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Symptomatic perioperative venous thromboembolism is a frequent complication in patients with a history of deep vein thrombosis.

Abstract

OBJECTIVES

Patients who undergo surgery are at risk for venous thromboembolism (VTE), and a history of prior deep vein thrombosis (DVT) increases that risk. This study determined the incidence and risk factors for symptomatic perioperative VTE in patients with a prior diagnosis of DVT.

METHODS

All lower extremity DVTs, diagnosed between January 2002 and December 2006, were identified through a vascular database. Patients who had subsequent surgery were reviewed. The following data were evaluated: location of DVT, time interval between DVT and surgery, type of surgery, common clinical VTE risk factors, postoperative venous duplex scans, computed tomography (CT) scans of the chest, and ventilation-perfusion scans.

RESULTS

A total of 372 patients with prior DVT underwent 1081 subsequent surgical procedures. One hundred nine patients undergoing 211 procedures had a follow-up venous duplex scan within 30 days after surgery. Of them, 46% received an inferior vena caval (IVC) filter, and pulmonary emboli were diagnosed in 3 patients (<1%). Overall, 24% of the patients developed DVT extension or new-site DVT in the perioperative period. The median time interval between the original DVT and surgery was 1.5 weeks in patients with DVT recurrence and 4 weeks in patients without recurrence (P = .22, Mann-Whitney). High-risk surgeries were associated with a >three-fold increased risk for recurrence, when compared with low-risk procedures (34% vs 11%; P = .009, chi(2)). Perioperative VTE recurrence was not influenced by the location of the original thrombus or other VTE risk factors.

CONCLUSION

In patients with prior DVT, perioperative symptomatic recurrence is common and is associated with high-risk procedures. A longer time interval between a DVT episode and subsequent surgery may decrease the risk of recurrence, but large clinical trials are needed to confirm this. Further prospective evaluations are needed to identify and treat patients at greatest risk for recurrence.

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  • Authors+Show Affiliations

    ,

    Division of Vascular Surgery and the Division of Hematology/Oncology, Oregon Health & Science University, Portland, Ore 97239, USA. liemt@ohsu.edu

    , , , , , ,

    Source

    Journal of vascular surgery 52:3 2010 Sep pg 651-7

    MeSH

    Adult
    Aged
    Chi-Square Distribution
    Female
    Humans
    Incidence
    Logistic Models
    Lower Extremity
    Male
    Middle Aged
    Odds Ratio
    Oregon
    Perfusion Imaging
    Pulmonary Embolism
    Recurrence
    Retrospective Studies
    Risk Assessment
    Risk Factors
    Surgical Procedures, Operative
    Time Factors
    Tomography, X-Ray Computed
    Ultrasonography, Doppler, Duplex
    Venous Thromboembolism
    Venous Thrombosis

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    20558025

    Citation

    Liem, Timothy K., et al. "Symptomatic Perioperative Venous Thromboembolism Is a Frequent Complication in Patients With a History of Deep Vein Thrombosis." Journal of Vascular Surgery, vol. 52, no. 3, 2010, pp. 651-7.
    Liem TK, Huynh TM, Moseley SE, et al. Symptomatic perioperative venous thromboembolism is a frequent complication in patients with a history of deep vein thrombosis. J Vasc Surg. 2010;52(3):651-7.
    Liem, T. K., Huynh, T. M., Moseley, S. E., Minjarez, R. C., Landry, G. J., Mitchell, E. L., ... Moneta, G. L. (2010). Symptomatic perioperative venous thromboembolism is a frequent complication in patients with a history of deep vein thrombosis. Journal of Vascular Surgery, 52(3), pp. 651-7. doi:10.1016/j.jvs.2010.04.029.
    Liem TK, et al. Symptomatic Perioperative Venous Thromboembolism Is a Frequent Complication in Patients With a History of Deep Vein Thrombosis. J Vasc Surg. 2010;52(3):651-7. PubMed PMID: 20558025.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Symptomatic perioperative venous thromboembolism is a frequent complication in patients with a history of deep vein thrombosis. AU - Liem,Timothy K, AU - Huynh,Thanh M, AU - Moseley,Shannon E, AU - Minjarez,Renee C, AU - Landry,Gregory J, AU - Mitchell,Erica L, AU - Deloughery,Thomas G, AU - Moneta,Gregory L, Y1 - 2010/06/16/ PY - 2010/01/26/received PY - 2010/04/06/revised PY - 2010/04/12/accepted PY - 2010/6/19/entrez PY - 2010/6/19/pubmed PY - 2010/9/29/medline SP - 651 EP - 7 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 52 IS - 3 N2 - OBJECTIVES: Patients who undergo surgery are at risk for venous thromboembolism (VTE), and a history of prior deep vein thrombosis (DVT) increases that risk. This study determined the incidence and risk factors for symptomatic perioperative VTE in patients with a prior diagnosis of DVT. METHODS: All lower extremity DVTs, diagnosed between January 2002 and December 2006, were identified through a vascular database. Patients who had subsequent surgery were reviewed. The following data were evaluated: location of DVT, time interval between DVT and surgery, type of surgery, common clinical VTE risk factors, postoperative venous duplex scans, computed tomography (CT) scans of the chest, and ventilation-perfusion scans. RESULTS: A total of 372 patients with prior DVT underwent 1081 subsequent surgical procedures. One hundred nine patients undergoing 211 procedures had a follow-up venous duplex scan within 30 days after surgery. Of them, 46% received an inferior vena caval (IVC) filter, and pulmonary emboli were diagnosed in 3 patients (<1%). Overall, 24% of the patients developed DVT extension or new-site DVT in the perioperative period. The median time interval between the original DVT and surgery was 1.5 weeks in patients with DVT recurrence and 4 weeks in patients without recurrence (P = .22, Mann-Whitney). High-risk surgeries were associated with a >three-fold increased risk for recurrence, when compared with low-risk procedures (34% vs 11%; P = .009, chi(2)). Perioperative VTE recurrence was not influenced by the location of the original thrombus or other VTE risk factors. CONCLUSION: In patients with prior DVT, perioperative symptomatic recurrence is common and is associated with high-risk procedures. A longer time interval between a DVT episode and subsequent surgery may decrease the risk of recurrence, but large clinical trials are needed to confirm this. Further prospective evaluations are needed to identify and treat patients at greatest risk for recurrence. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/20558025/Symptomatic_perioperative_venous_thromboembolism_is_a_frequent_complication_in_patients_with_a_history_of_deep_vein_thrombosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(10)00983-3 DB - PRIME DP - Unbound Medicine ER -