Should we follow the 9th ACCP guidelines for VTE prevention in surgical patients?

Arcelus, Juan I.; Villar, Jesús; Muñoz, Nuria Muñoz

doi:10.1016/j.thromres.2012.08.260

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…The ACCP are evidence-based clinical practice guidelines that were established in a methodical fashion. The heterogeneity of including all trauma injuries, lack of data from well-designed studies and few studies available in the literature concerning the prevention of VTE in patients with pelvic and acetabular fracture, most of them from observational studies, prevents surgeons from warranting these recommendations are relevant to patients with pelvic fractures and emphasizes the necessity for further investigation in this high-risk population [ 56 ]. This problem was documented by the National Institute of Clinical Excellence (NICE) in its 2012 guidelines update on decreasing the risk of VTE, concluding that the most practical approach of thromboprophylaxis in patients with pelvic and acetabular fractures remains uncertain from the existing evidence [ 57 ].…”

Section: Guidelinesmentioning

confidence: 99%

Methods and Guidelines for Venous Thromboembolism Prevention in Polytrauma Patients with Pelvic and Acetabular Fractures

Chana-Rodríguez¹,

Mañanes²,

Rojo-Manaute³

et al. 2015

TOORTHJ

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Sequential compression devices and chemical prophylaxis are the standard venous thromboembolism (VTE) prevention for trauma patients with acetabular and pelvic fractures. Current chemical pharmacological contemplates the use of heparins or fondaparinux. Other anticoagulants include coumarins and aspirin, however these oral agents can be challenging to administer and may need monitoring. When contraindications to anticoagulation in high-risk patients are present, prophylactic inferior vena cava filters can be an option to prevent pulmonary emboli. Unfortunately strong evidence about the most effective method, and the timing of their commencement, in patients with pelvic and acetabular fractures remains controversial.

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Section: Guidelinesmentioning

confidence: 99%

Methods and Guidelines for Venous Thromboembolism Prevention in Polytrauma Patients with Pelvic and Acetabular Fractures

Chana-Rodríguez¹,

Mañanes²,

Rojo-Manaute³

et al. 2015

TOORTHJ

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“…2 Factors that are specific to patients undergoing major orthopedic surgery that contribute to the increased risk of VTE include obesity, older age >75 years (particularly ≥85 years), poor ambulation (prior to surgery), and cardiovascular disease. 3 Highest risk procedures are reported in hip and knee arthroplasty, hip fracture surgery, pelvic, and multiple fractures. 4 Lower risk procedures include minor orthopedic procedures (eg, arthroscopic procedures, foot and ankle surgery), where the patient cohort is generally younger and more active.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature Search

2019

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Objective: The objective of the study was to review the current literature for prophylactic enoxaparin dosing in obese orthopedic patients. Method: A literature search was undertaken using OVID Medline, OVID Embase, and Cochrane Central databases, accessed through hospital library websites. Key search terms (in UK and US spelling) included orthopaedics, low-molecular-weight heparin, enoxaparin, venous thromboembolism prophylaxis, weight, obese, morbid obesity. Possible related subheadings, such as bone, fractures, anticoagulants, overweight, body mass index, deep vein thrombosis, pulmonary embolism, were also included in the database search to optimize the search strategies. The search was restricted to human subjects and limited to articles published from 1998 to the present. Results: The search identified 429 potentially relevant articles. Once duplicates were removed, 345 were screened for inclusion in this review. Only 3 articles (a case-control study, an observational prospective study, and a case report) met both the inclusion and exclusion criteria. The findings from this review need to be interpreted cautiously due to limitations in study designs and the potential for confounding bias. Conclusion: The results of a multiple database search draw one to the conclusion that there is very limited evidence in the literature with regard to prophylactic enoxaparin dosing in obese orthopedic-specific patients. Orthopedic patients are among the highest risk of all surgical specialties for venous thromboembolism. There is strong evidence to support an increased prophylactic low-molecular-weight heparin doses in obese patients; thus, the authors recommend higher prophylactic enoxaparin dosing in obese orthopedic patients.

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“…Th e American College of Chest Physicians (ACCP) guidelines from 2012 suggest that the baseline risk in orthopedic surgery is 1% for PE and 1.8% for DVT 1 . According to some authors, the rate of DVT can be by 50% higher if no thromboprophylaxis is used in orthopedic surgery 2 .…”

Section: Introductionmentioning

confidence: 99%

Influence of Fondaparinux Versus Nadroparin Calcium Thromboprophylaxis on Clinical Parameters Following Total Knee Arthroplasty

Mihaljević¹

2016

acc

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SUMMARY -Fondaparinux has been shown to be as eff ective as low molecular weight heparin in orthopedic surgery, with no cases of heparin induced thrombocytopenia proven until today. Th e main goal of this prospective randomized controlled trial was to defi ne whether thromboprophylaxis in patients with primary osteoarthritis of the knee undergoing total knee arthroplasty (TKA) infl uences clinical parameters in the same manner in patients receiving fondaparinux as in those receiving nadroparin during the fi rst 7 postoperative days. Sixty patients with primary knee osteoarthritis underwent unilateral TKA performed by the same surgeon and were randomized into two groups of 30 patients receiving either fondaparinux or nadroparin thromboprophylaxis. Patients were compared according to the duration of operation, perioperative blood loss, laboratory results and clinical evaluation of the edema during the early postoperative period. No diff erences were found between the groups in the mean duration of surgery, perioperative blood loss, and most of laboratory results. Th e level of urea was signifi cantly lower in the nadroparin group on the fi rst and second postoperative day. No cases of heparin induced thrombocytopenia, deep vein thrombosis or pulmonary embolism were noted during the study. Study results showed both fondaparinux and nadroparin to have the same infl uence on clinical parameters during the fi rst 7 postoperative days in patients undergoing TKA.

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Should we follow the 9th ACCP guidelines for VTE prevention in surgical patients?

Cited by 4 publications

References 18 publications

Methods and Guidelines for Venous Thromboembolism Prevention in Polytrauma Patients with Pelvic and Acetabular Fractures

Methods and Guidelines for Venous Thromboembolism Prevention in Polytrauma Patients with Pelvic and Acetabular Fractures

Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature Search

Influence of Fondaparinux Versus Nadroparin Calcium Thromboprophylaxis on Clinical Parameters Following Total Knee Arthroplasty

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