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Thrombophlebitis perioperative prophylaxis

Dilli Ram Poudel, Sushil Ghimire, Rashmi Dhital, Daniel A Forman, Theodore E Warkentin
Recently published reports have established a heparin-induced thrombocytopenia (HIT)-mimicking thromboembolic disorder without proximate heparin exposure, called spontaneous HIT syndrome. Although the pathophysiology remains unclear, anti-platelet factor 4 (PF4)/heparin antibodies possibly triggered by exposure to knee cartilage glycosaminoglycans or other non-heparin polyanions found on bacterial surfaces and nucleic acids have been postulated. We present a 53-year-old female receiving antithrombotic prophylaxis with aspirin following right total knee replacement surgery (without perioperative or any previous lifetime heparin exposure) who acutely presented with high-risk pulmonary embolism (PE) and right great saphenous vein thrombophlebitis on postoperative day (POD) 14; her platelet count at presentation was 13 × 10(9)/L...
September 2017: Platelets
R Buzelé, L Barbier, A Sauvanet, B Fantin
Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever...
August 2016: Journal of Visceral Surgery
S M Siboni, E Biguzzi, G Pasta, P M Mannucci, C Mistretta, N N Fantini, L P Solimeno, F Peyvandi
Knowledge regarding the management of orthopaedic surgery in patients with rare bleeding disorders (RBDs) is limited. Retrospective data collection and analysis of 35 orthopaedic procedures (6 minor and 29 major) carried out in 22 patients with RBD between 1982 and 2013. These surgeries were performed using heterogeneous regimens of hemostatic therapy, except for seven procedures performed with no hemostatic treatment in four patients with mild factor deficiency. Of the 28 procedures carried out with hemostatic treatment, nine (32%) were performed using replacement therapy with dosages of concentrates of the deficient factor aimed to achieve perioperative plasma levels judged to be compatible with hemostasis; three (11%) using factor replacement therapy associated with fresh frozen plasma (FFP); four (14%) using recombinant activated factor VII; four (14%) using virus inactivated plasma alone; three (11%) using virus inactivated plasma associated with desmopressin; one (4%) using FFP alone; and four (14%) procedures using tranexamic acid alone...
September 2014: Haemophilia: the Official Journal of the World Federation of Hemophilia
Guadalupe Zaragoza-Lemus, Raúl Carrillo-Esper
BACKGROUND: Thromboprophylaxis in surgical patients requires specific measures to implement regional anesthesia techniques. In this regard the current clinical practice guidelines of anesthesiology summarizes the recommendations of the review of current evidence. OBJECTIVE: We must recognize the general guidelines for thromboprophylaxis and impact modifiers of coagulation for the Surgical Team to implement the actions for each specific patient. DISCUSSION: The most feared event by anesthesiologists is the spinal hematoma, but given its rarity there is a prospective randomized study, nor is there currently a laboratory model...
September 2012: Cirugia y Cirujanos
C Sánchez Gutiérrez, A Alemán Martín, V Coronado Hijón, P Jiménez Delgado
Spinal epidural haematoma after neuroaxial anaesthesia is a rare but serious complication. Most cases are attributed to anticoagulant therapy or bleeding tendency. It presents as an acute spinal cord compression and usually requires emergency surgical decompression. The interval between the onset of clinical signs and surgical evacuation is very important, influencing the neurological prognosis. We report a case of a spinal epidural haematoma after epidural analgesia in a patient who was treated with low molecular weight heparin for thrombo-prophylaxis in the perioperative period...
November 2012: Revista Española de Anestesiología y Reanimación
C M Samama
The overall thromboembolic risk is the resultant of patient-related risk and surgical risk. The surgical risk is decreasing, especially with the introduction of new procedures (fast-track surgery). The value of prophylaxis has been firmly established. Mechanical prophylaxis is to be used as first-line prophylaxis when there is a risk of bleeding. Combining this with drugs increases the antithrombotic efficacy. However, the effectiveness of prophylaxis on pulmonary embolism and mortality has not been demonstrated...
December 2008: Annales Françaises D'anesthèsie et de Rèanimation
Brian S Knipp, Susan A Blackburn, Jess R Bloom, Elaine Fellows, William Laforge, John R Pfeifer, David M Williams, Thomas W Wakefield et al.
OBJECTIVE: We hypothesize that endovenous laser ablation (EVA) therapy is equally successful in improving venous insufficiency symptoms in patients with or without deep venous insufficiency (DVI). METHODS: From January 2005 through August 2007, EVA of the great saphenous vein (GSV) was attempted in 364 patients (460 limbs) with symptomatic GSV reflux. The GSV was successfully cannulated and obliterated in all but 17 limbs. EVA was performed alone in 308 limbs (69...
December 2008: Journal of Vascular Surgery
A Cyrkowicz, J Fiala, J Kacalski, P Jackowski, K Bielaszka, A Smida
OBJECTIVES: To compare the frequency of DVT and PE (pulmonary embolism) events in patients who had undergone gynecological operations under epidural/spinal anaesthesia without LMWH prophylaxis with patients receiving LMWH prophylaxis. DESIGN: Retrospective, hospital record based study. MATERIALS AND METHODS: The majority of patients had undergone vaginal operations. 441 consecutive, unselected patients without LMWH prophylaxis vs. 463 ones treated with LMWH...
November 1998: Ginekologia Polska
B Detournay, A Planes, N Vochelle, F Fagnani
The risk of late-occurring deep vein thrombosis and pulmonary embolism after total hip replacement persists for at least 3 weeks after hospital discharge. Recent clinical trials have demonstrated that prolonged prophylaxis with enoxaparin, a low-molecular-weight heparin (LMWH), significantly reduces this risk. We used a decision-analysis model to determine the incremental outcomes associated with the routine use of such prophylaxis, administered during hospitalisation for total hip replacement and for 3 weeks after discharge, instead of short term prophylaxis administered only during hospitalisation...
January 1998: PharmacoEconomics
E R Calkins
The active and experienced hand surgeon should have enough knowledge to recognize both common and uncommon hand infections. Control of hospital-acquired infections, including surgical site infections, requires a knowledge of potential personal risk factors and ongoing surveillance systems to aid in prevention and early detection. Current national trends may soon require that surgical-site infections be diagnosed by specific criteria that will allow comparisons of data from various locations. Although most hand surgery procedures are now performed on an ambulatory basis, it is important for the hand surgeon to be aware of current methodologies for the prevention, control, surveillance, and treatment of hospital-acquired infections...
November 1998: Hand Clinics
A Cyrkowicz, K Orczyk, M Bajorek, J Kawecki, P Jackowski
For many gynecological surgery patients belonging to deep vein thrombosis (DVT) high-risk group the analgesia of choice is regional spinal analgesia. Perioperatively LMWH--Fraxiparine was administered to 426 gynecological surgery patients and to 113 caesarean section patients. The first dose 7500 ICU s.c. was administered 2 hours before operation and consecutive ones every 24 hours for 5 to 7 days. The drug didn't cause any anaesthesia complications like enhanced bleeding after lumbar punction. It was emphasised in the discussion that in choosing this kind of prophylaxis certain conditions should be fulfilled in order to avoid spinal hematoma...
November 1997: Ginekologia Polska
E Voog
An increased incidence of deep vein thrombosis is reported in cancer patients as compared with general population. Several risk factors for deep vein thrombosis have been identified: venous stasis, direct invasion of venous wall by tumor, and hypercoagulability state by inadequate secretion of procoagulant activities. Reports have suggested that chemotherapeutic agents and hormonal treatment may contribute to this risk. Few papers are available concerning the prophylaxis and curative treatment of deep vein thrombosis in cancer patients and no consensus has been reached yet...
July 1998: Bulletin du Cancer
S Eriksson, L Backman, K G Ljungström
BACKGROUND: Suggested risk factors for postoperative thrombosis such as high fatty acid levels, hypercholesterolemia and diabetes are common in obese patients. METHODS: In a retrospective study, the case records of 328 patients operated for obesity by gastric procedure from September 1977 until December 1993 were analyzed: 253 women and 75 men with a mean age of 38 years and a mean body mass index (BMI) of 44 kg/m2. The operation time, use of epidural anesthesia, and the occurrence of risk factors; fatty acid levels, hypercholesterolemia and diabetes were recorded...
August 1997: Obesity Surgery
A H Graf, B Graf, M G Brandis, H D Kogelnik, A Staudach, H Traun
Venous thromboembolism is reported to be a leading cause of death and morbidity after surgery and during radiotherapy for gynecologic malignancies. This study was performed to evaluate the incidence of thromboembolism as well as the benefit and risk of its prophylaxis with coumarin in this patient selection. Between 1988 and 1992, 132 patients with gynecologic malignancies underwent postoperative or primary radiotherapy (53 patients without prior surgery). Heparin (5000 IU t.i.d., s.c.) was administered perioperatively, and coumarin (International normalized ratio = INR target 2...
May 1998: Anticancer Research
D H Ryan, M A Crowther, J S Ginsberg, C W Francis
BACKGROUND: A point mutation in coagulation factor V (A1691G) is associated with increased risk for venous thrombosis. However, limited information is available about the prospective risk for deep venous thrombosis in specific high-risk clinical settings. OBJECTIVE: To determine whether the factor V Leiden mutation is associated with an increased occurrence of deep venous thrombosis in patients undergoing hip or knee replacement surgery. DESIGN: Retrospective analysis of plasma samples obtained during six prospective clinical trials that compared different antithrombotic prophylaxis regimens in patients undergoing hip or knee replacement surgery...
February 15, 1998: Annals of Internal Medicine
G D Lowe
The prediction of patients who are at sufficiently high risk of postoperative deep venous thrombosis to indicate perioperative antithrombotic prophylaxis has traditionally used only clinical risk factors. The associations of preoperative and/or postoperative haemostatic tests with postoperative deep venous thrombosis are reviewed. In general, the results support the biological concept of a preoperative and postoperative prothrombotic tendency in patients who develop deep venous thrombosis. Increased levels of coagulation activation markers and decreased assays of fibrinolytic potential show consistent relationships to postoperative deep venous thrombosis...
1997: International Journal of Clinical & Laboratory Research
T T Horlocker, J A Heit
No abstract text is available yet for this article.
October 1997: Anesthesia and Analgesia
J F Azorin, J F Regnard, M Dahan, M Pansart
A French multicentre, open, randomized trial was conducted in lung cancer surgery in order to test the optimal dosage regimen: Fraxiparine 3075 IU AXa (fixed dosage) and Fraxiparine 4100 or 6150 IU AXa (dosage adjusted for body weight only), over a period of 8 days. 75 patients were allocated to each group. Efficacy (Doppler ultrasonography at D0 and D8, controlled by bilateral ascending phlebography when positive) and safety, i.e. perioperative blood loss and postoperative bleeding complications were the main assessment criteria...
May 1997: Annales de Cardiologie et D'angéiologie
G D Lowe
Prediction of patients at sufficiently high risk of postoperative deep vein thrombosis (DVT) to indicate perioperative antithrombotic prophylaxis usually employs only clinical risk factors. Studies of preoperative and/or postoperative haemostatic tests in the prediction of postoperative DVT are reviewed. In general, the results support the biological concept of a preoperative and postoperative prothrombotic tendency in patients who develop DVT. However, the clinical utility of such tests is unproven; so at present they cannot be advocated for routine preoperative or postoperative screening...
July 1997: Thrombosis and Haemostasis
A Sagripanti, A Ferretti, A Nicolini, A Carpi
Bleeding and thrombosis are major causes of morbidity and mortality in patients with chronic myeloproliferative disorders. We retrospectively evaluated 101 consecutive patients affected by primary thrombocytosis (46 male, 55 female, aged 18-84 years; mean +/- SD 61 +/- 15) followed for a period ranging from 6 months up to 10 years (median 5 years) at our hematological unit. At the time of diagnosis 48 patients were asymptomatic; 26 had clinical evidence of atherothrombosis (cerebral ischemic attacks, ischemic heart disease, peripheral occlusive arterial disease), ten had venous thrombosis, four experienced major hemorrhages, 23 presented microvascular ischemic manifestations namely erythromelalgia, paresthesias, acrocyanosis and dizziness...
1996: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
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