Thromboprophylaxis in surgical patients with pulmonary embolism and deep vein thrombosis in Murska Sobota General Hospital
Abstract
Background: Venous thromboembolism is the formation of clot in a deep vein, which causes complete or partial obstruction of the vein. This can be shown as a deep vein thrombosis or a pulmonary embolism. Deep vein thrombosis or pulmonary embolism, consequently, are a common complication after surgical procedures. Therefore, the need for appropriate guidelinebased preventive therapy of venous thromboembolism is crucial.
The aim of our study was to determine the adequacy of preventive therapy for deep vein thrombosis or pulmonary embolism in surgical patients who were diagnosed with deep vein thrombosis or pulmonary embolism from 1.1.2007 to 31.12.2011 at the Murska Sobota General Hospital as a complication of surgical treatment and to compare the test group with the control group, in which there was no not either deep vein thrombosis or pulmonary embolism after surgical treatment.
Methods: We reviewed the guidelines for the prevention of venous thromboembolism and determined the appropriate selection of drugs, the adequacy of dose and dosing interval, and the appropriate duration of therapy based on the risk assessment score provided by the guidelines. In the test group, we included 144 patients who were treated in the surgical department at the Murska Sobota General Hospital between 2007 and 2011 and had deep venous thrombosis or pulmonary embolism as main or associated diagnosis as a complication during surgical treatment. In the control group, we included 142 patients who were treated in the surgical department at the Murska Sobota General Hospital and did not had venous thromboembolism as the principal or accompanying diagnosis. Both groups were compared.
Results: In the control group, 77% of patients received thromboprophylaxis according to the guidelines, while the proportion in the test group was 56%. Significant differences receiving adequate thromboprophylaxis (p <0.05) between the two groups were demonstrated with the chi-square test.
Conclusion: According to the findings of our study we can conclude that the proportion of patients with adequate thromboprophylaxis in surgical patients is still not optimal. The key to appropriate thromboprophylaxis is a good risks assessment of the patient and appropriate selection of thromboprophylaxis therapie. We believe, that it would be reasonable to introduce a formal and active strategies for the prevention of venous thromboembolism to provide the most appropriate protection of patients at increased risk.
Downloads
References
Lefkowitz JB. Coagulation pathway and physiology. Dec 2012. Dosegljivo na: http://www.cap.org/apps/docs/cap_press/hemostasis_testing/coagulation_pathway.pdf
Kocijančič A, Mrevlje F, Štajer D: Interna medicina, tretja izdaja, Založba Littera Picta d.d.o., Ljubljana, 2005: 273-86.
Gailani D, Renné T. Intrinsic pathway of coagulation and arterial thrombosis. Arterioscler Thromb Vasc Biol; 2007; 27:2507-13.
Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Berggvist D, Brecht JG, Greer IA, Heit JA, Hutchinson JL, Kakkar AK, Mottier D, Oger E, Samama MM, Spannagl M. Venous thromboembolism (VTE) in Europe. Thromb Haemost 2007; 98: 756–64.
Kahn SR, Ginsberg JS. Relationship between deep venous thrombosis and the postthrombotic sydrome. Arch Intern Med. 2004; 164:17-26
Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, Albanese P, Biasiolo A, Pegoraro C, Iliceto S, Prandoni P. Thromboembolic pulmonary hypertension study group. N Engl J Med 2004; 350:2257-64.
Richard HW. The epidemiology of venous thromboembolism, Circulation 2003; 107:I-4-I-8.
Hawkins D: The role of oral direct thrombin inhibitors in the prophylaxis of venous thromboembolism, Pharmacotherapy. 2004; 24: 179S-183S.
Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practical guidelines. Chest 2012; 141:e227S.
Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, Huang W, Zayaruzny M, Emery L, Anderson FA. Venous thromboembolism risk and prophylaxis in the acute hospital care (ENDORSE study): a multinational cross—sectional study. Lancert 2008; 371:387-94.
Baza podatkov o zdravilih. Sept 2012. Dosegljivo na: http://www.zdravila.net
Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, Bandel TJ, Beckmann H, Muehlhofer E, Misselwitz F, Greets W. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008; 358:2765-75.
Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, Kälebo P, Christiansen AV, Hantel S, Hettiarachchi R, Schnee J, Büller HR. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 2007; 5: 2178–85.
Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Hornick P. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. The Lancet; 2010:807-15.
Lassen MR, Gallus A, Raskob GE, Pineo G, Chen D, Ramirez LM. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med 2010; 363:2487-98.
Ponikvar M, Vene N, Mavri A, Boc A, Fokter SK. Preprečevanje venske trombembolije pri artroplastiki kolka in kolena: Zdrav Vestn 2010; 79: 235-43.
Coon WW, Willis PW. Deep venous thrombosis and pulmonary embolism: prediction, prevention and treatment. Am J Cardiol; 1959;4:611.
Kim DY, Kobayashi L, Barmparas G, Fortlage D, Curry T, Coimbra R: Venous thromboembolism in the elderly: the result of comorbid conditions or a consequence of injury. J Trauma Acute Care Surg; 2012; 72(5): 1286-91.
Wattanakit K, Lutsey PL, Bell EJ, Gornik H, Cushman M, Heckbert SR, Rosamond WD, Folsom AR. Association between cardiovascular disease risk factors and occurrence of venous thromboembolism. A time-dependent analysis. Thromb Haemost; 2012; 108(3):508-15.
Stroh K, Luderer D, Weiner R, Horbach T, Ludwig K, Benedix E, Wolff S, Knoll C, Lippert H, Manger T. Actual situation of thromboembolic prophylaxis in obesity surgery: data of quality assurance in bariatric surgery in Germany. Thrombosis; 2012.
Mirkazemi C, Bereznicki LR, Peterson GM. Thromboprophylaxis following hip and knee arthroplasty. Intern Med J; 2013; 43(2):124-9
Rajabi F, Sadeghi M, Karbasian F, Torkan A. Is thromboprophylaxis effective in reducing the pulmonary thromboembolism? ARYA Atheroscler; 2012; 8(1):16-20.
Yu HT, Dylan ML, Lin J, Dubois RW. Hospitals' compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm; 2007; 1;64(1):69-76.
Persson G, Strömberg J, Svennblad B, Sandblom G. Risk of bleeding associated with use of systemic thromboembolic prophylaxis during laparoscopic cholecystectomy. Br J Surg; 2012; 99(7):979-86
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
