candidates for elective off-pump coronary artery bypass graft: A randomized clinical trial

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

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