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extended thromboprophylaxis

Eric S Daniel, Anastasia E Dean, Mingjoe Lim, Mobin Master, Peter Gibbs, Ian Faragher
BACKGROUND: Studies have suggested a benefit from extended venous thromboprophylaxis post-operatively in colorectal cancer with an assumed base rate of zero venous thromboembolic events prior to treatment. We aim to establish the incidence of pulmonary embolism in patients with newly diagnosed stage III or IV colorectal cancer prior to any treatment. METHOD: Consecutive patients presenting to a single health service with a new diagnosis of stage III or IV colorectal cancer were identified from a prospective database, for the period between January 2011 and September 2014...
October 9, 2016: ANZ Journal of Surgery
Agnes M Lamon, Ashraf S Habib
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients...
2016: Local and Regional Anesthesia
Joseph J Pariser, Shane M Pearce, Blake B Anderson, Vignesh T Packiam, Vivek N Prachand, Norm D Smith, Gary D Steinberg
PURPOSE: Venous thromboembolic events (VTE) are a significant source of morbidity after radical cystectomy (RC). At our institution, subcutaneous heparin was historically given to RC patients immediately prior to incision and throughout the inpatient stay. In an effort to decrease the overall rate of VTE and post-discharge VTE, a regimen including extended-duration enoxaparin was initiated for patients undergoing RC. MATERIALS AND METHODS: In January 2013, thromboprophylaxis was modified for patients undergoing RC by replacing a regimen of subcutaneous heparin before induction and then every eight hours until discharge with enoxaparin daily for postoperative prophylaxis continued until 28 days after discharge...
August 25, 2016: Journal of Urology
Amihai Rottenstreich, Ram Elazary, Yosef Kalish
BACKGROUND: Thrombotic events involving the portal-splenic-mesenteric venous system (PSMVT) are rare but potentially lethal after bariatric surgery. OBJECTIVES: To investigate the incidence, clinical presentation, management, and outcome of thrombotic events after bariatric surgery. SETTING: Two university hospitals. METHODS: A retrospective review of individuals who underwent bariatric surgery between January 2006 and December 2015...
May 12, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Mustapha A El Lakis, Agostino Pozzi, Jad Chamieh, Bassem Safadi
BACKGROUND: Portomesenteric vein thrombosis following laparoscopic bariatric surgical procedures is a serious and potentially lethal complication. It is quite rare, and its clinical presentation, management, and sequelae remain poorly understood. METHODS: We searched PubMed, Medline, Google Scholar, Ovid, and Cochrane databases for articles reporting case series and systematic reviews in the English language on patients who underwent laparoscopic bariatric surgery and had a subsequent portal or mesenteric vein thrombosis...
July 7, 2016: Surgical Endoscopy
Haider Mahdi, Qataralnada Aljebori, David Lockart, Laura Moulton
STUDY OBJECTIVE: To determine the incidence of venous thromboembolism (VTE) after laparoscopic surgery for gynecologic cancer DESIGN: Retrospective analysis of the ACS-NSQIP database DESIGN CLASSIFICATION: Retrospective analysis of a national surgical database SETTING: Academic and community health care institutions across the United States PATIENTS: Women who underwent at least one major laparoscopic surgery for uterine, ovarian and cervical cancers INTERVENTION: Data was collected on surgical procedure, patient demographic variables type of malignancy and VTE and mortality outcomes within 30 days of surgery MEASUREMENTS: VTE was defined as deep venous thrombosis requiring therapy (DVT) and pulmonary embolism (PE) confirmed by imaging or autopsy within 30 days of surgery...
June 21, 2016: Journal of Minimally Invasive Gynecology
Alexander T Cohen, Robert A Harrington, Samuel Z Goldhaber, Russell D Hull, Brian L Wiens, Alex Gold, Adrian F Hernandez, C Michael Gibson
BACKGROUND: Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. METHODS: Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days...
August 11, 2016: New England Journal of Medicine
Pamela Kathleen Sykes, Kenneth Walsh, Chenqu Mimi Darcey, Heather Lee Hawkins, Duncan Scott McKenzie, Ritam Prasad, Anita Thomas
BACKGROUND: Deep vein thrombosis and pulmonary embolism are known collectively as venous thromboembolism (VTE). These conditions are possible complications in hospitalized patients that can extend hospital stay, result in unplanned readmission, and are associated with long-term disability and death. Despite strong evidence, many patients do not receive optimal thromboprophylaxis. VTE prevention is a top priority in healthcare systems worldwide. AIM: The aim of the project was to establish a standardized hospital-wide VTE prevention program and to improve awareness of, and compliance with, best practice standards in the prevention of VTE...
June 2016: International Journal of Evidence-based Healthcare
H W Clouston, P A Rees, H Shaker, S Duff, C C Kirwan
INTRODUCTION: Up to 6% of patients develop venous thromboembolism (VTE) following elective colorectal cancer surgery despite thromboprophylaxis. Clinical practices for perioperative thromboprophylaxis remains variable, particularly the use and duration of extended thromboprophylaxis. Identification of factors associated with a prolonged postoperative hypercoagulable state may allow the development of algorithms that allow more targeted thromboprophylaxis. AIM: To identify patient, tumour and surgical risk factors for prolonged (two and six weeks) hypercoagulability in colorectal cancer patients undergoing surgical resection...
April 2016: Thrombosis Research
H W Clouston, H Shaker, S Duff, C C Kirwan
INTRODUCTION: Venous thromboembolism (VTE) is a major cause of death in patients undergoing colorectal cancer surgery and usually arise from Deep Vein Thrombosis's (DVTs). In patients with cancer below knee and asymptomatic DVTs are at risk of propagating and result in a VTE. Retrospective, population based studies predating extended course venous thromboprophylaxis report an incidence of symptomatic VTE in colorectal cancer patients of approximately 5.5%. Clinical studies have suggested that pre-operative d-dimer may predict the development of post-operative DVTs...
April 2016: Thrombosis Research
Miguel Farfan, Maria Bautista, Guillermo Bonilla, Jorge Rojas, Adolfo Llinás, José Navas
INTRODUCTION: Increased risk of venous thromboembolism following major orthopedic surgery (MOS) is well described. The American Academy of Chest Physician (ACCP) has generated evidence-based recommendations for thromboprophylaxis; however, there is a gap between guidelines recommendations and clinical practice. The aim of this study is to compare worldwide adherence rates to the last 4 editions of ACCP guidelines for thromboprophylaxis after MOS. MATERIALS AND METHODS: A systematic review of literature and meta-analysis was performed...
May 2016: Thrombosis Research
Jason D Wright, Ling Chen, Soledad Jorge, William M Burke, Ana I Tergas, June Y Hou, Jim C Hu, Alfred I Neugut, Cande V Ananth, Dawn L Hershman
OBJECTIVE: Extended-duration thromboprophylaxis for 4weeks after discharge has been demonstrated to reduce venous thromboembolic events (VTE) in cancer patients undergoing abdominopelvic surgery and is recommended in national guidelines. We examined the utilization and effectiveness of extended-duration low molecular weight heparin prophylaxis in high-risk cancer patients. METHODS: We analyzed patients with colon, ovarian, and uterine cancer who underwent surgery from 2009 to 2013 and who were recorded in the MarketScan database...
June 2016: Gynecologic Oncology
Rachel Forster, Marlene Stewart
BACKGROUND: The optimal duration of thromboprophylaxis after total hip or knee replacement, or hip fracture repair remains controversial. It is common practice to administer prophylaxis using low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) until discharge from hospital, usually seven to 14 days after surgery. International guidelines recommend extending thromboprophylaxis for up to 35 days following major orthopaedic surgery but the recommendation is weak due to moderate quality evidence...
2016: Cochrane Database of Systematic Reviews
Ali Aminian, Amin Andalib, Zhamak Khorgami, Derrick Cetin, Bartolome Burguera, John Bartholomew, Stacy A Brethauer, Philip R Schauer
OBJECTIVE: To determine the risk factors for 30-day postdischarge venous thromboembolism (VTE) after bariatric surgery and to identify potential indications for extended pharmacoprophylaxis. BACKGROUND: VTE is among most common causes of death after bariatric surgery. Most VTEs occur after hospital stay; still a few patients receive extended pharmacoprophylaxis postdischarge. METHODS: From American College of Surgeons-National Surgical Quality Improvement Program, we identified 91,963 patients, who underwent elective primary and revisional bariatric surgery between 2007 and 2012...
March 8, 2016: Annals of Surgery
Andrei Fagarasanu, Ghazi S Alotaibi, Ramona Hrimiuc, Agnes Y Y Lee, Cynthia Wu
BACKGROUND: Abdominopelvic cancer surgery increases the risk of postoperative venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) thromboprophylaxis is recommended, and the role of extended thromboprophylaxis (ETP) is controversial. We performed a systematic review to determine the effect of ETP on deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and all-cause mortality after abdominal or pelvic cancer surgery. METHODS: A search of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was undertaken, and studies were included if they compared extended duration (2-6 weeks) with conventional duration of thromboprophylaxis (2 weeks or less) after cancer surgery...
May 2016: Annals of Surgical Oncology
James C Iannuzzi, Christopher T Aquina, Aaron S Rickles, Bradley J Hensley, Christian P Probst, Katia Noyes, John R T Monson, Fergal J Fleming
BACKGROUND: Current guidelines recommend extended-duration thromboprophylaxis for all abdominal oncologic resections. However, other high-risk patients may benefit from extended thromboprophylaxis. OBJECTIVE: The purpose of this study was to identify risk factors for postdischarge venothromboembolism after colorectal procedures. DESIGN: This was a retrospective cohort study. DATA SOURCES: The New York Statewide Planning and Research Cooperative System database (2005-2013) was the data source for this study...
March 2016: Diseases of the Colon and Rectum
D J Humes, A J Walker, B J Hunt, A A Sultan, J F Ludvigsson, J West
BACKGROUND: Appendicectomy is the commonest intra-abdominal emergency surgical procedure, and little is known regarding the magnitude and timing of the risk of venous thromboembolism (VTE) after surgery. This study aimed to determine absolute and relative rates of symptomatic VTE following emergency appendicectomy. METHODS: A cohort study was undertaken using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data of patients who had undergone emergency appendicectomy from 2001 to 2011...
March 2016: British Journal of Surgery
Tarik Sammour, Raaj Chandra, James W Moore
There is level one evidence to support combined mechanical and chemical thromboprophylaxis for 7-10 days after colorectal cancer surgery, but there remains a paucity of data to support extended prophylaxis after discharge. The aim of this clinical review is to summarise the currently available evidence for extended venous thromboprophylaxis after elective colorectal cancer surgery. Clinical review of the major clinical guidelines and published clinical data evaluating extended venous thromboprophylaxis after elective colorectal cancer surgery...
July 2016: Journal of Thrombosis and Thrombolysis
M-V Sénat, L Sentilhes, A Battut, D Benhamou, S Bydlowski, A Chantry, X Deffieux, F Diers, M Doret, C Ducroux-Schouwey, F Fuchs, G Gascoin, C Lebot, L Marcellin, G Plu-Bureau, B Raccah-Tebeka, E Simon, G Bréart, L Marpeau
OBJECTIVE: To determine the post-partum management of women and their newborn whatever the mode of delivery. MATERIAL AND METHODS: The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS: Because breastfeeding is associated with a decrease in neonatal morbidity (lower frequency of cardiovascular diseases, infectious, atopic or infantile obesity) (EL2) and an improvement in the cognitive development of children (EL2), exclusive and extended breastfeeding is recommended (grade B) between 4 to 6 months (Professional consensus)...
December 2015: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
K Pawlaczyk, M Gabriel, L Dzieciuchowicz, M Stanisić, B Begier-Krasinska, Z Gabriel, M Olejniczak-Nowakowska, T Urbanek
OBJECTIVE/BACKGROUND: In light of the methods generally used to assess the risk of venous thromboembolism (VTE), major vascular operations should be regarded as high risk procedures. Nevertheless, no principles for implementing and maintaining thromboprophylaxis have so far been developed. The aim of this study was to determine the frequency and nature of VTE occurrence in patients routinely applying pharmacological thromboprophylaxis following implantation of an aorto-bifemoral prosthesis...
January 2016: European Journal of Vascular and Endovascular Surgery
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