The Rate of Bleeding Complications After Pharmacologic Deep Venous Thrombosis Prophylaxis

Leonardi, Michael J.; McGory, Marcia L.; Ko, Clifford Y.

doi:10.1001/archsurg.141.8.790

Cited by 129 publications

(88 citation statements)

References 32 publications

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“…Another meta-analysis reported that the mean risk of wound hematoma and bleeding requir ing reoperation in the control groups of randomized trials of thromboprophyaxis with LDUH or LMWH were 0.8% and 0.7%, respectively. 95 When making trade-offs between benefi ts and harms of pharmacologic prophylaxis, we estimated that the baseline risk of major bleeding is 1.8 times greater in high-risk patients based on data from Cohen et al 96 VTE. A systematic review of 37 studies of varying design concluded that obesity is a risk factor for VTE in both medical and bariatric surgical patients.…”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Mamentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,821

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Mamentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,821

744

View full text Add to dashboard Cite

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“…Meta-analyses have shown that , 1% of patients require an additional operative procedure because of chemoprophylaxis-associated bleeding. 31 However, the available meta-analysis data examined the surgical population as a whole. Bleeding risk was not stratifi ed by VTE risk, which is a marker of the aggressiveness of prophylaxis regimen.…”

Section: Acknowledgmentsmentioning

confidence: 99%

A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical Patients

Pannucci¹,

Laird²,

Dimick³

et al. 2014

Chest

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Background: VTE is the proximate cause of 100,000 deaths in the United States each year. Perioperative VTE risk among surgical patients varies by 20-fold, which highlights the importance of risk stratifi cation to identify high-risk patients, in whom chemoprophylaxis can decrease VTE risk, and low-risk patients, for whom the risk-benefi t relationship of prophylaxis may be unfavorable. Methods: We used data from a statewide surgical quality collaborative for surgical procedures performed between 2010 and 2012. Regression-based techniques identifi ed predictors of 90-day VTE while adjusting for procedural complexity and comorbid conditions. A weighted risk index was created and was validated subsequently in a separate, independent dataset. Results: Data were available for 10,344 patients, who were allocated randomly to a derivation or validation cohort. The 90-day VTE rate was 1.4%; 66.2% of the derivation cohort and 65.5% of the validation cohort received chemoprophylaxis. Seven risk factors were incorporated into a weighted risk index: personal history of VTE, current cancer, sepsis/septic shock/systemic infl ammatory response syndrome, age Ն 60 years, BMI Ն 40 kg/m 2 , male sex, and family history of VTE. Prediction for 90-day VTE was similar in the derivation and validation cohorts (areas under the receiver operator curve, 0.72 and 0.70, respectively). An 18-fold variation in 90-day VTE rate was identifi ed. Conclusions: A weighted risk index quantifi es 90-day VTE risk among surgical patients and identifi es an 18-fold variation in VTE risk among the overall surgical population.

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“…5 The benefits of VTE chemoprophylaxis are high but should be considered in light of the risk of VTE and of bleeding complications, for which data are conflicting. 6,7 Studies estimating the incidence of VTE in diverse populations of otolaryngology patients reported rates between 0.1% and 0.3% for DVT and 0.05% and 0.2% for PE, which are much lower than in other surgical populations. 8,9 The reported incidence was 6 times higher among patients undergoing head and neck procedures compared with those undergoing general otolaryngology procedures (0.6% vs 0.1%) because of higher risks associated with older age and malignancy.…”

mentioning

confidence: 99%

Chemoprophylaxis for Venous Thromboembolism in Otolaryngology

Bahl

Shuman

et al. 2014

JAMA Otolaryngol Head Neck Surg

146

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Effectiveness and safety of VTE chemoprophylaxis differed between patient subgroups, defined by Caprini risk score and by procedure. Effectiveness was most evident in patients with high Caprini risk scores and microvascular free tissue reconstruction. Bleeding complications were associated with VTE chemoprophylaxis administered in close proximity to potent antiplatelet therapy. The Caprini risk assessment model appears to be an effective tool to stratify otolaryngology patients by risk for VTE. Patients undergoing free tissue reconstruction merit further study before developing recommendations for VTE prophylaxis because of their higher risk of both VTE and bleeding.

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The Rate of Bleeding Complications After Pharmacologic Deep Venous Thrombosis Prophylaxis

Cited by 129 publications

References 32 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical Patients

Chemoprophylaxis for Venous Thromboembolism in Otolaryngology

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