Reduction in Fatal Pulmonary Embolism and Venous Thrombosis by Perioperative Administration of Subcutaneous Heparin

Collins, Rory; Scrimgeour, Alison; Yusuf, Salim; Pető, Richárd

doi:10.1056/nejm198805053181805

Cited by 1,228 publications

(210 citation statements)

References 95 publications

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“…à P = 0.502 (two-sided FisherÕs exact test). asymptomatic deep vein thrombosis and decrease in symptomatic events with the use of antithrombotic agents [3,[26][27][28][29][30][31][32][33], supporting the view that asymptomatic deep vein thrombosis is a valid surrogate outcome measure in venous thromboembolism studies [34]. It is worth noting that, in our study, fondaparinux reduced by 86% the rate of proximal deep vein thromboses, which are more prone to embolize than calf vein thrombi.…”

Section: Discussionsupporting

confidence: 71%

Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double‐blind comparison

Turpie

Bauer

Caprini³

et al. 2007

Journal of Thrombosis and Haemostasis

138

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Summary. Background: The benefit of combined mechanical and pharmacologic methods for venous thromboembolism prevention after abdominal surgery has not been clearly established. Objectives: To compare the efficacy and safety of fondaparinux in conjunction with intermittent pneumatic compression vs. intermittent pneumatic compression alone in this context. Patients and Methods: This was a randomized, double-blind, placebo-controlled superiority trial. Patients aged at least 40 years undergoing abdominal surgery were randomized to receive either fondaparinux 2.5 mg or placebo s.c. for 5-9 days, starting 6-8 h postoperatively. All patients received intermittent pneumatic compression. The primary efficacy outcome was venous thromboembolism up to day 10. The main safety outcomes were major bleeding and all-cause mortality. Follow-up lasted 32 days. Results: Of the 1309 patients randomized, 842 (64.3%) were evaluable for efficacy. The venous thromboembolism rate was 1.7% (7/424) in the fondaparinux-treated patients and 5.3% (22/418) in the placebo-treated patients (odds ratio reduction 69.8%; 95% confidence interval 27.9-87.3; P = 0.004). Fondaparinux significantly reduced the proximal deep vein thrombosis rate from 1.7% (7/417) to 0.2% (1/424; P = 0.037). Major bleeds occurred in 1.6% (10/635) and 0.2% (1/650) of fondaparinuxtreated and placebo-treated patients, respectively (P = 0.006), none being fatal or involving a critical organ. By day 32, eight patients (1.3%) receiving fondaparinux and five (0.8%) receiving placebo had died. Conclusions: In patients undergoing abdominal surgery and receiving intermittent pneumatic compression, fondaparinux 2.5 mg reduced the venous thromboembolism rate by 69.8% as compared to pneumatic compression alone, with a low bleeding risk as compared to placebo.

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Section: Discussionsupporting

confidence: 71%

Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double‐blind comparison

Turpie

Bauer

Caprini³

et al. 2007

Journal of Thrombosis and Haemostasis

138

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“…Early studies in patients with hip fractures found the risk to be around 10%, 11,12 but a more recent overview in postoperative patients has suggested that predominantly subclinical DVT diagnosed by 125 I fibrinogen scanning is associated with a 5% risk of fatal PE. 13,14 Although there are few data on the natural history of untreated subclinical DVT in stroke patients, in one study patients with proximal subclinical DVT had a 35% risk of clinical PE. 15 Fatal pulmonary emboli usually arise from proximal DVT, 16 which accounts for one third of all DVTs in surgical patients.…”

Section: Clinical Significance Of Asymptomatic Proximal Dvt After Strokementioning

confidence: 99%

“…Prophylactic use of UFH in surgical patients reduces the incidence of DVT, PE, fatal PE, and total mortality, 13 and LMWH is at least as effective. 69 An overview of 10 trials of prophylactic UFH or LMWH in more than 1000 patients with ischemic stroke has shown an approximate 80% reduction in the incidence of DVT as detected by 125 I fibrinogen scanning or venography, though the numbers were too small to draw firm conclusions about the effect on the incidence of PE and total mortality.…”

Section: Heparin Thromboprophylaxis After Strokementioning

confidence: 99%

Venous Thromboembolism After Acute Stroke

Kelly

Rudd

Lewis

et al. 2001

Stroke

220

165

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Background-Treatment for venous thromboembolism (VTE) is highly effective in preventing morbidity and mortality, yet pulmonary embolism (PE) accounts for up to 25% of early deaths after stroke. This is because the current diagnostic paradigm is reactive rather than proactive: the clinician responds to VTE when it becomes symptomatic, in the expectation that initiation of treatment will prevent progression to more serious manifestations. This approach is flawed, because sudden death from PE is frequently unheralded and nonfatal symptomatic pulmonary emboli are often unrecognized or misdiagnosed. Summary of Comment-Morbidity and mortality from PE could be reduced either by more effective thromboprophylaxis or earlier diagnosis and treatment of established VTE. The fact that early use of short-term, low-dose, unfractionated heparin (UFH) is not associated with sustained, clinically meaningful benefit suggests that a fundamental change in the diagnostic approach to VTE is needed, one which requires a greater appreciation that clinically apparent events are merely the tip of the thromboembolism iceberg. Conclusions-Research into a strategy of screening for subclinical VTE in these patients is needed, with a view to identifying a subgroup at risk of progression to symptomatic and life-threatening events, in whom outcome might be improved by anticoagulation. (Stroke. 2001;32:262-267.)

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“…The application of thromboprophylaxis can decrease the risk of venous thromboembolism significantly in a broad spectrum of patients with a very low risk of adverse effects 24. For orthopedic patients, prophylaxis reduces DVT risk by more than two thirds 25. It is a disappointing fact that the use of prophylaxis is far from ideal despite the overwhelming evidence supporting thromboprophylaxis for most hospital patients.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

Wang

Chen

et al. 2012

IJOO

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Background:Pelvic and acetabular fractures have been known as one of the high risk factors for developing deep vein thrombosis (DVT), but thromboprophylaxis for patients with such fractures remains underused despite its widely accepted benefits. Current guidelines have not been universally adopted in clinical practice. The purpose of this study is to introduce a Thrombotic Risk Assessment Questionary (assessment table) according to evidence-based guidelines and evaluate its impact on the use of thromboprophylaxis for patients with pelvic and acetabular fractures.Materials and Methods:We retrospectively reviewed 305 consecutive patients with pelvic and acetabular fractures from August 1, 2008 through September 30, 2010. The control group without using the assessment table included 153 patients admitted during the first 13 months, and the assessment group using the assessment table included 152 patients admitted during the following months. Data on clinical outcomes of DVT, the number of patients receiving prophylaxis, and the time of the first dose of anticoagulant were collected.Results:Compared with the control group, Patients using the assessment table were more likely to be given DVT prophylaxis (84.2% vs. 37.3%, P < 0.05) and the time of the first dose of anticoagulant was reduced (4.32 days ± 4.78 days vs. 6.6 days ± 5.96 days, P < 0.05). Patients in the assessment group had lower risk of developing DVT (8.6% vs. 20.3%, P < 0.05).Conclusion:The assessment table can significantly improve the use of thromboprophylaxis after pelvic and acetabular fractures, which will likely reduce the incidence of DVT. Developing individual hospital prophylaxis strategy is an effective way to determine whether hospitalized patients should receive pharmacologic and/or mechanical prophylaxis or not.

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Reduction in Fatal Pulmonary Embolism and Venous Thrombosis by Perioperative Administration of Subcutaneous Heparin

Cited by 1,228 publications

References 95 publications

Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double‐blind comparison

Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double‐blind comparison

Venous Thromboembolism After Acute Stroke

Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

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