Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Roderick, Paul; Ferris, Georgette; Wilson, Kevin C.; Halls, Heather; Jackson, Donald E.; Collins, R; Baigent, Colin

doi:10.3310/hta9490

Cited by 266 publications

(168 citation statements)

References 104 publications

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“…20 Increased hematocrit has been the only predictive factor of venous and arterial thrombosis in subjects with polycythemia vera, whereas high platelet counts and abnormal platelet function were not significantly linked to polycythemia vera-associated thrombosis. 9,11,12 Rheological therapies, including compression devices 21 and hemodilution with dextran, 22 have been shown to reduce the risk of deep vein thrombosis in patients with polycythemia vera.…”

Section: Discussionmentioning

confidence: 99%

Hematocrit and risk of venous thromboembolism in a general population. The Tromso study

Brækkan¹,

Mathiesen²,

Njølstad³

et al. 2009

Haematologica

163

119

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BackgroundHematocrit above the normal range for the population, such as in primary or secondary erythrocytosis, predisposes to both arterial and venous thrombosis. However, little is known about the association between hematocrit and risk of venous thromboembolism in a general population. Design and MethodsHematocrit and related hematologic variables such as hemoglobin, red blood cell count, mean corpuscular volume, and baseline characteristics were measured in 26,108 subjects, who participated in the Tromsø Study in 1994-1995. Incident venous thromboembolic events during follow-up were registered up to September 1 st , 2007. ResultsThere were 447 venous thromboembolic events during a median of 12.5 years of followup. Multivariable hazard ratios per 5% increment of hematocrit for the total population, adjusted for age, body mass index and smoking, were 1.25 (95% CI: 1.08-1.44) for total venous thromboembolism and 1.37 (95% CI: 1.10-1.71) for unprovoked venous thromboembolism. In category-based analyses, men with a hematocrit in the upper 20 th percentile (≥46% in men) had a 1.5-fold increased risk of total venous thromboembolism (95% CI: 1.08-2.21) and a 2.4-fold increased risk of unprovoked venous thromboembolism (95% CI: 1.36-4.15) compared to men whose hematocrit was in the lower 40 th percentile. The risk estimates were higher for men than for women both in continuous and category-based analyses. The findings for hemoglobin and red blood cell count were similar to those for hematocrit, whereas mean corpuscular volume was not associated with venous thromboembolism. ConclusionsOur findings suggest that hematocrit and related hematologic variables such as hemoglobin and red blood cell count are risk factors for venous thromboembolism in a general population.Key words: hematocrit, population range, arterial and venous thrombosis. Study. Haematologica. 2010; 95:270-275. doi:10.3324/haematol.2009 Hematocrit and risk of venous thromboembolism in a general population. The Tromsø study Citation: Braekkan SK, Mathiesen EB, Njølstad I, Wilsgaard T, and Hansen J-B. Hematocrit and risk of venous thromboembolism in a general population. The Tromsø

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Section: Discussionmentioning

confidence: 99%

Hematocrit and risk of venous thromboembolism in a general population. The Tromso study

Brækkan¹,

Mathiesen²,

Njølstad³

et al. 2009

Haematologica

163

119

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“…A metaanalysis evaluating clinical trials in which patients were randomly assigned to receive either low-dose unfractionated heparin (ufh) or lmwh revealed similar efficacy and safety in preventing screen-detected vte 66 . A variety of mechanical thromboprophylactic methods have also been evaluated, but in general, they have been shown to be less effective than pharmacologic prophylaxis 67,68 . The ideal duration of vte prophylaxis in patients with cancer undergoing major surgery remains unclear.…”

Section: Thromboprophylaxis In Surgical Patients With Cancermentioning

confidence: 99%

Cancer and Venous Thromboembolic Disease: From Molecular Mechanisms to Clinical Management

et al. 2014

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bleeding, and disseminated intravascular coagulation 2 . Prevention and management of those complications in cancer patients can significantly affect patient treatment, prognosis, and quality of life.Venous thromboembolism (vte), which includes deep venous thrombosis (dvt) and pulmonary embolism, might precede or coincide with a diagnosis of cancer. In this patient group, vte can potentially complicate surgery, hospitalization, or systemic chemotherapy 3-5 . Risk for vte is increased by a factor of approximately 6 in patients with cancer compared with non-cancer patients, and patients with cancer account for 20% of all newly diagnosed cases of vte 6 . Postmortem studies suggest that the incidence of vte in cancer patients might be as high as 50%, in keeping with the finding that, after cancer itself, vte represents the second leading cause of death in hospitalized patients with cancer 7-9 .Venous thromboembolism is associated with high morbidity, mortality, and economic burden. Its diagnosis and management can interrupt essential cancer therapy and cause potentially serious bleeding complications 10 . Moreover, approximately 25% of cancer patients with vte require readmission because of bleeding or recurrent vte 11,12 . MECHANISMS UNDERLYING THE CANCER-ASSOCIATED PROTHROMBOTIC PHENOTYPEDirect and indirect mechanisms contribute to the pathogenesis of cancer-associated vte 13-15 (Figure 1

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“…The LMWHs have emerged as the most effective pharmacologic prophylaxis option for the greatest spectrum of patients 26. Mechanical methods of thromboprophylaxis have also been demonstrated to reduce the incidence of DVT in one or more patient groups 27. The study showed that the incidence of DVT confirmed by ultrasonography in the assessment group was lower than that in the control group (8.6% vs. 20.3%).…”

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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Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Cited by 266 publications

References 104 publications

Hematocrit and risk of venous thromboembolism in a general population. The Tromso study

Hematocrit and risk of venous thromboembolism in a general population. The Tromso study

Cancer and Venous Thromboembolic Disease: From Molecular Mechanisms to Clinical Management

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

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