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Pharmacological thromboprophylaxis

Elisa M Jorgensen, Anjie Li, Anna M Modest, Katherine Leung, Tiffany A Moore Simas, Hye-Chun Hur
OBJECTIVE: To evaluate the incidence of postoperative venous thromboembolism after gynecologic surgery by mode of incision. METHODS: We conducted a retrospective cohort study of all patients who underwent gynecologic surgery from May 2006 to June 2015 at two tertiary care academic hospitals in Massachusetts. Billing and diagnosis codes were used to identify surgeries and cases of venous thromboembolism. RESULTS: A total of 43,751 surgical encounters among 37,485 individual patients were noted during the study...
October 5, 2018: Obstetrics and Gynecology
Reinout R O Heijboer, Bart Lubberts, Daniel Guss, A Holly Johnson, Christopher W DiGiovanni
INTRODUCTION: Among patients undergoing below-knee orthopaedic surgery, no consensus exists regarding the need for or type of postoperative prophylaxis to prevent venous thromboembolic (VTE) events. The purpose of this study was to assess the incidence and risk factors associated with symptomatic VTE among orthopaedic patients undergoing below-knee surgery who were subject to different types of pharmacologic thromboprophylactic strategies. METHODS: A total of 20,043 adult patients who underwent surgery for a below-knee orthopaedic condition between August 2005 and August 2015 were identified...
October 4, 2018: Journal of the American Academy of Orthopaedic Surgeons
Nibal Chamoun, Elsy Ramia, Christelle Lteif, Pascale Salameh, Hala Zantout, Georges Ghanem, Rajaa Chatila
BACKGROUND: In this study, the authors utilized the IMPROVE bleeding definition to explore the safety profile of pharmacologic VTE prophylaxis in patients with CLD and concurrent coagulopathy (INR≥ 1.5). METHODS: A retrospective study was conducted on 193 adult patient admissions with a diagnosis of CLD and INR ≥1.5 not due to therapeutic anticoagulation. Patients were stratified based on their receipt of pharmacological thromboprophylaxis or not during hospitalization...
September 17, 2018: Current Medical Research and Opinion
Alexander M Friedman, Cande V Ananth, Jessica A Lavery, Adiel A Fleischer, Cynthia Chazotte, Mary E D'Alton
OBJECTIVE:  To determine whether a state-level initiative to reduce obstetric venous thromboembolism (VTE) risk affected outcomes and process measures. METHODS:  In 2013, the Safe Motherhood Initiative (SMI) developed a VTE safety bundle to reduce obstetric VTE risk. A total of 117 of 124 hospitals providing obstetrical services in New York participated in SMI. Data evaluating thromboembolism events (deep vein thrombosis and pulmonary embolism) and thromboprophylaxis process measures were collected from March through November 2015...
September 13, 2018: American Journal of Perinatology
Tyler C Lewis, Jennifer Cortes, Diana Altshuler, John Papadopoulos
Venous thromboembolism (VTE) is a major health concern associated with significant morbidity and mortality. Critically ill patients are at an increased risk of VTE compared to general medical patients due to unique risk factors: prolonged immobilization, invasive lines and devices, certain medications, and acquired thrombophilia. Furthermore, VTE in the critically ill is associated with increased duration of mechanical ventilation, increased length of intensive care unit and hospital stay, and a trend toward increased mortality...
August 30, 2018: Journal of Intensive Care Medicine
Bogna Grygiel-Górniak, Nattakarn Limphaibool, Mariusz Puszczewicz
Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) displays a severe disease sub-phenotype with vascular manifestations ranging from peripheral thrombosis to neurologic and ophthalmic symptoms. The prevalence of morbidities including thrombosis, renal lesions, and cognitive impairment contributes to a higher risk of organ damage and a reduced quality of life in patients. In addition to the clinical heterogeneity, the diagnostic challenge is heightened in elderly patients as APS-related SLE is primarily diagnosed in young females...
June 2018: Przeglad Menopauzalny, Menopause Review
Kristijonas Milinis, Joseph Shalhoub, Alexander P Coupland, Justin D Salciccioli, Ankur Thapar, Alun Huw Davies
OBJECTIVE: There is an increasing evidence base to support the use of extended pharmacologic thromboprophylaxis in selected surgical patients to prevent venous thromboembolism (VTE). The benefit of graduated compression stockings (GCS) in addition to extended pharmacologic thromboprophylaxis is unclear. The aim of this study was to systematically review the evidence relating to the effectiveness of using GCS in conjunction with extended pharmacologic thromboprophylaxis to prevent VTE in surgical patients...
August 17, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Mohammad Amre Fallaha, Sarkhell Radha, Sheena Patel
Background: Venous thromboembolism (VTE) remains a significant complication following knee and hip arthroplasty. National and international guidelines recommend pharmacological and mechanical thromboprophylaxis following surgery, unless contraindicated, to reduce the risk of VTE. This study aimed to explore the safety and efficacy profile of an adapted thromboprophylaxis regimen consisting of sequential enoxaparin and rivaroxaban for thromboprophylaxis following knee or hip arthroplasty at a London teaching hospital...
2018: Patient Safety in Surgery
Mohammed Biset Ayalew, Boressa Adugna Horsa, Meseret Tilahun Zeleke
Background: Most of hospitalized patents are at risk of developing deep vein thrombosis (DVT). The use of pharmacological prophylaxis significantly reduces the incidence of thromboembolic events in high risk patients. The aim of this study was to assess appropriateness of DVT prophylaxis in hospitalized medical patients in an Ethiopian referral hospital. Methods: Cross-sectional study design was employed. Patients with a diagnosis of DVT, taking anticoagulant therapy, and those who refused to participate were excluded from the study...
2018: International Journal of Vascular Medicine
Katie Lee, Samantha Cham, Sum Lam
Venous thromboembolism (VTE) is a common and preventable cause of morbidity and mortality in hospitalized patients. Low-molecular-weight heparin, low-dose unfractionated heparin, fondaparinux, and warfarin have been the mainstay options for the prevention and treatment of VTE before the emergence of nonvitamin K antagonist oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban. Despite the advantages of NOACs in improving patient adherence, none of them are approved for the prevention of VTE in acutely ill medical patients at high risk of thromboembolism...
November 2018: Cardiology in Review
Marcello Di Nisio, Matteo Candeloro, Anne Wilhelmina Saskia Rutjes, Valerio Galli, Marcello Tritto, Ettore Porreca
BACKGROUND: Cancer patients hospitalized for an acute medical illness are considered to be at high risk of venous thromboembolism (VTE). Information on bleeding and symptomatic VTE in these patients remains scant. The objectives of this study were to evaluate the incidence of bleeding and VTE during hospitalization and after discharge in a prospective cohort of hospitalized medically-ill cancer patients. METHODS: Consecutive patients with active cancer admitted for an acute medical illness...
September 2018: Thrombosis Research
Menno V Huisman, Frederikus A Klok
Venous thromboembolism (VTE) in acute medically ill patients is a leading cause of in-hospital morbidity and mortality. A majority of these VTE events occur post-discharge, and patients remain at increased VTE risk for up to 3 months post-discharge. Recent clinical trials of extended-duration thromboprophylaxis with enoxaparin, rivaroxaban, and apixaban in acute medically ill patients did not demonstrate a net clinical benefit compared with in-hospital thromboprophylaxis, and were shown to be associated with higher risks of major bleeding...
May 2018: European Heart Journal Supplements: Journal of the European Society of Cardiology
Joseph Margolick, Charlotte Dandurand, Katrina Duncan, Wenjia Chen, David C Evans, Mypinder S Sekhon, Naisan Garraway, Donald E G Griesdale, Peter Gooderham, S Morad Hameed
BACKGROUND: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of pharmacological venous thromboprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the postinjury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. METHODS: MEDLINE and EMBASE databases were searched. Inclusion criteria were studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation...
July 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Hu Wang, Utku Kandemir, Ping Liu, Hong Zhang, Peng-Fei Wang, Bin-Fei Zhang, Kun Shang, Ya-Hui Fu, Chao Ke, Yan Zhuang, Xing Wei, Zhong Li, Kun Zhang
PURPOSE: To determine perioperative incidence and locations of deep vein thrombosis (DVT) in injured and uninjured lower extremities following isolated lower extremity fractures (ILEFs). METHODS: Retrospective analysis of a prospectively collected data of a consecutive patient series with ILEFs who underwent surgical treatment between September 2014 and September 2017 was performed. Patients' bilateral lower extremities were screened for DVT with duplex ultrasonography (DUS) before and after surgery...
May 22, 2018: Injury
Deborah K Rose, Barak Bar
Vitamin K antagonists (VKAs), such as warfarin, have been used for thromboprophylaxis and for the treatment of thromboembolic events in patients with nonvalvular atrial fibrillation for over 60 years. The increasing use of direct oral anticoagulants (DOACs) in recent years has shown greater advantages and safer use over VKA, including reduced bleeding, fewer drug interactions, no food interactions, a quick onset and offset of activity, and predictable dose-response properties. Despite their advantages, there are a couple of major limitations that raise concerns among clinicians, including the need for more coagulation assays to monitor their effects and more specific reversal antidotes in life-threatening circumstances of bleeding...
August 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Desirae E Lindquist, David W Stewart, Aaryn Brewster, Caitlin Waldroup, Brian L Odle, Jessica E Burchette, Hadi El-Bazouni
BACKGROUND: Guidelines recommend the use of multiple pharmacologic agents and/or mechanical compressive devices for prevention of venous thromboembolism, but preference for any specific agent is no longer given in regard to safety or efficacy. OBJECTIVE: To compare postoperative bleeding rates in patients receiving enoxaparin, rivaroxaban, or aspirin for thromboprophylaxis after undergoing elective total hip arthroplasty or total knee arthroplasty. METHODS: This retrospective cohort analysis evaluated patients who received thromboprophylaxis with either enoxaparin, rivaroxaban, or aspirin...
November 2018: Clinical and Applied Thrombosis/hemostasis
Robert F Łukaszuk, Justyna Dolna-Michno, Krzysztof Plens, Grzegorz Czyżewicz, Anetta Undas
Aim of the study: Thromboprophylaxis in cancer patients during hospitalization reduces the risk of venous thromboembolism (VTE). Material and methods: To assess the underuse and the overuse of thromboprophylaxis in cancer patients at a tertiary oncology department, we retrospectively analyzed 1983 consecutive hospitalizations of 498 cancer patients who received chemotherapy from October 2016 to May 2017. The Padua prediction score (≥ 4 points) and Caprini risk assessment (≥ 5 points) were used to identify patients at high risk of VTE...
2018: Contemporary Oncology Współczesna Onkologia
Yu-Fen Ma, Yuan Xu, Ya-Ping Chen, Xiao-Jie Wang, Hai-Bo Deng, Yu He, Xin-Juan Wu
Venous thromboembolism (VTE) is a common vascular disorder with high mortality and morbidity. Clinical nurses are a pivotal group that can serve as first-line health care providers. Lack of knowledge about VTE is an important barrier to effective nursing performance. This study aimed to determine nurses' knowledge of VTE prophylaxis through a nationwide survey across China, to understand gaps between current knowledge, and guidelines, and to help improve clinical nursing.The survey included 5 topics with 68 items on VTE, including basic knowledge, risk assessment, basic prophylaxis, physical prophylaxis, and pharmacological prophylaxis...
April 2018: Medicine (Baltimore)
Sarah Goldman, Paulina Frączek, Krzysztof Szklanny, Elżbieta Papuga-Szela, Andrzej Stanisz, Anetta Undas
BACKGROUND:  Prothrombotic clot phenotype may characterize patients developing deep vein thrombosis (DVT) despite pharmacological thromboprophylaxis. We studied the role of fibrin clot properties and its potential determinants in individuals who experienced DVT after lower limb injury. METHODS:  In a case-control study, we assessed 50 patients who developed DVT despite prophylactic use of low-molecular-weight heparins (the failed thromboprophylaxis group) after a lower limb injury, and three age- and sex-matched control groups, 50 patients each: (1) patients with trauma-related DVT without prior thromboprophylaxis; (2) individuals with unprovoked DVT; (3) patients without history of DVT (the no-DVT controls)...
April 2018: Thrombosis and Haemostasis
Sabine Eichinger, Lisbeth Eischer, Hana Sinkovec, Gabriela Wittgruber, Ludwig Traby, Michael Kammer, Paul A Kyrle, Oskar Steinbrecher, Herbert Kaloud, Victoria Kyrle, Hartwig Moser, Renate Wildburger
BACKGROUND: Patients with spinal cord injury (SCI) are at risk of thrombosis and bleeding. Data on the risks during rehabilitation are inconsistent, and thromboprophylactic strategies are heterogeneous. We aimed to evaluate the thrombotic risk and bleeding events of SCI patients during rehabilitation. METHODS: We retrospectively collected hospital record data of 263 consecutive SCI patients admitted at a rehabilitation clinic. 78 patients with acute venous thromboembolism (VTE) at the primary center, without acute trauma or lower extremity paresis, less than one month rehabilitation, or reasons for long-term therapeutic anticoagulation, were excluded...
2018: PloS One
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