17 Sep 11
Posted in Venous thromboembolism at 19:37 by Laci
By O Gajic, D Warner, P Decker, R Rana, D Bourke and J Sprung
Mayo Clin Proc. June 2005 80(6):728-731
To investigate the incidence of postoperative venous thromboembolism (VTE) in patients who had flown long distances before major surgery.
Patients and methods
Using the Mayo Clinic computerized patient database, we identified patients who had flown more than 5000 km before major surgery (travelers) and had experienced an episode of clinically significant VTE within 28 days after surgery. Individual medical records were reviewed for the diagnosis of VTE, pertinent risk factors, and outcome. We compared the incidence of VTE in travelers to the incidence of VTE in patients from North America (nontravelers) undergoing similar surgical procedures.
Results
Eleven patients met our criteria for long-haul air travel and clinically significant VTE within 28 days after surgery. Compared with nontravelers undergoing similar surgical procedures, long-haul travelers had a higher incidence of VTE (4.9% vs 0.15%; P<.001). Compared with nontravelers who developed VTE, travelers were younger (P=.006), developed VTE earlier in the postoperative course (P=.01), had higher American Society of Anesthesiologists physical status classification (P=.02), and had higher prevalence of smoking (P=.007). Of the 11 travelers with VTE, 10 were of Middle Eastern origin.
Conclusion
Prolonged air travel before major surgery significantly increases the risk of perioperative VTE. Such patients should receive more intensive VTE prophylactic measures during the flight and throughout the perioperative period.
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24 Feb 10
Posted in Anesthesia, Pre-operatie evaluation, Venous thromboembolism at 12:17 by Laci
NICE clinical guideline CG92
This guidance is about the care and treatment of people who are at risk of developing deep vein thrombosis (DVT) while in hospital in the NHS in England and Wales.
The advice in the NICE guideline covers the care and treatment that should be offered to all adults (aged 18 and over) who are admitted to hospital as inpatients (including those admitted for day-case procedures).
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22 Jan 09
Posted in BNP, Venous thromboembolism at 0:26 by Laci
By R Cavallazzi, A Nair, T Vasu and P E Marik
Intensive Care Med 2008:34;2147-2156
Patients with pulmonary embolism (PE) have a high risk of death, and it is important to recognize factors associated with higher mortality. Recently, several biomarkers have been studied for risk stratification in patients with PE.
Objectives
Evaluate the available evidence on (a) the accuracy of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) for the diagnosis of right ventricular dysfunction and (b) their value as a prognostic factor of all-cause in-hospital or short-term mortality in patients with PE.
Data sources
MEDLINE, Embase, and citation review of relevant primary and review articles.
Selection criteria We selected studies evaluating the accuracy of BNP or NT-proBNP for the diagnosis of right ventricular dysfunction. We also selected studies that reported data on BNP or NT-proBNP as a predictor of short-term mortality in patients with PE.
Results
Sixteen studies met our inclusion criteria. The pooled diagnostic odds ratio for the diagnosis of right ventricular dysfunction in pulmonary embolism was 39.45 (95% CI; 15.54ñ100.12) and 24.73 (95% CI 2.02ñ302.37) for BNP and NT-proBNP, respectively. The pooled odds ratio for all-cause in-hospital or short-term mortality was 6 (95% CI 1.31±27.43; p: 0.021) and 16.12 (95% CI 3.1±83.68; p: 0.001) for BNP (cutoff: 100 pg/ml) and NT-proBNP (cutoff: 600 ng/L), respectively.
Conclusion
The results of this meta-analysis indicate that BNP and NT-proBNP are associated with the diagnosis of right ventricular dysfunction (RVD) in patients with an acute PE and are significant predictors of all-cause in-hospital or short-term mortality in these patients.
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03 Dec 08
Posted in Venous thromboembolism at 0:11 by Laci
By SA Ibrahim, RA Stone, DS Obrosky, M Geng, MJ Fine, D Aujesky
Arch Intern Med 2008;168:2183-2190
In the management of acute pulmonary embolism, the prevalence of thrombolytic therapy is uncertain, and its benefits compared with standard anticoagulation remain a subject of debate.
Methods
This analysis included 15 116 patient discharges with a primary diagnosis of pulmonary embolism from 186 acute care hospitals in Pennsylvania (January 2000 to November 2002). We compared propensity score–adjusted mortality between patients who received thrombolysis and those who did not, using logistic regression to model mortality within 30 days of presentation and Poisson regression to model in-hospital mortality.
Results
Of the 15 116 patient discharges, only 356 (2.4%) received thrombolytic therapy. The overall 30-day mortality rate for patients who received thrombolytic therapy was 17.4% compared with 8.6% for those who did not. The corresponding in-hospital mortality rates were 19.6 and 8.3, respectively, per 1000 person-days. However, mortality risk associated with thrombolysis varied with the propensity to receive thrombolysis: the odds ratios of 30-day mortality were 2.8 (P = .007), 3.9 (P < .001), 1.8 (P = .09), 1.0 (P = .98), and 0.7 (P = .30) for patients in the lowest to the highest quintiles of the propensity score distribution who received thrombolysis. A similar pattern was observed in the risk ratios for in-hospital death.
Conclusions
In this large sample of patients hospitalized for acute pulmonary embolism, thrombolytic therapy was used infrequently. Risk of in-hospital and 30-day mortality appears to be elevated for patients who were unlikely candidates for this therapy based on characteristics at presentation, but not for patients with a relatively high predicted probability of receiving thrombolysis.
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