Humans ; Perioperative Period ; Thoracic Surgical Procedures ; adverse effects ; Venous Thromboembolism ; etiology ; prevention & control

PURPOSE: Static progressive stretch (SPS) can be applied to treat chronic joint stiffness. However, the impacts of subacute application of SPS to the distal lower limbs, where deep vein thrombosis (DVT) is common, on venous thromboembolism remain unclear. This study aims to explore the risk of venous thromboembolism events following subacute application of SPS. METHODS: A retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022. Patients with unilateral lower limb comminuted para-articular fractures, transferred to rehabilitation ward for further treatment within 3 weeks after operation, followed up more than 12 weeks since initial manual physiotherapy, and diagnosed DVT by ultrasound before rehabilitation course were included in the study. Patients with polytrauma, without evidence of previous peripheral vascular disease or incompetence, had medication for thrombosis treatment or prophylaxis before the operation, detected with paralysis due to nervous system impairment, infected after operation during the regime, or with acute progression of DVT were excluded. The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation. Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups. SSPS 28.0 and GraphPad Prism 9 were used for data processing. A p < 0.05 was set significant difference. RESULTS: In total of 154 patients with DVT participating in this study, 75 of them were treated with additional SPS for postoperative rehabilitation. The participants in the SPS group showed improved range of motion (12.3° ± 6.7°). However, in the SPS group, there was no difference in thrombosis volume between the start and termination (p = 0.106, p = 0.787, respectively), although difference was seen intra-therapy (p < 0.001). Contingency analysis revealed the pulmonary embolism incidence (OR = 0.703) in the SPS group compared to the mean physiotherapy. CONCLUSION The SPS technique is a safe and reliable option to prevent potential joint stiffness without aggravating the risk of distal DVT for postoperative patients suffering from relevant trauma.
Humans ; Venous Thromboembolism/prevention & control* ; Venous Thrombosis/etiology* ; Retrospective Studies ; Pulmonary Embolism/complications* ; Lower Extremity ; Risk Factors

Venous thromboembolism is a common vascular disease with clinically high morbidity and mortality. Prevention and treatment strategies should be based on risk stratification. Anticoagulation remains the mainstay of therapy for patients with venous thromboembolism. More evidence-based studies should be performed to establish the strategy of prevention and treatment for venous thromboembolism in China.
Anticoagulants ; therapeutic use ; China ; Humans ; Secondary Prevention ; Thrombectomy ; Vena Cava Filters ; Venous Thromboembolism ; etiology ; prevention & control ; therapy

China ; Consensus ; Expert Testimony ; Humans ; Neoplasms ; surgery ; Perioperative Period ; Thoracic Surgical Procedures ; adverse effects ; Venous Thromboembolism ; etiology ; prevention & control

BACKGROUNDVenous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few. The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) or GCS alone.

METHODSThe study was performed on 108 patients who were randomly assigned to two groups. The first group received GCS before the operation and IPC during the operation (IPC + GCS group). The second group received GCS before the operation (GCS group). To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures, the incidence of adverse reactions was assessed.

RESULTSThe morbidity associated with DVT was 4.8% (5/104) in the IPC + GCS group and 12.5% (14/112) in the GCS group. There were significant statistical differences between the two groups. There were no adverse effects in either group.

CONCLUSIONSThe therapeutic combination of GCS and IPC was more effective than GCS alone for thrombosis prevention in high-risk patients undergoing gynaecological pelvic surgery, and there were no adverse effects in either group.

Aged ; Female ; Gynecologic Surgical Procedures ; adverse effects ; Humans ; Intermittent Pneumatic Compression Devices ; Male ; Middle Aged ; Pelvis ; surgery ; Stockings, Compression ; Thromboembolism ; etiology ; prevention & control ; Venous Thrombosis ; etiology ; prevention & control

PURPOSE: The aim of this study was to investigate the efficacy of low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolism in Korean patients who underwent hip fracture surgery (HFS). MATERIALS AND METHODS: Prospectively, a total 181 cases were classified into the LMWH user group (116 cases) and LMWH non-user group (65 cases). Each group was sub-classified according to fracture types as follows: 81 cases of intertrochanteric fracture (group A: 49, group B: 32) and 100 cases of neck fracture (group C: 67, group D: 33). We compared the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) according to LMWH use. RESULTS: Of the 181 cases, four DVTs were found in the LMWH user groups (1 in group A, and 3 in group C). One case of PE was found in LMWH non-user group D. The incidences of DVT and PE showed no statistically significant differences between the LMWH user and non-user groups (p=0.298 and 0.359, respectively). In subgroup analysis, no statistically significant differences were found between groups A and B and between groups C and D. CONCLUSION: The administration of LMWH was not effective in the prevention of venous thromboembolism and PE in the Korean patients who underwent HFS.
Aged ; Anticoagulants/*therapeutic use ; Female ; Heparin, Low-Molecular-Weight/*therapeutic use ; Hip Fractures/classification/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/*prevention & control ; Pulmonary Embolism/etiology/*prevention & control ; Republic of Korea ; Venous Thromboembolism/*prevention & control ; Venous Thrombosis/etiology/*prevention & control

OBJECTIVEThe aim of this study was to compare the efficacy of low molecular weight heparin (LMWH) combined with graduated compression stockings (GCS) with GCS alone as prophylactic measures for venous thromboembolism (VTE) in post-operative patients with gynecologic cancer.

METHODSPatients diagnosed with gynecologic cancer undergoing primary major surgery between 2010 and 2011 in our institute were randomized to receive LMWH+GCS or GCS as VTE prophylaxis post-operatively.

RESULTSAltogether 247 patients were enrolled. The incidence of VTE in patients treated with LMWH + GCS was significantly lower than that in patients using GCS alone (0.8% Vs. 8.1%, P = 0.01). There were no severe bleeding complications in the patients with prophylactic use of LMWH and the occurrence rate of wound dehiscence was comparable between the two groups (P > 0.05). Multivariable logistic regression analysis revealed that age over 60 years (P = 0.015) , duration of operation over 3 hours (P = 0.04) and without prophylactic use of LMWH (P = 0.02) were independent risk factors for VTE.

CONCLUSIONSDual prophylaxis with LMWH and GCS should be recommended for gynecologic cancer patients undergoing major surgery for its better efficacy than GCS. Prophylactic use of LMWH is safe and convenient. Patients with older age and prolonged operation time are at highest risk of developing VTE post-operatively.

Anticoagulants ; therapeutic use ; Female ; Genital Neoplasms, Female ; surgery ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Postoperative Complications ; prevention & control ; Postoperative Period ; Stockings, Compression ; Venous Thromboembolism ; etiology ; prevention & control

OBJECTIVETo systematically review the efficacy and safety of fondaparinux and enoxaparin in the prevention of venous thromboembolism (VTE) after major orthopedic surgery.

METHODSThe MEDLINE, EMbase, the Cochrane Library, CNKI, CBM, VIP and Wanfang databases (from their establishment to October, 2012) were searched for randomized controlled trials (RCTs) comparing the effects of fondaparinux and enoxaparin in preventing VTE after major orthopedic surgery. The related journals and conference papers were manually searched. The outcome measurements were the incidence of total VTE, deep venous thrombosis (DVT), symptomatic VTE, pulmonary embolism (PE), major bleeding and any other adverse event. The quality of literatures was evaluated and the data were extracted for meta-analysis.

RESULTSFive RCTs involving 7611 patients were included pertaining to major knee surgery (1 RCT), hip fracture surgery (2 RCTs) and total hip arthroplasty (3 RCTs). The incidences of total VTE and DVT were significantly lower in fondaparinux group than in enoxaparin group [RR=0.52, 95%CI (0.40,0.67), P<0.00001; RR=0.49, 95%CI (0.42, 0.58), P<0.00001]. The incidence of symptomatic VTE was similar between the two groups [RR=1.52, 95%CI (0.80,2.88), P=0.20]. Fondaparinux was associated with a significantly increased incidence of major bleeding compared to enoxaparin group [RR=1.55, 95%CI (1.14,2.12), P=0.006], but the mortality rates were comparable between the two groups [RR=0.93, 95%CI (0.63,1.37), P=0.72].

CONCLUSIONCompared with enoxaparin, fondaparinux can reduce the risk of postoperative VTE and do not increase the mortality rate following major orthopedic surgery though with an increased risk of major bleeding.

Enoxaparin ; adverse effects ; therapeutic use ; Humans ; Orthopedic Procedures ; adverse effects ; Polysaccharides ; adverse effects ; therapeutic use ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Venous Thromboembolism ; etiology ; prevention & control

Intermittent pneumatic compression (IPC) device is an effective method to prevent deep vein thrombosis. This method has been known to be safe with very low rate of complications compared to medical thromboprophylaxis. Therefore, this modality has been used widely in patients who underwent a hip fracture surgery. We report a patient who developed extensive bullae, a potentially serious skin complication, beneath the leg sleeves during the use of IPC device after hip fracture surgery.
Aged, 80 and over ; Blister/*etiology/pathology ; Female ; Hip Fractures/*surgery ; Humans ; Intermittent Pneumatic Compression Devices/*adverse effects ; *Postoperative Complications ; Venous Thromboembolism/prevention & control

BACKGROUNDEnoxaparin is routinely used for prevention of venous thromboembolism (VTE) after total hip or knee arthroplasty. The purpose of this study was to compare the efficacy and safety of apixaban, a newly oral direct inhibitor of factor Xa versus enoxaparin.

METHODSWe performed a meta-analysis of relevant randomized-controlled trials (RCTs) identified in PubMed, Cochrane Library, Embase China Biological Medical Literature database, Countries Journal full-text database, VIP database, and WanFang database. The primary efficacy outcome for our meta-analysis was all VTE and all-cause mortality. The secondary efficacy outcomes included major VTE, non-fatal pulmonary embolism, and mortality. The primary safety outcome was bleeding events, categorized as major, clinically relevant non-major, or minor events.

RESULTSFour RCTs, involving 14 065 patients, were included in our meta-analysis. Compared to enoxaparin, thromboprophylaxis with apixaban was associated with significantly fewer VTE and all-cause mortality (8346 patients, risk ratio (RR): 0.63, 95%CI 0.42 - 0.95) and similar incidence of bleeding events (major bleeding, 11 525 patients, RR 0.76, 95%CI 0.43 - 1.33; clinically relevant non-major bleeding, 11 525 patients, RR 0.83, 95%CI 0.69 - 1.01; and minor bleeding, 11 828 patients, RR 0.93, 95%CI 0.79 - 1.09). However, our meta-analysis revealed similar effects of apixaban with enoxaparin for thromboprophylaxis with regard to the secondary efficacy outcomes.

CONCLUSIONSApixaban was more effective than recommended dose of enoxaparin and had a similar safety profile for thromboprophylaxis after hip and knee arthroplasty. But more evidence, especially well designed head-to-head RCTs, is needed to confirm the superior efficacy of apixaban.

Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Enoxaparin ; therapeutic use ; Humans ; Pyrazoles ; therapeutic use ; Pyridones ; therapeutic use ; Randomized Controlled Trials as Topic ; Venous Thromboembolism ; etiology ; prevention & control