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VTE prophylaxis

Brandon Cave, Augustus Hough, Paul P Dobesh
Prophylaxis for venous thromboembolism (VTE) in hospitalized acutely ill medical patients is a well-established practice. Despite the increased use of inpatient prophylaxis, the duration of hospitalization is typically shorter than the duration of VTE prophylaxis provided in clinical trials. In addition, VTE events after hospitalization are not unusual, with the majority of events occurring within 30 days of hospital discharge. Therefore, the 30-day time period post discharge has been identified as a stage in which patients are still at high-risk of developing VTE...
March 15, 2018: Pharmacotherapy
Patrick B Murphy, Kelly N Vogt, Brandyn D Lau, Jonathan Aboagye, Neil G Parry, Michael B Streiff, Elliott R Haut
Importance: Venous thromboembolism (VTE) is the most preventable cause of morbidity and mortality in US hospitals, and approximately 2.5% of emergency general surgery (EGS) patients will be diagnosed with a VTE event. Emergency general surgery patients are at increased risk of morbidity and mortality because of the nature of acute surgical conditions and the challenges related to prophylaxis. Observations: MEDLINE, Embase, and the Cochrane Database of Collected Reviews were searched from January 1, 1990, through December 31, 2015...
March 14, 2018: JAMA Surgery
Haixia Zhou, Yuehong Hu, Xiaoqian Li, Lan Wang, Maoyun Wang, Jun Xiao, Qun Yi
AIM: The optimal risk assessment model (RAM) to stratify the risk of venous thromboembolism (VTE) in medical inpatients is not known. We examined and compared how well the Padua Prediction Score (PPS) and the Caprini RAM stratify VTE risk in medical inpatients. METHODS: We undertook a retrospective case-control study among medical inpatients admitted to a large general hospital in China during a 4-year period. In total, 902 cases were confirmed to have VTE during hospitalization and 902 controls were selected randomly to match cases by medical service...
March 13, 2018: Journal of Atherosclerosis and Thrombosis
Nitin Agarwal, Georgios A Zenonos, Prateek Agarwal, Frank J Walch, Eileen Roach, Sandra J Stokes, Robert M Friedlander, Peter C Gerszten
BACKGROUND: Pharmacological prophylaxis for venous thromboembolism (VTE) in the neurosurgical population is still a matter of debate, as the risk-to-benefit ratio is not well defined. OBJECTIVE: To further evaluate the risk-to-benefit ratio of VTE prophylaxis (VTEP) for all neurosurgical procedures. METHODS: A prospective evaluation was performed after the initiation of a VTEP protocol for 11 436 patients undergoing neurosurgical procedures over 24 mo...
March 9, 2018: Neurosurgery
Audrey A Merriam, Yongmei Huang, Cande V Ananth, Jason D Wright, Mary E D'Alton, Alexander M Friedman
OBJECTIVE:  This article evaluates trends in venous thromboembolism (VTE) prophylaxis during delivery hospitalizations in the United States. METHODS:  We utilized an administrative database to determine if women hospitalized for vaginal or cesarean delivery received pharmacologic VTE prophylaxis, mechanical VTE prophylaxis, or both from January 2011 through March 2015. Mechanical prophylaxis included sequential compression devices, graduated compression stockings, and other pneumatic devices...
February 2, 2018: American Journal of Perinatology
Diren Arsoy, Nicholas J Giori, Steven T Woolson
BACKGROUND: The use of chemoprophylaxis to prevent thromboembolic disease after primary THA and TKA can be associated with postoperative bleeding complications. Mechanical prophylaxis has been studied as an alternative to chemoprophylaxis with greater safety in patients undergoing THA, but no data have been published comparing the safety of chemoprophylaxis versus mechanical methods for patients undergoing TKA. The risk of readmission resulting from bleeding and venous thromboembolism (VTE) has also not been determined for patients undergoing THA or TKA when treated with low-molecular-weight heparin (LMWH) alone compared with mechanical prophylaxis plus aspirin (ASA)...
February 2018: Clinical Orthopaedics and related Research
Victor O Popoola, Brandyn D Lau, Esther Tan, Dauryne L Shaffer, Peggy S Kraus, Norma E Farrow, Deborah B Hobson, Jonathan K Aboagye, Michael B Streiff, Elliott R Haut
PURPOSE: Results of a study to characterize patterns of nonadministration of medication doses for venous thromboembolism (VTE) prevention among hospitalized patients are presented. METHODS: The electronic records of all patients admitted to 4 floors of a medical center during a 1-month period were examined to identify patients whose records indicated at least 1 nonadministered dose of medication for VTE prophylaxis. Proportions of nonadministered doses by medication type, intended route of administration, and VTE risk categorization were compared; reasons for nonadministration were evaluated...
March 15, 2018: American Journal of Health-system Pharmacy: AJHP
Ewa Zabrocka, Marek Z Wojtukiewicz, Ewa Sierko
Advanced cancer patients in hospice are at notably increased risk of venous thromboembolism (VTE) due to age, local and distal advancement of the malignancy and bed confinement, among other factors. Asymptomatic VTE prevalence among palliative care patients has been found to reach 50%, whereas the clinically overt form occurs in 10%. Hospice patients are frequently given medications increasing VTE risk, for instance megestrol which is a drug commonly used in cancer cachexia. Many of the available guidelines encourage the implementation of thromboprophylaxis (TPX) in cancer patients, e...
February 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Robert F Łukaszuk, Krzysztof Plens, Anetta Undas
BACKGROUND: Underuse of thromboprophylaxis in hospitalized medical patients is still common worldwide. Little is known about the use of thromboprophylaxis in patients with pulmonary diseases in everyday hospital practice. OBJECTIVES: The aim of this study was to assess the use of pharmacological prophylaxis of venous thromboembolism (VTE) in real-life patients with pulmonary diseases. MATERIAL AND METHODS: In this retrospective study, 2 validated scoring systems, i...
February 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Majed S Al Yami, Sawsan Kurdi, Ivo Abraham
Background: Standard-duration (7-10 days) thromboprophylaxis with low molecular weight heparin, low dose unfractionated heparin, or fondaparinux in hospitalized medically ill patients is associated with ~50% reduction in venous thromboembolism (VTE) risk. However, these patients remain at high risk for VTE post-discharge. The direct oral anticoagulants (DOACs) apixaban, rivaroxaban and betrixaban have been evaluated for extended-duration (30-42 days) thromboprophylaxis in this population...
2018: Journal of Blood Medicine
Ben Jacobs, Peter K Henke
Venous thromboembolism (VTE) remains a significant mortal and morbid disease. The major risks have not changed and many patients present with unprovoked VTE disease. Prevention of VTE in hospitalized patients depends on comprehensive risk factor assessment, with an individual risk score. Proper and timely prophylaxis with mechanical, pharmacologic, or both is then effective. Treatment of VTE with parenteral anticoagulation followed by either a direct oral anticoagulant or warfarin is standard to reduce risk of VTE recurrence and death...
April 2018: Surgical Clinics of North America
Luca Depietri, Marco Marietta, Stefania Scarlini, Matteo Marcacci, Elena Corradini, Antonello Pietrangelo, Paolo Ventura
International guidelines recommend the use of pharmacological prophylaxis in hospitalized medical patients at high risk of venous thromboembolism (VTE). The same international guidelines suggest the employment of standardized risk assessment models (RAMs) when evaluating the administration of pharmacological prophylaxis in acutely ill medical patients. The Padua Prediction Score and the Improve Bleeding Score have been indicated as the best available RAMs to predict thrombotic and haemorrhagic risk in hospitalized medical patients, but it is still unknown whether their combined use may lead to a significant reduction in thrombotic and haemorrhagic events...
March 3, 2018: Internal and Emergency Medicine
Daniel C Thomas, Brian N Arnold, Jessica R Hoag, Michelle C Salazar, Daniel J Boffa, Frank C Detterbeck, Anthony W Kim, Justin D Blasberg
BACKGROUND: Few studies have examined the risk factors and timing of venous thromboembolism (VTE) in patients undergoing surgery for lung cancer, and there is limited data to formulate guidelines for extended VTE prophylaxis after hospital discharge. This study sought to identify risk factors for post-discharge VTE following lung resection. METHODS: Patients undergoing anatomic resection for lung cancer were identified in the National Surgical Quality Improvement Program database from 2005-2015...
March 1, 2018: Annals of Thoracic Surgery
Ameer M Elbuluk, Kelvin Y Kim, Kevin K Chen, Afshin A Anoushiravani, Ran Schwarzkopf, Richard Iorio
The objective of this study was to evaluate the efficacy of respiratory synchronized compression devices (RSCDs) versus nonsynchronized intermittent pneumatic compression devices (NSIPCDs) in preventing venous thromboembolism (VTE) after total joint arthroplasty. A systematic literature review was conducted. Data regarding surgical procedure, deep vein thrombosis, pulmonary embolism, mortality, and adverse events were abstracted. Compared with control groups, the risk ratio of deep vein thrombosis development was 0...
April 2018: Orthopedic Clinics of North America
Alanna O'Brien, Bernice Redley, Beverley Wood, Mari Botti, Anastasia F Hutchinson
AIMS AND OBJECTIVES: The purpose of this research was to develop and test a clinical tool to guide nurses' assessment of postoperative patients for Deep Vein Thrombosis (DVT). BACKGROUND: Preventing venous thromboembolism (VTE) in hospitalised patients is an international patient safety priority. Despite high-level evidence for optimal VTE prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis (DVT) remains high. METHODS: A two stage sequential multi-method design was used...
March 1, 2018: Journal of Clinical Nursing
John D Cramer, Andrew G Shuman, Michael J Brenner
Objective The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in otolaryngology-head and neck surgery. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite national efforts in VTE prevention, guidelines do not exist for otolaryngology-head and neck surgery in the United States. Data Sources PubMed/MEDLINE. Review Methods A comprehensive review of literature pertaining to VTE in otolaryngology-head and neck surgery was performed, identifying data on incidence of thrombotic complications and the outcomes of regimens for thromboprophylaxis...
February 1, 2018: Otolaryngology—Head and Neck Surgery
Roopen Arya
Pregnancy-related venous thromboembolism (VTE) remains a leading cause of maternal morbidity and mortality. While the absolute risk is low, it is problematic considering the population comprises young women undergoing a common physiological process, and the risk is greatest postpartum. The evident benefits of targeted postpartum thromboprophylaxis ensure that expert guidance worldwide recommends risk assessment antenatally and at delivery and administration of thromboprophylaxis to those at high risk of VTE...
February 23, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
Eliza W Beal, Dmitry Tumin, Jeffery Chakedis, Erica Porter, Dimitrios Moris, Xu-Feng Zhang, Sherif Abdel-Misih, Mary Dillhoff, Andrei Manilchuk, Jordan Cloyd, Carl R Schmidt, Timothy M Pawlik
BACKGROUND: The objective of the current study was to define risk factors associated with the 30-day post-operative risk of VTE after HPB surgery and create a model to identify patients at highest risk of post-discharge VTE. METHODS: Patients who underwent hepatectomy or pancreatectomy in the ACS-NSQIP Participant Use Files 2011-2015 were identified. Logistic regression modeling was used; a model to predict post-discharge VTE was developed. Model discrimination was tested using area under the curve (AUC)...
February 19, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Linda S Yang, Sumaya Alukaidey, Katherine Croucher, Damian Dowling
BACKGROUND: Cirrhosis was previously perceived as a haemorrhagic disease state due to frequent associations with coagulopathy and bleeding. However, the coagulopathy of cirrhosis is complex with defects in both pro-coagulant and anticoagulant factors. Derangements in common laboratory indices of coagulation do not accurately reflect bleeding risk or protection from thrombotic events. AIM: We aim to assess the rate of pharmacological prophylaxis for VTE among hospital inpatients with cirrhosis and analyse factors associated with prophylaxis being inappropriately withheld...
February 21, 2018: Internal Medicine Journal
Christopher P Childers, Anaar E Siletz, Emily S Singer, Claire Faltermeier, Q Lina Hu, Clifford Y Ko, Gregory J Golladay, Stephen L Kates, Elizabeth C Wick, Melinda Maggard-Gibbons
Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery-a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
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