Can venous thrombosis be a predictor of postoperative death?
Barinov V., Lobastov K., Boyarintsev V., Brehov E., Schastlivtsev I., Tsaplin S.
1. Clinical Hospital № 1 Office of the President of the Russian Federation, Moscow
2. Teaching and Research Medical Center, Office of the President of the Russian Federation, Department of Surgery with the course of urology and endoscopy
3. Russian National Research University. NI Pirogov, Department of General Surgery and Radiology Medical Faculty
The aim of the study was to evaluate the significance of venous thrombosis as a predictor of postoperative death in high risk surgical patients under standard VTE prophylaxis.
Materials and methods. It was a prospective observational study included 140 surgical patients with high risk of VTE, which underwent major abdominal surgery (47.9%) or neurosurgery (52.1%). The prophylactic protocol included administration of direct anticoagulants in standard doses (if there were no contraindications) and elastic compression of lower limbs. Instrumental verification of VTE was made by duplex ultrasound scanning at first 12 hours after surgery and then every 3-5 days until discharge, by lung scintigraphy and/or heart ultrasound and by autopsy in died patients.
Results. The rate of postoperative DVT was 27.9% (95% CI: 20.5-35.3%), of proximal DVT: 8.6% (95% CI: 3.9-13.2%), of PE: 9.3% (95% CI: 4.5-14.1%), and pulmonary embolism was the main cause of postoperative death. Regression analyses was used to assess the most important predictors of postoperative death. For common mortality, they were: SAPS II scores (p=0.026), male gender (p=0.012) and venous thrombosis (р<0.001). For non-PE-mortality the only predictor was venous thrombosis (р=0.007). In patients who died from PE thrombosis usually occurred in shin and thigh veins on 4.4±2.0 day after surgery. In patients who died not from PE thrombosis usually occurred in muscle veins of calf (isolated occlusion of gastrocnemius and soleus veins) on 6.9±3.1 day after surgery (n.s.). In recovered patients thrombosis was found usually on 13.9±3.2 day (p<0,0001 in comparison with died patients) without any specific localization.
Conclusion: postoperative venous thrombosis that occurs under standard VTE prophylaxis in high risk surgical patients can be a strong predictor of postoperative death. The time and localization of this thrombosis can predict the outcome of the main disorder.
venous thrombosis, pulmonary embolism, venous thromboembolism, high risk, predictor
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