scholarly journals Extended venous thromboembolism prophylaxis after abdominopelvic cancer surgery: a retrospective review

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
M. Laureano ◽  
M. Ebraheem ◽  
M. Crowther
Keyword(s):  
Venous Thromboembolism ◽  
Tertiary Care ◽  
Transitional Cell ◽  
Cancer Surgery ◽  
Pelvic Surgery ◽  
Serous Carcinoma ◽  
Guideline Recommendation ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Pelvic Cancer

Objective Extended prophylaxis against venous thromboembolism (vte) after abdominal or pelvic cancer surgery with low molecular weight heparin (lmwh) is recommended by multiple guidelines. The primary objective of the present study was to assess adherence to that guideline recommendation at tertiary care centres within Hamilton Health Sciences (hhs).Methods Given that an estimated 70% of the study population would be expected to receive extended prophylaxis, a sample size of 105 patients was calculated. Patients who had undergone abdominal or pelvic surgery for cancer from March 2012 to December 2015 were identified, and data were collected from electronic health records. The primary outcome was prescription of extended vte prophylaxis.Results Of 105 patients, only 3 received extended vte prophylaxis. Those 3 patients had serous carcinoma of the uterus, transitional cell carcinoma of the bladder, and cecal cancer. Of the 3 patients, 2 were followed by the thrombosis service while in hospital; none of the other 102 patients received any form of extended vte prophylaxis.Conclusions Based on multiple randomized controlled trials, guidelines suggest lmwh prophylaxis for up to 4 weeks after major abdominal or pelvic cancer surgery. Despite those recommendations, postoperative extended vte prophylaxis is not commonly prescribed at hhs facilities. Next steps will include identification of barriers and an examination of how those barriers could be addressed. Failure to use prophylaxis is not consistent with evidencebased guidelines and is placing patients at risk of vte.

Implementation of extended prolonged venous thromboembolism prophylaxis with rivaroxaban after major abdominal and pelvic surgery safety and early outcomes.

2020 ◽  
Vol 92 (5) ◽  
pp. 1-5
Author(s):  
Volodymyr Tyselskyi ◽  
Vitaliy Poylin ◽  
Daniel Wong ◽  
Yegor Tryliskyy ◽  
Andrey Kebkalo
Keyword(s):  
Venous Thromboembolism ◽  
Colorectal Surgery ◽  
Factor Xa ◽  
Pelvic Surgery ◽  
Minor Bleeding ◽  
Thromboembolism Prophylaxis ◽  
Post Discharge ◽  
Vte Prophylaxis ◽  
Abdominal Bleeding ◽  
Patient Reported

Abstract Purpose: Venous thromboembolism (VTE) after colorectal surgery is a well-documented complication, resulting in a general recommendation of extended post discharge prophylaxis. Rivaroxaban, a factor Xa inhibitor, is a daily tablet approved for treatment of VTE and prophylaxis after orthopedic surgery. The purpose of this study is to evaluate the safety of rivaroxaban for extended prophylaxis after major abdominal and pelvic surgery. Methods: This is a retrospective review of patients undergoing major colorectal surgery at a regional hospital in Kiev, Ukraine. Patients received peri-operative VTE prophylaxis with subcutaneous heparin and then transitioned to rivaroxaban for a total of 30 days. Occurrences of major or minor bleeding, blood transfusion, and a need for re-intervention were noted. Phone surveys were administered on post-operative day 30 to assess compliance and satisfaction with the regimen. Results A total of 51 patients were included in the study with an average age of 62.4 years old. Seventy-one percent of the cases were abdominal cases, 29% were pelvic cases and 59% were done laparoscopically. There was one episode of major intra-abdominal bleeding requiring return to the operating room. There were 2 minor bleeding episodes not requiring intervention. There were no VTE events in the group. The phone survey response rate was 100%. All but one patient reported completing the full course of rivaroxaban. Patients reported that oral prophylaxis was easy to adhere to and preferable compared to injections. Conclusion Implementation of extended prophylaxis with rivaroxaban is easy, safe and does not increase rates of post-operative bleeding.

Post-discharge venous thromboembolism prophylaxis for surgical oncology patients.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 79-79
Author(s):  
Ashlie Nadler ◽  
Mary Ellen Morba ◽  
Jesse Pezzella ◽  
Jeffrey M. Farma
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Compliance Rate ◽  
Surgical Oncology ◽  
Pelvic Surgery ◽  
Cancer Center ◽  
Thromboembolism Prophylaxis ◽  
Post Discharge ◽  
Oncology Patients ◽  
Vte Prophylaxis

79 Background: A number of guidelines have been proposed for prolonged venous thromboembolism (VTE) prophylaxis following hospital discharge for cancer patients undergoing major abdominal or pelvic surgery. However, there is disparity in how closely these guidelines are followed. The purpose of this study was to examine the administration and complications of post-discharge chemical VTE prophylaxis (pdVTE) at an institutional level among surgical oncology patients to help inform policy creation. Methods: A retrospective study at a tertiary referral cancer center was performed. Data was analyzed for patients undergoing surgery in 2015. Chi-square tests were performed. Results: Of 566 colorectal, urologic, and gynecologic surgical oncology procedures performed in 2015, 24% (137) were discharged with a prescription for enoxaparin for pdVTE. An additional 24 patients were already on another form of anticoagulation at the time of discharge. Of the patients discharged on pdVTE, 77% (105) had the prescriptions filled. The compliance rate of those patients was 96% (101). The rate of VTE was 3.5% for all patients. There was a significantly greater rate of VTE amongst patients that received pdVTE (10.4%) compared to those who did not (1.6%) (OR 7.20, CI 2.80-18.46, p < 0.001). For each subspecialty, there was also a significantly greater rate of VTE amongst patients that received pdVTE (p < 0.001). Conclusions: There is a very low rate of pdVTE administration despite current guidelines. Identifying patients who received pdVTE appears to identify patients at high risk for VTE rather than the benefits of pdVTE. Institutional policies regarding prolonged VTE prophylaxis should be implemented to target high-risk patients and to ensure appropriate prescribing practices. [Table: see text]

scholarly journals Quality Improvement at an Academic Cancer Center: Venous Thromboembolism Prophylaxis in Patients With Multiple Myeloma

2020 ◽  
Vol 27 (2) ◽  
pp. 107327482093020
Author(s):  
Rachid Baz ◽  
Roy Furman ◽  
Katherine Simondsen ◽  
Christine Stone
Keyword(s):  
Multiple Myeloma ◽  
Quality Improvement ◽  
Venous Thromboembolism ◽  
Patient Education ◽  
Tertiary Care ◽  
Cancer Center ◽  
Prior History ◽  
Thromboembolism Prophylaxis ◽  
Practice Improvement ◽  
Vte Prophylaxis

Patients with multiple myeloma are at elevated risk of venous thromboembolism (VTE), the second leading cause of death in patients with cancer, but physician adherence to VTE prevention guidelines is low. Several organizations partnered in designing and implementing a 2-year quality improvement (QI) program in a tertiary care/academic cancer center, to increase awareness of VTE prophylaxis for patients with multiple myeloma and thus improve adherence to prophylaxis guidelines and protocols. The QI arm included 2 chart audits, conducted 2 years apart, of unmatched cohorts of 100 patients with multiple myeloma. An Education arm included 2 grand rounds presentations, 3 web-based case discussions, and a patient education module. Twenty providers took part in the continuous QI arm. More than 1100 learners participated in the online cases; the patient education curriculum reached 112 multiple myeloma patients. The initiative proved helpful in defining barriers to guideline adherence and identifying data-driven practice improvement strategies for VTE prophylaxis. It also increased learner awareness of VTE guidelines, patient risk stratification, and optimal thromboprophylaxis strategies. There was a reduction in VTE events (primary clinical outcome) from 10% at baseline to 4% in the follow-up cohort, although this was not statistically significant. Higher rates of guideline-based prophylaxis were observed in low-risk patients, and a lower incidence of VTE was observed in multiple myeloma patients with a prior history of VTE. Additional research is needed to refine prophylaxis guidelines. With appropriate institutional support, this type of QI program can be readily adopted by other organizations to address practice improvement needs.

Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: a UK national audit

2014 ◽  
Vol 115 (2) ◽  
pp. 223-229 ◽  
Author(s):  
Simon Pridgeon ◽  
Paula Allchorne ◽  
Bruce Turner ◽  
John Peters ◽  
James Green
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Surgery ◽  
National Audit ◽  
Vte Prophylaxis ◽  
Pelvic Cancer

Lack of extended venous thromboembolism prophylaxis in high-risk patients undergoing major orthopaedic or major cancer surgery

2009 ◽  
Vol 102 (07) ◽  
pp. 56-61 ◽  
Author(s):  
Klaus-Arno Siebenrock ◽  
Urs Metzger ◽  
Philipp Tuor ◽  
Daniel Sterzing ◽  
Kurt Oehy ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Knee Replacement ◽  
Hip Replacement ◽  
Orthopaedic Surgery ◽  
Cancer Surgery ◽  
Interquartile Range ◽  
Major Surgery ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis

SummaryExtended pharmacological venous thromboembolism (VTE) prophylaxis beyond discharge is recommended for patients undergoing high-risk surgery. We prospectively investigated prophylaxis in 1,046 consecutive patients undergoing major orthopaedic (70%) or major cancer surgery (30%) in 14 Swiss hospitals. Appropriate in-hospital prophylaxis was used in 1,003 (96%) patients. At discharge, 638 (61%) patients received prescription for extended pharmacological prophylaxis: 564 (77%) after orthopaedic surgery, and 74 (23%) after cancer surgery (p <0.001). Patients with knee replacement (94%), hip replacement (81%), major trauma (80%), and curative arthroscopy (73%) had the highest prescription rates for extended VTE prophylaxis; the lowest rates were found in patients undergoing major surgery for thoracic (7%),gastrointestinal (19%),and hepatobiliary (33%) cancer. The median duration of prescribed extended prophylax is was longer in patients with orthopaedic surgery (32 days, interquartile range 14–40 days) than in patients with cancer surgery (23 days, interquartile range 11–30 days; p<0.001).Among the 278 patients with an extended prophylaxis order after hip replacement, knee replacement, or hip fracture surgery, 120 (43%) received a prescription for at least 35 days, and among the 74 patients with an extended prophylaxis order after major cancer surgery, 20 (27%) received a prescription for at least 28 days. In conclusion, approximately one quarter of the patients with major orthopaedic surgery and more than three quarters of the patients with major cancer surgery did not receive prescription for extended VTE prophylaxis. Future effort should focus on the improvement of extended VTE prophylaxis, particularly in patients undergoing major cancer surgery.

Venous Thromboembolism Prophylaxis

2006 ◽  
Author(s):  
Richard C. Becker ◽  
Frederick A. Spencer
Keyword(s):  
Venous Thromboembolism ◽  
Orthopedic Surgery ◽  
Large Scale ◽  
Development Program ◽  
Thromboembolism Prophylaxis ◽  
Double Blind ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Disease States ◽  
Phase Ii Studies

Venous thromboembolism represents a true worldwide medical problem that is encountered within all realms of practice. Venous thromboembolism (VTE) occurs in approximately 100 patients per 100,000 population yearly in the United States and increases exponentially with each decade of life (White, 2003). Approximately one-third of patients with symptomatic deep vein thrombosis (DVT) experience a pulmonary embolism (PE). Death occurs within 1 month in 6% of patients with DVT and 12% of those with PE. Early mortality is associated strongly with presentation as PE, advanced age, malignancy, and underlying cardiovascular disease. An experience dating back several decades has provided a better understanding of disease states and conditions associated with VTE (Anderson and Spencer, 2003). Given the potential morbidity and mortality associated with VTE, it is apparent that prophylaxis represents an important goal in clinical practice. A variety of anticoagulants including unfractionated heparin, low-molecular-weight heparin (LMWH), and warfarin have been studied. More recently, two new agents have been developed that warrant discussion. Fondaparinux underwent a worldwide development program in orthopedic surgery for the prophylaxis of VTE. The program consisted mainly of four large, randomized, double-blind phase II studies comparing fondaparinux (SC), at a dose of 2.5 mg starting 6 hours postoperatively, with the two enoxaparin regimens approved for VTE prophylaxis—40 mg qd or 30 mg twice daily beginning 12 hours postoperatively. The results support a greater protective effect with fondaparinux, yielding a 55.2% relative risk reduction of VTE (Bauer et al., 2001; Eriksson et al., 2001; Lassen et al., 2002; Turpie et al., 2001, 2002; ). A European program of three large-scale clinical trials (MElagatran for THRombin inhibition in Orthopedic surgery [METHRO] I, II, and III, and EXpanded PRophylaxis Evaluation Surgery Study [EXPRESS]) (Eriksson et al., 2002a, b, 2003a, b) evaluated the safety and efficacy of subcutaneous melagatran followed by oral ximelagatran compared with LMWH for thromboprophylaxis following total hip replacement (THR) and total knee replacement (TKR) surgery.

scholarly journals Effectiveness and safety of inpatient versus extended venous thromboembolism (VTE) prophylaxis with heparin following major pelvic surgery for malignancy: protocol for a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Bridget Heijkoop ◽  
Natalie Parker ◽  
George Kiroff ◽  
Daniel Spernat
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Systematic Reviews ◽  
Pelvic Surgery ◽  
Current Evidence ◽  
Cochrane Library ◽  
Vte Prophylaxis ◽  
Optimum Duration ◽  
Number Of Patients ◽  
Increased Risk

Abstract Background Venous thromboembolism (VTE) is a common postoperative complication associated with significant morbidity and mortality. The use of prophylactic heparin postoperatively reduces this risk, and the use of extended duration prophylaxis is becoming increasingly common. Malignancy and pelvic surgery both independently further increase the risk of postoperative VTE and patients undergoing major pelvic surgery for malignancy are at particularly high risk of VTE. However, the optimum duration of prophylaxis specifically in this population currently remains unclear. Methods We will conduct a systematic review of literature in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.,2011) to evaluate current evidence of the effectiveness and safety of inpatient versus extended VTE prophylaxis with heparin (all forms) following major pelvic surgery for malignancy. We will search PubMed, EMBASE, and the Cochrane Library. Regarding safety, Food and Drug Administration (FDA), and Therapeutic Goods Administration (TGA) websites will be searched, including all levels of evidence. Results will be the postoperative timeframe in which a VTE event can be considered to have been provoked by the surgery, and the number of patients needed to treat with both inpatient and extended prophylaxis to prevent a VTE event in this timeframe, comparing these to determine if there is a significant benefit from extended prophylaxis. Discussion This systematic review will aim to identify the postoperative period in which patients undergoing major pelvic surgery for malignancy are at further increased risk of VTE as a result of their surgery and the optimum duration of heparin VTE prophylaxis with heparin to reduce this risk. Determining this will allow evidence-based recommendations to be made for the optimum duration of heparin VTE prophylaxis post major pelvic surgery for malignancy, leading to improved standards of care that are consistent between different providers and institutions. Systematic review registration In accordance with guidelines, our systematic review was submitted to PROSPERO for consideration of registration on 16/12/17 and was registered on 12/1/18 with the registration number CRD42018068961, and it was last updated on December 1, 2018.

Venous Thromboembolism Prophylaxis in Aesthetic Surgery: A Survey of Plastic Surgeons’ Practices

2020 ◽  
Vol 40 (12) ◽  
pp. 1351-1369 ◽  
Author(s):  
Victoria L Aimé ◽  
Matthew R Neville ◽  
Danielle A Thornburg ◽  
Shelley S Noland ◽  
Raman C Mahabir ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Assessment Tool ◽  
Aesthetic Surgery ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Electronic Survey ◽  
The Aesthetic

Abstract Background Deep venous thrombosis and pulmonary embolism, collectively known as venous thromboembolism (VTE), are among the most feared yet preventable surgical complications. Although many recommendations exist to reduce the risk of VTE, the actual VTE prophylaxis practices of aesthetic plastic surgeons remain unknown. Objectives The primary aim of this study was to elucidate plastic surgeons’ experiences with VTE, preferred VTE prophylaxis practices, and areas in which VTE prevention may be improved. Methods Members of The Aesthetic Society were queried via a 55-question electronic survey regarding their experience with VTE as well as their VTE prophylaxis practices. Anonymous responses were collected and analyzed by the Mayo Clinic Survey Research Center. Results The survey was sent to 1729 of The Aesthetic Society members, of whom 286 responded. Fifty percent, 38%, and 6% of respondents reported having had a patient develop a deep venous thrombosis, pulmonary embolism, or death secondary to VTE, respectively. Procedures performed on the back or trunk were associated with the highest rate of VTE. Lower extremity procedures were associated with a significantly higher rate of VTE than expected. Over 90% of respondents reported utilizing a patient risk stratification assessment tool. Although at least one-half of respondents reported that the surgical facility in which they operate maintains some form of VTE prophylaxis protocol, 39% self-reported nonadherence with these protocols. Conclusions Considerable variability exists in VTE prophylaxis practices among The Aesthetic Society responders. Future efforts should simplify guidelines and tailor prophylaxis recommendations to the aesthetic surgery population. Furthermore, education of plastic surgeons performing aesthetic surgery and more diligent surgical venue supervision is needed to narrow the gap between current recommendations and actual practices.

scholarly journals Venous Thromboembolism Prophylaxis and Risk for Acutely Medically Ill Patients Stratified by Different Ages and Renal Disease Status

2019 ◽  
Vol 25 ◽  
pp. 107602961882328 ◽  
Author(s):  
Alpesh Amin ◽  
W. Richey Neuman ◽  
Melissa Lingohr-Smith ◽  
Brandy Menges ◽  
Jay Lin
Keyword(s):  
Venous Thromboembolism ◽  
Renal Disease ◽  
Age Groups ◽  
Disease Status ◽  
The United States ◽  
Hospitalized Patients ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Medically Ill Patients

The objectives of this study were to examine venous thromboembolism (VTE) prophylaxis patterns and risk for VTE events during hospitalization and in the outpatient continuum of care among patients hospitalized for acute illnesses in the United States with stratification by different age groups and renal disease status. Acutely ill hospitalized patients were identified from the MarketScan databases (January 1, 2012-June 30, 2015) and grouped by age (<65, 65-74, ≥75 years old) and whether or not they had a baseline diagnosis of renal disease, separately. Of acutely ill hospitalized patients, 60.1% (n = 10 748) were <65 years old, 15.7% (n = 2803) were 65 to 74 years old, and 24.3% (n = 4344) were ≥75 years old; 32.9% (n = 5892) had baseline renal disease. Among the study cohorts, the majority of patients received no VTE prophylaxis regardless of age or baseline renal status (52.1%-63.6%). Rates of VTE during hospitalization and in the 6 months postdischarge were 4.7%, 4.6%, and 4.5% for patients <65, 65 to 74, and ≥75 years old, respectively, and 6.3% and 3.8% for patients with and without baseline renal disease. The risk for VTE was elevated for 30 to 40 days after index admission regardless of age and renal disease status.

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