Prophylaxis and treatment of deep vein thrombosis in general surgery. 2005

Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
Department of General Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, D-62120 Heidelberg, Germany. carsten_gutt@med.uni-heidelberg.de

BACKGROUND Patients undergoing general surgery present an inherent risk of deep vein thrombosis (DVT). Evidence-based strategies for prevention and treatment of DVT should be continuously upgraded on the basis of good-quality recent trials. METHODS Articles were identified using MEDLINE, EMBASE, and the Cochrane Library databases (January 1980 to July 2003). Randomized clinical trials and meta-analyses in which different prophylactic and treatment methods were compared for general surgery patients were selected. CONCLUSIONS In general surgery, low-molecular weight heparins (LMWHs) are relied upon more and more for prophylaxis and initial anticoagulant treatment of DVT, because of their multiple advantages in efficacy, safety, and convenience in handling. For cost-effective reasons, full-dose vitamin K antagonists are still preferred as the standard long-term anticoagulation method, while LMWHs represent the exception. Long-term use of low-intensity warfarin should be considered a new standard of care for the management of venous thrombosis. Compared to LMWH, the new anticoagulant molecules fondaparinux and ximelagatran seem to have similar efficacy in the treatment of venous thromboembolism, but they have a 2-fold increased efficacy in its prophylaxis. Clinical implementation of these new anticoagulant molecules depends on their cost-effectiveness; however, they have the potential to become the treatment of choice in the next decade. Thrombolysis has an unacceptable risk of hemorrhagic complications when used in the treatment of postoperative DVT. Furthermore, there are no data to prove that thrombolysis reduces the incidence of postthrombotic syndrome (PTS), despite early and complete recanalization achieved by thrombolysis. Surgical thrombectomy is only meant to decompress the venous hypertension consecutive to massive thrombosis (phlegmasia cerulea dolens) and thus to avoid venous gangrene. Other mechanical percutaneous thrombectomy devices are under evaluation. In selected cases, a combination treatment consisting of locoregional thrombolysis of the crurofemoral venous axis and mechanical thrombectomy of the pelvic venous axis achieves high rates of complete desobliteration.

UI MeSH Term Description Entries
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D006495 Heparin, Low-Molecular-Weight Heparin fractions with a molecular weight usually between 4000 and 6000 kD. These low-molecular-weight fractions are effective antithrombotic agents. Their administration reduces the risk of hemorrhage, they have a longer half-life, and their platelet interactions are reduced in comparison to unfractionated heparin. They also provide an effective prophylaxis against postoperative major pulmonary embolism. LMWH,Low-Molecular-Weight Heparin,Low Molecular Weight Heparin,Heparin, Low Molecular Weight
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000925 Anticoagulants Agents that prevent BLOOD CLOTTING. Anticoagulant Agent,Anticoagulant Drug,Anticoagulant,Anticoagulant Agents,Anticoagulant Drugs,Anticoagulation Agents,Indirect Thrombin Inhibitors,Agent, Anticoagulant,Agents, Anticoagulant,Agents, Anticoagulation,Drug, Anticoagulant,Drugs, Anticoagulant,Inhibitors, Indirect Thrombin,Thrombin Inhibitors, Indirect
D013514 Surgical Procedures, Operative Operations carried out for the correction of deformities and defects, repair of injuries, and diagnosis and cure of certain diseases. (Taber, 18th ed.). Surgical Procedures,Ghost Surgery,Operative Procedures,Operative Surgical Procedure,Operative Surgical Procedures,Procedure, Operative Surgical,Procedures, Operative Surgical,Surgery, Ghost,Surgical Procedure, Operative,Operative Procedure,Procedure, Operative,Procedure, Surgical,Procedures, Operative,Procedures, Surgical,Surgical Procedure
D014812 Vitamin K A lipid cofactor that is required for normal blood clotting. Several forms of vitamin K have been identified: VITAMIN K 1 (phytomenadione) derived from plants, VITAMIN K 2 (menaquinone) from bacteria, and synthetic naphthoquinone provitamins, VITAMIN K 3 (menadione). Vitamin K 3 provitamins, after being alkylated in vivo, exhibit the antifibrinolytic activity of vitamin K. Green leafy vegetables, liver, cheese, butter, and egg yolk are good sources of vitamin K.
D014859 Warfarin An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. 4-Hydroxy-3-(3-oxo-1-phenylbutyl)-2H-1-benzopyran-2-one,Aldocumar,Apo-Warfarin,Coumadin,Coumadine,Gen-Warfarin,Marevan,Tedicumar,Warfant,Warfarin Potassium,Warfarin Sodium,Potassium, Warfarin,Sodium, Warfarin
D015912 Thrombolytic Therapy Use of infusions of FIBRINOLYTIC AGENTS to destroy or dissolve thrombi in blood vessels or bypass grafts. Fibrinolytic Therapy,Thrombolysis, Therapeutic,Therapeutic Thrombolysis,Therapy, Fibrinolytic,Therapy, Thrombolytic,Fibrinolytic Therapies,Therapeutic Thrombolyses,Therapies, Fibrinolytic,Therapies, Thrombolytic,Thrombolyses, Therapeutic,Thrombolytic Therapies
D017131 Thrombectomy Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called EMBOLECTOMY. Aspiration Thrombectomy,Percutaneous Aspiration Thrombectomy,Aspiration Thrombectomies,Aspiration Thrombectomies, Percutaneous,Aspiration Thrombectomy, Percutaneous,Percutaneous Aspiration Thrombectomies,Thrombectomies,Thrombectomies, Aspiration,Thrombectomies, Percutaneous Aspiration,Thrombectomy, Aspiration,Thrombectomy, Percutaneous Aspiration
D018570 Risk Assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988) Assessment, Risk,Benefit-Risk Assessment,Risk Analysis,Risk-Benefit Assessment,Health Risk Assessment,Risks and Benefits,Analysis, Risk,Assessment, Benefit-Risk,Assessment, Health Risk,Assessment, Risk-Benefit,Benefit Risk Assessment,Benefit-Risk Assessments,Benefits and Risks,Health Risk Assessments,Risk Analyses,Risk Assessment, Health,Risk Assessments,Risk Benefit Assessment,Risk-Benefit Assessments

Related Publications

Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
January 2007, Phlebology,
Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
February 2024, Cureus,
Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
January 1988, Acta chirurgica Scandinavica. Supplementum,
Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
January 2000, Seminars in thrombosis and hemostasis,
Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
April 1995, Thrombosis and haemostasis,
Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
January 1999, Seminars in thrombosis and hemostasis,
Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
May 1989, Canadian journal of surgery. Journal canadien de chirurgie,
Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
January 2018, Jornal vascular brasileiro,
Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
December 2009, Chest,
Carsten N Gutt, and Traian Oniu, and Frédéric Wolkener, and Ari Mehrabi, and Shilu Mistry, and Markus W Büchler
January 2013, Revista medica del Instituto Mexicano del Seguro Social,
Copied contents to your clipboard!