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PubMed1986

Rates of venous thrombosis after general surgery: combined results of randomised clinical trials.

Despite evidence that prophylaxis against deep-vein thrombosis (DVT) is effective, a large proportion of general surgical patients receive no prophylaxis. To determine the extent to which various prophylactic methods reduce the incidence of postoperative DVT, data from randomised controlled trials of these methods were combined by means of meta-analysis. The rates of DVT diagnosed by the fibrinogen uptake test were: control/no therapy 27.0% (95% confidence limits 21.9%, 32.1%); heparin 9.6% (7.2%, 11.9%); gradient compression stockings 11.1% (5.3%, 16.8%); intermittent pneumatic compression 17.6% (6.1%, 29.1%); heparin plus stockings 6.3% (0%, 17.6%); heparin plus dihydroergotamine 9.9% (6.2%, 13.6%); and stockings plus intermittent pneumatic compression 4.5% (1.1%, 8.0%). These results confirm the value of prophylaxis to reduce the incidence of DVT and suggest that combined treatments may be most effective.

Clinical Trials as Topic↗

PubMed1983

Postoperative deep venous thrombosis in Japan. Incidence and prophylaxis.

The incidence of postoperative deep venous thrombosis was investigated using the iodine-125-fibrinogen method in 256 patients undergoing major surgery. Deep venous thrombosis was found in 49 patients (15.3 percent), and nonfatal pulmonary embolism developed in one of seven patients in whom the thrombus extended to the popliteal vein. The same investigation was performed in 110 patients who wore a graduated compression stocking on one leg, with the other leg serving as a control. Deep venous thrombosis was found in 4 of 110 stockinged legs (3.6 percent) and in 16 of 110 control legs (14.5 percent). The incidence of deep venous thrombosis decreased significantly in patients who wore the stocking. An increase in femoral venous flow velocity was found in the stockinged legs by the Doppler method. The mean velocity of venous return by xenon-133 clearance was significantly greater in the stockinged legs than in the control legs. These findings were considered to support the efficacy of graduated compression stockings for the prevention of deep venous thrombosis.

Adolescent↗

PubMed1998

Meta-analysis of effectiveness of intermittent pneumatic compression devices with a comparison of thigh-high to knee-high sleeves.

This meta-analysis used all original articles from 1966 to June 1996 that fit the preset inclusion criteria to examine the clinical effectiveness of intermittent pneumatic compression (IPC) devices in preventing deep vein thrombosis (DVT) and pulmonary embolism and to compare the results of knee-high sleeves to thigh-high sleeves. IPC devices decreased the relative risk of DVT by 62 per cent when compared with placebo, 47 per cent compared with graduated compression stockings, and 48 per cent compared with mini-dose heparin. IPC devices significantly decreased the relative risk of DVT compared with placebo in high-risk patients such as neurosurgery and major orthopedic surgery patients and in modest risk patients such as general surgery patients. In major orthopedic surgery patients, the incidence of DVT was similar for IPC- and warfarin-treated patients; however, IPC was significantly better than warfarin at decreasing the incidence of calf only DVT, whereas warfarin seemed to be better at decreasing proximal DVT. IPC devices are effective in decreasing the incidence of DVT in patients at moderate to high risk and are probably more efficacious than graduated compression stockings or mini-dose heparin; however, IPC devices are not protective against pulmonary embolism. The data directly comparing the various methods of compression (knee-high versus thigh-high sleeves and graded-sequential versus uniform compression) are sparse and conflicting.

Bandages↗

PubMed2004

Relationship between deep venous thrombosis and the postthrombotic syndrome.

The postthrombotic syndrome (PTS) is a frequent complication of deep venous thrombosis (DVT). Clinically, PTS is characterized by chronic, persistent pain, swelling, and other signs in the affected limb. Rarely, ulcers may develop. Because of its prevalence, severity, and chronicity, PTS is burdensome and costly. Preventing DVT with the use of effective thromboprophylaxis in high-risk patients and settings and minimizing the risk of ipsilateral DVT recurrence are likely to reduce the risk of development of PTS. Daily use of compression stockings after DVT might reduce the incidence and severity of PTS, but consistent and convincing data about their effectiveness are not available. Future research should focus on standardizing diagnostic criteria for PTS, identifying patients at high risk for PTS, and rigorously evaluating the role of thrombolysis in preventing PTS and of compression stockings in preventing and treating PTS. In addition, novel therapies should be sought and evaluated.

Bandages↗

PubMed2001

Could deep vein thrombosis be safely treated at home?

BACKGROUND: The aim of this prospective study was to analyse the group of patients with DVT (deep vein thrombosis) treated at home with LMWH (low-molecular weight heparin), compression, intensive mobilization. METHODS: 106 consecutive patients with the diagnosis of DVT were treated at home with enoxaparin (Clexane Rhône-Poulenc) administered subcutaneously (1 mg/kg) b.i.d. for a minimum of 7 days. All patients wore elastic second degree compression stockings during the whole treatment and for further 12 months, and were encouraged to walk 1-2 kms daily. In this group of 106 patients the upper limit of thrombosis was iliofemoral vein--45 pts (42.4%), femoral or popliteal vein--33 pts (31%), crural veins--28 pts (26%). The diagnosis was done by compression ultrasonography, by contrast phlebography, platelet scintigraphy (Tromboscint test). RESULTS: Perfusion gammagraphy of the lungs was done in 54 patients where thrombosis was localised in the popliteal and iliofemoral veins. In 28 patients there were signs of non-fatal pulmonary embolism (52%), but only 7 pts (25%) suffered from mild non-specific clinical signs; 21 pts (75%) with the diagnosis of pulmonary embolism were symptom-free. 8-12 weeks after this treatment, control sonography and phlebography were done in 75 pts (71%), in 53% (40 pts), we found partial, and in 32% (24 pts) total recanalisation. In the rest of 11 pts (15%) there were no signs of recanalisation. Compared with the group of patients treated by the classical method (UH, immobilisation) in the period from January 1995 to February 1997, out of 48 pts where the recanalisation was retrospectively analysed, 17 pts (36%) did not show any signs of recanalisation. The difference is significant (p < 0.01). In this group of 54 pts, 4 died of PE (post mortem verified) compared with no death in the group treated with LMWH and mobilisation. The difference is not significant (p < 0.9). Eighty six patients (81%) out of 106 were satisfied and pleased with home treatment and mobilization. From this group of patients treated with LMWH and forced mobilisation 46 were investigated after one year by duplex scan. None of these patient had recurrence, but 7 pts (15%) had pathological reflux (more than 0.5 s) in the deep venous system, majority of them--5 pts on the popliteal vein. CONCLUSION: Home treatment of DVT is possible and effective, safe and cost-effective. On the average, 40 percent of expenses per patient were saved when compared with hospital stay in spite of more expensive LMWH. The patients who received LMWH spent a mean of 1.2 days in the hospital, as compared with 12.7 days for the standard-heparin group. A long-term (12 months at minimum) of compressive stocking (45 mmHg) with activation of the muscle-venous pump by forced mobilisation can prevent recurrence and decrease the percentage of the post-thrombotic syndromes. (Ref. 15.)

Ambulatory Care↗

PubMed1994

The clinical course of patients following extensive deep venous thrombosis.

Following deep venous thrombosis (DVT), patients may develop leg swelling, skin changes and ulceration. Early studies have suggested that patients suffer progressive deterioration and poor eventual outcome. The objective of this study was to determine whether extensive DVT still carries a poor prognosis. In this study 83 patients with 86 affected limbs were followed with annual review for 12-135 months, median 47 months. Thirty-seven patients were referred at time of DVT and 46 patients referred with established symptoms following DVT. In the latter group, time from DVT to referral ranged from mean 2-45 years (median 7 years). All patients had phlebographically proven deep venous thrombosis. The main outcome measures were subjective improvement in symptoms, healing of leg ulcer or development of a new leg ulcer. Deterioration or improvement in signs of post-thrombotic syndrome were documented by one observer (CVR). Patients were routinely provided with graduated compression stockings. They were given advice, as appropriate, on weight reduction and care of the limb. Improvement of symptoms was reported in 25 (29%) limbs, 49 (57%) had no change and 12 (14%) deteriorated. Three patients (3%) developed a new leg ulcer. The great majority of patients following extensive deep venous thrombosis, when provided with graduated compression stockings and regularly supervised, either remained stable or improved when followed long-term. The development of a new leg ulcer was uncommon. The post-thrombotic syndrome does not carry the poor prognosis reported in earlier studies.

Adult↗

PubMed2006

The post-thrombotic syndrome: progress and pitfalls.

The post-thrombotic syndrome (PTS) develops in up to one half of patients after symptomatic deep venous thrombosis (DVT) and is the most common complication of DVT. Typical features of PTS include chronic pain, swelling, heaviness, oedema and skin changes in the affected limb. In severe cases, venous ulcers may develop. The frequency of PTS is likely to be reduced by preventing DVT with the use of effective thromboprophylaxis in high-risk patients and settings and by minimising the risk of ipsilateral DVT recurrence. Use of compression stockings for 2 years after DVT appears to reduce the incidence and severity of PTS but issues remain regarding their use and effectiveness. Future research should focus on elucidating the pathophysiology and risk factors for PTS, assessing the safety and effectiveness of catheter-directed thrombolysis to prevent PTS and evaluating the optimal use of compression stockings to prevent and treat PTS. In addition, new therapies to treat PTS should be sought and evaluated.

Bandages↗

PubMed2002

Travellers' thrombosis.

Anecdotal reports have suggested a link between flying and the development of blood clots. A recent prospective study looking at passengers before and after flying has demonstrated a much higher incidence of asymptomatic venous thrombosis than we expected. In the same paper, graduated elastic compression stockings reduced this incidence of asymptomatic venous thrombosis. Further studies are required to see how many passengers develop symptomatic deep vein thrombosis and to assess the overall incidence of venous thromboembolic disease. A major epidemiological study, an interventional study to assess the efficacy of mechanical methods of venous thrombosis prophylaxis and the effect of graduated compression stockings, and studies to look at the effect of the cabin environment on thromboembolism are planned.

Aerospace Medicine↗

PubMed2001

Incidence of deep venous thrombosis after thoracotomy.

BACKGROUND: Incidence of deep venous thrombosis (DVT) after thoracotomy has not been widely studied. DVT is a frequent complication in major surgery involving abdominal and pelvic areas and lower extremities. The aim of the present study was to evaluate the rate of postoperative DVTs after surgery of the lung. METHODS: In this prospective study with 25 patients undergoing thoracotomy both legs were studied with venous duplex imaging (VDI) preoperatively and on the second postoperative day. Clinically manifest thromboembolic events during one-month postoperative period were reviewed from the patients' records. DVT prophylaxis included compression stockings and early mobilization without low-molecular weight heparin. RESULTS: Frequency of postoperative DVTs was 4%. There were no clinically manifest thromboembolic events during one-month postoperative period. In 8% of the patients an old DVT was found preoperatively. CONCLUSIONS: Based on this material, incidence of DVT is low after thoracotomy. Early mobilization and the use of compression stockings may be a sufficient form of prophylaxis in these patients. The relatively small sample size and the use of ultrasound as a screening method should be noted in judging the results.

Adult↗

PubMed2002

Physical methods for preventing deep vein thrombosis in stroke.

BACKGROUND: Deep vein thrombosis (DVT) and resulting pulmonary embolism (PE) are uncommon but important complications of stroke. There is good evidence that anticoagulants can reduce the risk of DVT and PE after stroke, but this benefit is offset by a small but definite risk of serious haemorrhages. Physical methods to prevent DVT and PE (such as compression stockings applied to the legs) are not associated with any bleeding risk and are effective in some categories of medical and surgical patients. We sought to assess their effects in stroke patients. OBJECTIVES: To assess the effectiveness and safety of physical methods of preventing the onset of deep vein thrombosis and fatal or non fatal pulmonary embolism in patients with recent stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched October 2001). In addition we searched the following electronic bibliographic databases: Cochrane Controlled Trials Register (1999, Issue 3), MEDLINE (1966- Jan 2001), EMBASE (1980- Jan 2001) and CINAHL (1982-May 1999). The reference lists of all relevant papers were screened for additional trials. SELECTION CRITERIA: All completed randomised unconfounded trials or controlled clinical trials comparing physical methods in patients allocated to receive physical methods, applied within one week of onset of stroke, with patients allocated to no physical methods. DATA COLLECTION AND ANALYSIS: Two reviewers independently searched for relevant trials and three others independently checked the results. MAIN RESULTS: We identified two small trials which included 123 patients. In one trial of 97 patients, compression stockings were associated with a non significant trend towards a reduction in DVT detected by Doppler ultrasound. In one trial of 26 patients, an intermittent pneumatic compression device was not associated with a significant reduction in DVT detected by 125-I-fibrinogen scanning. Overall, physical methods were not associated with a significant reduction in DVT (Odds ratio 0.59, 95%.CI 0.24-1.48) or death (Odds ratio 5.06, 95% CI 0.96-26.78). REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to support the routine use of physical methods for preventing DVT in acute stroke.

Bandages↗

PubMed2004

Physical methods for preventing deep vein thrombosis in stroke.

BACKGROUND: Deep vein thrombosis (DVT) and resulting pulmonary embolism (PE) are uncommon but important complications of stroke. There is good evidence that anticoagulants can reduce the risk of DVT and PE after stroke, but this benefit is offset by a small but definite risk of serious haemorrhages. Physical methods to prevent DVT and PE (such as compression stockings applied to the legs) are not associated with any bleeding risk and are effective in some categories of medical and surgical patients. We sought to assess their effects in stroke patients. OBJECTIVES: To assess the effectiveness and safety of physical methods of preventing the onset of deep vein thrombosis and fatal or non fatal pulmonary embolism in patients with recent stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register (last searched June 2003). In addition we searched the following electronic bibliographic databases: Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2003), MEDLINE (1966 to June 2003), EMBASE (1980 to June 2003) and CINAHL (1982 to June 2003). The reference lists of all relevant papers were screened for additional trials. SELECTION CRITERIA: Unconfounded randomised controlled trials comparing physical methods for the prevention of DVT with control, in which prophylaxis was started within seven days of the onset of stroke. DATA COLLECTION AND ANALYSIS: Two reviewers independently searched for relevant trials and three others independently checked the results. MAIN RESULTS: We identified two small trials which included 123 patients. In one trial of 97 patients, compression stockings were associated with a non significant trend towards a reduction in DVT detected by Doppler ultrasound. In one trial of 26 patients, an intermittent pneumatic compression device was not associated with a significant reduction in DVT detected by 125-I-fibrinogen scanning. Overall, physical methods were not associated with a significant reduction in DVT during the treatment period in survivors (Odds ratio (OR) 0.54, 95% Confidence Interval (CI) 0.18 to 1.57) or death (OR 1.54, 95% CI 0.5 to 4.77). REVIEWERS' CONCLUSIONS: There is insufficient evidence from randomised trials to support the routine use of physical methods for preventing DVT in acute stroke.

Bandages↗

PubMed2006

Low-molecular-weight heparin and postoperative bleeding in rhytidectomy.

BACKGROUND: Postoperative bleeding and hematoma are unwanted complications, especially for face lifts, where the rate of hematoma is reported to be high. The authors investigated the rate of complications. As expected, the major adverse event was postoperative bleeding, requiring surgical evacuation of hematoma in 5.6 percent of cases. Plastic surgeons in Europe are currently under pressure to use low-molecular-weight heparin in every face lift patient because of the guidelines of the European Consensus Conference for Prophylaxis of Thromboembolism. METHODS: Over a period of 1.5 years, a total of 126 patients took part in a retrospective, controlled trial on postoperative bleeding, with two comparative groups. Thirty-seven patients had received low-molecular-weight heparin; in 89 patients, no heparin thrombosis prophylaxis was used. The standard for each of the 126 rhytidectomy patients operated on was as follows: one surgeon, use of compression stockings, analgosedation, and mobilization of the patient on the day of operation. RESULTS: The authors observed a 16.2 percent rate of postoperative bleeding in the low-molecular-weight heparin-group, compared with 1.1 percent in the group where no low-molecular-weight heparin was used. This was highly significant, especially when the Fisher's exact test was applied (p < 0.003). In 89 patients, when using compression stockings, analgosedation, and mobilization of the patient on the day of operation, the authors observed had no symptomatic thrombosis or pulmonary embolism if not using low-molecular-weight heparin. CONCLUSIONS: The authors conclude that the rate of postoperative bleeding in face lifts under the use of low-molecular-weight heparin is higher than generally expected. As no symptomatic thrombosis or embolism without using low-molecular-weight heparin occurred, it seems that the use of low-molecular-weight heparin in face lifts is not categorically necessary in low-risk patients.

Anticoagulants↗

PubMed2003

Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery.

AIM: To determine the risk of postoperative hemorrhage during a 3-year period of early postoperative administration of nadroparin (Fraxiparin) plus compression stockings in a large cohort of patients who underwent spinal surgery. METHODS: A total of 1,954 spinal procedures at different levels (503 cervical, 152 thoracic and 1,299 lumbar), performed between June 1999 and 2002 at the Department of Neurosurgery, Johann-Wolfgang-Goethe University Frankfurt, were included in this study. To prevent venous thromboembolic events (VTE), all patients were routinely treated subcutaneously with 0.3 ml of early (less than 24 h) postoperative nadroparin calcium (Fraxiparin) (2850 IU anti-Xa, Sanofi Winthrop Industrie, France) plus intra- and postoperative compression stockings until discharge. The occurrence of a postoperative hematoma (defined as a hematoma requiring surgical evacuation because of space occupation and/or neurological deterioration) and a deep venous thrombosis (DVT) were recorded in a database and analyzed retrospectively. RESULTS: 13 (0.7%) of the 1,954 spinal operations were complicated by major postoperative hemorrhages. In 5 of the 13 patients (38.5%) the hemorrhage occurred on the day of surgery before the administration of nadroparin. Thus, the hemorrhage rate of patients receiving nadroparin was 0.4% (8/1,949). Ten (77%) of the 13 patients with major postoperative hematoma showed a progressive neurological deficit, which resolved in 6 patients and resulted in a hematoma-related morbidity of 31% (4/13). Only 1 patient (0.05%) in this series developed a clinically evident DVT, and none of the patients suffered from pulmonary embolus during the hospital stay. CONCLUSION: Although retrospective, this is to date the largest study providing information about the hemorrhage rate associated with early postoperative anticoagulation following spinal surgery. The results confirm that early postoperative pharmacological thromboembolic prophylaxis using nadroparin in patients with spinal surgery is not associated with an increased risk of postoperative hemorrhage.

Adult↗

PubMed2001

The risk of haemorrhage associated with early postoperative heparin administration after intracranial surgery.

BACKGROUND: To analyse the rate of postoperative haemorrhage during a 4-year period of early postoperative administration (< 24 hours) of fractionated heparin plus compression stockings in a large cohort of patients undergoing intracranial surgery. METHOD: A total of 1564 patients who underwent intracranial surgery at our institution were included in our study. 1197 of the 1564 patients (77%) had major intracranial surgery (group 1). Group 2 was made up of 367 patients in whom ventriculoperitoneal shunting or external ventriculostomy was performed (minor intracranial procedures). All patients were investigated retrospectively for the occurrence of major postoperative haemorrhage confirmed by CT scanning and requiring surgical evacuation. The protocol for prophylaxis of thrombo-embolic events included early (< 24 hours) postoperative fractionated low-dose heparin (3 x 5000 IE subcutaneously) until discharge plus intra- and postoperative compression stockings. FINDINGS: Major postoperative haemorrhages were observed in 31 of the 1564 patients (2.0%). In three patients, the haemorrhage occurred on the day of surgery before the administration of heparin. The haemorrhage rate of patients receiving heparin was 1.8% (28/1564). All haemorrhages occurred in patients undergoing major intracranial procedures (group 1; 31/1197; 2.6%). There was no haemorrhage in minor intracranial procedures (group 2; 0/367; 0%). INTERPRETATION: Although retrospective, this is to date the largest study supporting the concept of postoperative pharmacological thrombo-embolic propylaxis in patients undergoing intracranial surgery. The question as to whether pharmacological prophylaxis is beneficial for a given patient can only be answered by weighing the risk reduction of thrombo-embolic events against the risk increase of postoperative haemorrhage associated with different surgical procedures and heparin protocols.

Adolescent↗

PubMed2003

Risk of postoperative hemorrhage after intracranial surgery after early nadroparin administration: results of a prospective study.

OBJECTIVE: Early postoperative pharmacological prophylaxis of deep vein thrombosis after intracranial surgery is still a matter of debate because of concerns regarding the formation of postoperative hematoma. The objective of this study was to prospectively analyze the rate of postoperative hemorrhage during a 3-year period of early postoperative administration of the low molecular weight heparin nadroparin (Fraxiparin) plus compression stockings in a large cohort of patients undergoing intracranial surgery. METHODS: A total of 2823 intracranial neurosurgical procedures, performed between June 1999 and 2002, were studied. Of these operations, 1319 (46.7%) were major intracranial surgical procedures (Group 1). Group 2 comprised 1504 operations (53.3%) considered to be minor surgical procedures (e.g., shunt procedures, biopsies). All patients except those with transnasal transsphenoidal removal of pituitary tumors underwent early postoperative imaging (computed tomography or magnetic resonance imaging) to determine postoperative hemorrhage. All significant postoperative hematomas (defined as those requiring surgical evacuation because of relevant space occupation and/or neurological deterioration) were treated surgically. Prophylaxis of venous thromboembolic events included early (<24 h) postoperative administration of 0.3 ml nadroparin subcutaneously plus intra- and postoperative compression stockings until discharge. RESULTS: Forty-three major postoperative hemorrhages (1.5%) were observed after 2823 intracranial procedures (95% confidence interval, 1.1-2.05). Forty-two (3.2%) of 1319 postoperative hematomas occurred in patients undergoing major intracranial procedures (Group 1). There was only 1 (0.07%) significant hemorrhage after 1504 minor intracranial procedures (Group 2). A subgroup analysis of patients who needed preoperative anticoagulation because of medical comorbidity did not reveal an increased frequency of postoperative hematoma when anticoagulation was stopped 24 hours before surgery P = 0.1, chi(2) test; 95% confidence interval, 0.89-3.0). CONCLUSION: This report describes the largest prospective study conducted to date to determine the hemorrhage rate after early postoperative anticoagulation. The results support the concept of postoperative pharmacological thromboembolic prophylaxis in patients undergoing intracranial surgery.

Adult↗

PubMedDate not supplied

[Various aspects of phlebology in Sweden].

The incidence of symptomatic varicose veins seems to be about the same in most industrialized countries. After decades of radical surgical treatment of most cases with this condition a much more restrictive attitude seems to be present. Patients with limited varicose veins are often told that since there is no medical danger suffering from simple varicose veins, surgery is not necessary. A simple compression stocking is frequently advised. For those patients suffering from symptoms or a finding that their varicose veins are cosmetically disturbing, surgery is performed, however, restricted to be as minor as possible. The long saphenous vein is saved in those parts being competent. The surgical procedures are performed on an outpatient basis in almost all cases which means that the cost has been very much decreased. The incidence of venous leg ulcers has also decreased in Sweden. We seem to have an incidence of 0.3 p. cent ulcers of which 54 p. cent are of venous etiology. The cost for treatment of these patients is here as everywhere else very high as is also the cost for sick-leave. A conservative attitude using compressing stockings and screening to find out in which cases reconstructive venous surgery might be a possibility seems advisable especially in recurrent ulcer cases.

Adult↗

PubMed1992

Long-term results of compression treatment for lymphedema.

Although numerous operations have been devised for lymphedema, most surgeons manage this vexing condition by nonsurgical means. Previous studies by us showed that high-pressure (90 to 100 torr) sequential external pneumatic compression (SEP) reduced both limb girth and volume in a lymphedematous extremity. To assess the long-term effects of a program entailing (1) SEP, (2) elastic compression stockings to maintain the post-SEP girth, and (3) daily skin care, we reviewed the long-term courses of 49 patients managed by one surgeon. Limb girths measured at nine levels on the limb were obtained serially in follow-up (mean 25 months) by an independent observer to provide an objective response to therapy. The relative reduction in lymphedematous tissue was determined by the difference between the pretreatment, postacute treatment, and long-term treatment girths at nine points in the limb. In long-term follow-up, 26 of the patients maintained a full response (reduction at > 3 levels), whereas 10 maintained a partial response (reduction at < or = 3 levels). At late follow-up, calf and ankle girths were reduced by an absolute value of 5.37 +/- 1.01 and 4.63 +/- 0.88 cm in the full-response group and 5.43 +/- 1.58 and 3.98 +/- 1.18 cm in the partial-response group over pretreatment measurements. The degree of subcutaneous fibrosis in relationship to the duration of the edema appeared to influence results greatly. The treatment of lymphedema with SEP and compression stockings is associated with long-term maintenance of reduced limb girth in 90% of patients.

Adult↗

PubMed1997

Late venous thromboembolic disease after radical prostatectomy: effect of risk factors, warfarin and early discharge.

PURPOSE: We determined the incidence of late venous thromboembolic disease after radical prostatectomy, and the influence of risk factors, length of hospital stay and warfarin anticoagulation. MATERIALS AND METHODS: Patients undergoing radical prostatectomy received routine deep vein thrombosis prophylaxis that consisted of intermittent pneumatic compression stockings, early ambulation and warfarin administration during hospitalization with the goal of achieving a prothrombin time international normalized ratio of 1.5 or greater. When patients returned to the hospital for postoperative evaluation, venous duplex ultrasonography of the lower extremities was done. All patients were contacted at 2 months to ensure that they did not suffer a clinical thromboembolic event. RESULTS: One of 158 patients consenting to the study had a symptomatic thromboembolic event for a clinical incidence of 0.6% (95% confidence interval 0.0 to 3.5). Duplex ultrasonography was performed 21.4 +/- 7.8 days postoperatively and 3 of the 106 patients who completed the study had a positive ultrasound for an incidence of 2.8% (95% confidence interval 0.6 to 8.1). None of these patients suffered a symptomatic thromboembolic event. Age, body mass index, length of hospital stay, operative time, estimated blood loss, prostate specific antigen and Gleason score were evaluated for a statistical relationship with thromboembolic events. Only higher body mass index and length of hospitalization approached statistical significance. CONCLUSIONS: Late deep vein thrombosis can occur after radical retropubic prostatectomy. Shorter prophylaxis period, secondary to shorter periods of hospitalization, did not increase the risk of thromboembolic events. The combination of intermittent pneumatic compression stockings and warfarin anticoagulation may be contributing to the relatively low deep vein thrombosis rate in our study compared to previous studies.

Aged↗