Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Department of Clinical Epidemiology and Biostatistics, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada.
Chest (Impact Factor: 7.13). 02/2012; 141(2 Suppl):7S-47S. DOI: 10.1378/chest.1412S3
Source: PubMed
1 Bookmark
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: This prospective, non-randomised study was aimed at the assessment of prevalence of thromboembolic events in vascular patients routinely receiving anti-thrombotic prophylaxis following surgical revascularisation of the lower extremities. Material and methods: This study included 105 patients operated on for aortoiliac occlusive disease. Postoperatively all patients received pharmacological antithrom-botic prophylaxis with low-molecular-weight heparin. Sonographic examination of the veins of low extremities was routinely performed three times: one day before the surgery, on the discharge day and 30 days after hospital discharge. Results: Thromboembolic complications were found in 21 patients (19.05%), including 18 patients with deep venous thrombosis and 3 with pulmonary embolism. Thromboembolic events were more prevalent in older patients (68.22 vs. 62.65 years), those with necrotic lesions of the limbs, with lower preoperative concentration of hemoglobin (7.89 vs. 8.61 mmol/l), higher of fibrinogen (455 vs. 357 mg/dl) and of platelet count (334 vs. 250 × 10 9 /l). Other risk factor comprised the number of trans-fused packed red blood cell units (3.39 vs. 1.45 units) and plasma units (1.61 vs. 0.39 units), and the length of stay in the intensive care unit (4.78 vs. 2.24 days). Conclusions: Vascular patients develop thromboembolism very often, despite pharmacological prophylaxis. Thus, routine scanning for deep vein thrombosis before hospital discharge in order to exclude thrombosis should be considered in this group. Also, an extended post-discharge thromboprophylaxis in these patients should be considered.
    Przegl?d Flebologiczny 01/2014;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Warfarinised patients frequently present for total knee arthroplasty (TKA). Current practice of heparin `bridging¿ is potentially cumbersome and hazardous. The research question is if cessation of warfarin is necessary for TKA.Methods The study design was a retrospective case¿control series of 61 warfarinised patients and 61 control patients undergoing TKA. TKA was performed by the senior author using a medial parapatellar approach without tourniquet. The target perioperative international normalised ratio (INR) for warfarinised patients was 2¿2.2. Primary outcomes were changes in haemoglobin, transfusion requirements and complication rates.ResultsThere was no statistically significant difference between control and warfarin group in mean perioperative Hb (g/L) (pre-op 140 vs 141, day 0 115 vs 115, day 1 108 vs 111, P¿=¿0.63), transfusion rates (14.75% vs 9.83%, P¿=¿0.58), total complication rate (9.8% vs 9.8%, P¿=¿0.75), demographics, range of motion or length of stay. There was a statistically significant higher use of the re-infusion drain in the warfarinised group (47.5% vs 24.6 %, P¿=¿0.014).Conclusion This study supports the hypothesis that warfarin cessation is non-essential in patients undergoing TKA. This data is applicable to a patient group using re-infusion drains. Limitations of this study are typical of a small non-controlled observational study.
    Journal of Orthopaedic Surgery and Research 01/2015; 10(16). · 1.58 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Prior research has demonstrated that platelet count and inflammation are dominant contributors to hypercoagulability. Our objective is to determine whether elevated platelet count and systemic inflammatory response syndrome (SIRS) have an association with the development of venous thromboembolism (VTE) in hospitalized patients with a high clinical index of suspicion for thromboembolic disease. We performed a retrospective medical record review of 844 medical and surgical patients with suspected VTE hospitalized from July 2012 to May 2013 who underwent screening by venous duplex and computed tomography pulmonary angiogram. For our purposes, thrombocytosis was arbitrarily defined as platelet count ≥250×10(9)/L. Venous thromboembolic disease was detected in 229 patients (25.9%). Thrombocytosis was present in 389 patients (44%) and SIRS was present in 203 patients (23%) around the time of imaging. Thrombocytosis and SIRS were positively correlated with VTE (P<0.001). There was no correlation between thrombocytosis and SIRS. Multivariate analysis revealed that SIRS (odds ratio 1.91, 95% confidence interval 1.36-2.68, P<0.001) and thrombocytosis (odds ration 1.67, 95% confidence interval 1.23-2.26, P=0.001) were independently associated with VTE. Patients at high risk for VTE should be routinely assessed for thrombocytosis (≥250×10(9)/L) and SIRS; if either is present, consideration for empiric anticoagulation should be given while diagnostic imaging is undertaken.
    International Journal of General Medicine 01/2015; 8:37-40.


1 Download
Available from