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Venous thromboembolism in patients undergoing surgery: low rates of prophylaxis and high rates of filter insertion.

Abstract

Patients who undergo surgery are at a high risk of developing venous thromboembolism (VTE). To further define the demographics, comorbidities, and risk factors of VTE in patients undergoing major surgery, we analyzed 1,375 hospitalized non-orthopedic surgery patients in a prospective registry of 5,451 patients with ultrasound confirmed deep vein thrombosis (DVT) from 183 hospitals in the United States. Extremity edema (67.9%), extremity discomfort (44.9%), and dyspnea (18.9%) were among the most common presenting symptoms among these surgical patients. Compared to medical patients, surgical patients presented with a more occult clinical picture and complained less often of extremity edema (67.9% vs. 73.7%; p = 0.0001), extremity discomfort (44.9% vs. 56.4%; p < 0.0001), or difficulty walking (6.6% vs. 11.2%; p < 0.0001). Immobility within 30 days of DVT diagnosis, prior hospitalization within 30 days of DVT diagnosis, presence of an indwelling central venous catheter, obesity (BMI>30 kg/m2), and previous smoking were the most commonVTE risk factors among surgical patients. Among surgical patients who developed DVT, some form of prophylaxis had been used in only 44%. Once diagnosed with DVT, surgical patients received IVC filters more often than medical patients (20.0% vs. 14.1%; p < 0.0001; adjusted OR = 1.49, 95% CI = 1.17-1.92; p < 0.001). In conclusion, VTE prophylaxis remains underutilized in surgical patients. The IVC filter utilization rate in surgical patients is significantly higher than in medical patients. Future studies should focus on devising mechanisms to improve implementation of prophylaxis and investigate the long-term safety and efficacy of IVC filters in surgical patients.

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Authors+Show Affiliations

,

Cardiovascular Division, Brigham and Women's Hospital Boston, MA 02115, USA.

, ,

Source

Thrombosis and haemostasis 98:6 2007 Dec pg 1220-5

MeSH

Aged
Anticoagulants
Catheterization, Central Venous
Catheters, Indwelling
Dyspnea
Edema
Female
Guideline Adherence
Hospitalization
Humans
Immobilization
Male
Middle Aged
Obesity
Odds Ratio
Pain
Practice Guidelines as Topic
Prospective Studies
Registries
Risk Assessment
Risk Factors
Smoking
Surgical Procedures, Operative
Ultrasonography
United States
Vena Cava Filters
Venous Thromboembolism

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

18064317

Citation

Seddighzadeh, Ali, et al. "Venous Thromboembolism in Patients Undergoing Surgery: Low Rates of Prophylaxis and High Rates of Filter Insertion." Thrombosis and Haemostasis, vol. 98, no. 6, 2007, pp. 1220-5.
Seddighzadeh A, Zurawska U, Shetty R, et al. Venous thromboembolism in patients undergoing surgery: low rates of prophylaxis and high rates of filter insertion. Thromb Haemost. 2007;98(6):1220-5.
Seddighzadeh, A., Zurawska, U., Shetty, R., & Goldhaber, S. Z. (2007). Venous thromboembolism in patients undergoing surgery: low rates of prophylaxis and high rates of filter insertion. Thrombosis and Haemostasis, 98(6), pp. 1220-5.
Seddighzadeh A, et al. Venous Thromboembolism in Patients Undergoing Surgery: Low Rates of Prophylaxis and High Rates of Filter Insertion. Thromb Haemost. 2007;98(6):1220-5. PubMed PMID: 18064317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venous thromboembolism in patients undergoing surgery: low rates of prophylaxis and high rates of filter insertion. AU - Seddighzadeh,Ali, AU - Zurawska,Urszula, AU - Shetty,Ranjith, AU - Goldhaber,Samuel Z, PY - 2007/12/8/pubmed PY - 2008/2/27/medline PY - 2007/12/8/entrez SP - 1220 EP - 5 JF - Thrombosis and haemostasis JO - Thromb. Haemost. VL - 98 IS - 6 N2 - Patients who undergo surgery are at a high risk of developing venous thromboembolism (VTE). To further define the demographics, comorbidities, and risk factors of VTE in patients undergoing major surgery, we analyzed 1,375 hospitalized non-orthopedic surgery patients in a prospective registry of 5,451 patients with ultrasound confirmed deep vein thrombosis (DVT) from 183 hospitals in the United States. Extremity edema (67.9%), extremity discomfort (44.9%), and dyspnea (18.9%) were among the most common presenting symptoms among these surgical patients. Compared to medical patients, surgical patients presented with a more occult clinical picture and complained less often of extremity edema (67.9% vs. 73.7%; p = 0.0001), extremity discomfort (44.9% vs. 56.4%; p < 0.0001), or difficulty walking (6.6% vs. 11.2%; p < 0.0001). Immobility within 30 days of DVT diagnosis, prior hospitalization within 30 days of DVT diagnosis, presence of an indwelling central venous catheter, obesity (BMI>30 kg/m2), and previous smoking were the most commonVTE risk factors among surgical patients. Among surgical patients who developed DVT, some form of prophylaxis had been used in only 44%. Once diagnosed with DVT, surgical patients received IVC filters more often than medical patients (20.0% vs. 14.1%; p < 0.0001; adjusted OR = 1.49, 95% CI = 1.17-1.92; p < 0.001). In conclusion, VTE prophylaxis remains underutilized in surgical patients. The IVC filter utilization rate in surgical patients is significantly higher than in medical patients. Future studies should focus on devising mechanisms to improve implementation of prophylaxis and investigate the long-term safety and efficacy of IVC filters in surgical patients. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/18064317/Venous_thromboembolism_in_patients_undergoing_surgery:_low_rates_of_prophylaxis_and_high_rates_of_filter_insertion_ L2 - https://medlineplus.gov/surgery.html DB - PRIME DP - Unbound Medicine ER -