Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 868 - файл

These incidences are less for symptomatic DVT <0.5%, symptomatic PE <3.9%, and <0.7% for fatal PE.When a retrospective cohort of 10,638 patients was studied post open-heart surgery, only 0.7% had symptomatic DVT within 10days postop­eratively [42]. Similarly, this number remains low for a PE risk that was found in

0.6% of 5694 patients within 60 days post open-heart surgery. Predictors of PE included prolonged hospital stay, cardiac catheterization within 15days of surgery, and congestive heart failure. In another retrospective cohort, 500 off-pump coronary artery operations were done with no prophylaxis, and resulted in 1% thromboem­bolic complications, which caused death of one patient. This study concluded that VTE complications in off-pump CABG operations are comparable to those with cardiopulmonary bypass [43].

Major neurosurgical procedures are also associated with a DVT risk, which requires a form of VTE prophylaxis. Several characteristics pose a higher risk for VTE, including: longer time procedures, intracerebral procedures, lower extremity weak­ness, cancer, and older patients. Patients with cancerous brain tumors are especially at a higher risk of VTE both perioperatively and after discharge [44]. In a retrospec­tive review of 264 malignant glioma patients who did not receive any form of thromboprophylaxis, 36% of patients developed DVT within 6weeks of craniotomy [45]. An RCT of neurosurgical patients indicated that mechanical thromboprophy­laxis from GCS by itself or in conjunction with IPC can decrease the risk from 20 to 9% [46]. In another RCT, a statistically signicant decrease in DVT incidence from 34 to 6% was detected in 110 elective neurosurgical patients with the use of heparin prophylaxis [47]. Another RCT of 485 patients that studied the efcacy of

The incidence of VTE post major trauma is the highest among inpatients. In the absence of prophylaxis, it can be as high as 80%. Delay of thromboprophylaxis is usually attributed to injury-associated bleeding risks. In a multicenter prospective cohort of 315 patients, a delay of prophylaxis start was associated with three-fold increase of VTE risk [52]. The risk of DVT in trauma patients is increased due to several factors: spinal cord trauma, spinal injuries, increased age, pelvic trauma, requirement of surgical operation, delay in thromboprophylaxis initiation, and res­toration of major veins [51].

In a meta-analysis by Velmahos etal. there was no evidence that LDUH, LMWH was better than the other or even to no prophylaxis [51]. In a double- blinded RCT of 344 trauma patients with injury severity score of at least nine, and in the absence of intracranial bleed, patients were randomly assigned to LMWH versus LDUH subcutaneously every 12h. In this study, Geerts etal. concluded that LMWH was signicantly more effective than LDUH in VTE prophylaxis post vital trauma. Both interventions were similarly safe, with a bleeding risk of less than 2% [56]. In another RCT of 442 trauma patients receiving either IPC device or LMWH as thromboprophylaxis, proximal DVT and PE were seen in 3% of the IPC group and 1% of the LMWH group upon weekly follow-up with duplex US.In this study, the rate of major bleeding was again less than 2% [57]. In a prospective randomized comparison of 200 patients, Stannard et al. found signicantly less VTE among trauma patients who were treated on admission with foot pumps with the addition of LMWH on a delayed basis versus those treated with LMWH alone within 24–48h of admission [58]. In a review study of 2169 patients, Bandle etal. con­cluded that venous duplex surveillance of DVT is warranted in highest risk groups versus moderate-risk trauma patients [59]. In addition, a study by Allen et al. of 1218 trauma patients showed that venous duplex ultrasound surveillance with early DVT management had decreased rates of PE [60]. While the best duration of throm­boprophylaxis in trauma patients is not clear, the recommended VTE prophylaxis should usually continue until hospital or rehabilitation discharge. If this period takes longer than 14days, then the preferred method should be with an LMWH [61].

Postoperative risk of deep vein thrombosis in orthopedic surgery remains one of the highest among other surgical elds. Similar to any surgical eld, the risk of DVT in orthopedic surgical patients varies according to the risk of the procedure itself, be it total hip arthroplasty (THA), total knee arthroplasty (TKA), or pelvic surgery, which are considered higher risk than upper extremity (hand, elbow, and shoulder surgery) or lower extremity (foot, ankle, and tibial surgery). The higher risk surgery is mainly due to the venous stasis caused by immobility, reected by positioning of these patients and the risk of endothelial venous injury. There is paucity of data tackling thromboprophylaxis in minor-risk orthopedic surgery, and most of the guidelines and literature are derived from major orthopedic surgery in higher risk older patient population groups undergoing TKA and THA.Both the American College of Chest Physicians and the American Academy of Orthopedic Surgeons support prophylaxis recommendation in the high-risk orthopedic surgery patient population.