Venous thromboembolism risk factors

• Intermittent compression devices as antithrombotic strategy in neurosurgical interventions: a prospective randomised controlled trial (TIPOTEE)
• Khorana risk score in lung cancer patients treated with immune checkpoint inhibitors: a real-world study
• Deep Venous Thromboembolism Following Ambulatory General Surgery
• Retrospective analysis of the effectiveness and safety of sulodexide for venous thromboembolism prevention in neurosurgical patients
• Development of a predictive model for deep vein thrombosis in burn patients based on the Caprini Risk Assessment Scale
• Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy
• Three-Month Incidence of Venous Thromboembolism in Patients Who Underwent Neurological Surgeries
• Impact of Frailty on Surgical Outcomes of Patients With Cushing Disease Using the Multicenter Registry of Adenomas of the Pituitary and Related Disorders Registry

see Deep-Vein Thrombosis.

A risk stratification algorithm has demonstrated its convenience and significant predictive value for determining the risk of venous thromboembolism among elective neurosurgical patients. In addition, the different incidence of venous thromboembolism was demonstrated in patients with various neurosurgical diseases ¹⁾.

A meta-analysis revealed a high prevalence of venous thromboembolism in critically ill patients. The risk factors of VTE included thromboprophylaxis strategy, SAPS II, age, malignancy, sex, spinal cord injury, and ISS. Therefore, we need to pay more attention to high-risk populations of VTE in intensive care patients ²⁾.

VTE risk is linked to decreased mobility and hypercoagulability. Studies are needed to test short-term VTE prophylaxis beyond hospitalization in high-risk patients ³⁾.

Larger RBC transfusion volumes and higher case mix index scores were associated with an increased risk of VTE events. Physicians should be aware of how these dose-response relationships can influence a patient's risk of developing thrombotic complications postoperatively ⁴⁾.

A meta-analysis revealed a high prevalence of VTE in critically ill patients. The risk factors of VTE included thromboprophylaxis strategy, SAPS II, age, malignancy, sex, spinal cord injury, and ISS. Therefore, we need to pay more attention to high-risk populations of VTE in intensive care patients ⁵⁾.

Cushing's disease (CD) is associated with an increased risk of venous thromboembolism. The purpose of Rabiei et al was to discuss preventive strategies for postoperative thrombosis in CD patients and their impact on patient outcomes. A systematic review under PRISMA guidelines was conducted within PubMed, Embase, Web of Science, and Cochrane databases through July 2022. Of the 3207 papers retrieved, seven articles were included in a systematic review. Four hundred forty-eight patients were presented in the reviewed studies and the overall reported mortality was 2.67% (12/448). Three studies utilized prophylaxis methods including graduated compression stockings (GCS) and early ambulation (EA) while the remaining four studies only used anticoagulation medicine. Only 20 patients received pre-operative prophylactic treatment, while 366 patients received post-operative prophylaxis which was delivered either immediately after surgery or at different time intervals within 2 days following the surgery. Thrombotic events mainly occurred within two to 3 months after surgery. Overall, a higher frequency of thromboembolic events and mortality was observed in the control groups in comparison to groups receiving prophylaxis. A combination of anticoagulation, EA, and GCS might reduce thrombotic events and mortality in CD patients after treatment. Although the early commencement of a prophylactic anticoagulation regimen on the same day of surgery and continuing up to 3 months seems beneficial, the application of a prophylactic regimen should be utilized with caution since the number of included studies was insufficient to draw a strong conclusion, as well as neither prospective study nor randomized controlled trials existed ⁶⁾.

The incidence of VTE in meningioma patients is not negligible. Identified risk factors should be taken into account in the decision-making process for chemoprophylaxis when the risk of bleeding decreases ⁷⁾.

Patients with osteoporosis have a significantly higher risk of intraoperative blood volume loss and postoperative thromboembolic events ⁸⁾.

This retrospective cohort study was conducted at a single center, a university-based hospital in Thailand. Inclusion criteria comprised patients aged 15 years or older admitted for elective or emergency neurosurgery. Patients with preoperative VTE diagnosed within three months or a history of anticoagulant use were excluded. Outcomes measured included the 90-day incidences of VTE, any bleeding, major bleeding, and mortality. Between January 2021 and December 2022, 626 patients were included. The mean age was 50.21 ± 17.37 years, and 55.27% were males. Thromboprophylaxis was administered to 86 patients (13.74%, 95% CI 11.14-16.69). Fourteen patients were confirmed to have symptomatic VTE, resulting in an incidence of 2.24%, with a 95% confidence interval (CI) of 1.23-3.72. Patients aged ≥75 years (HR 4.53; 95% CI 1.25-16.38; p = 0.021), those with cancer (HR 8.51; 95% CI 2.95-24.60, p <0.001), and those experiencing postoperative paraparesis/paralysis (HR 3.26; 95% CI 1.12-9.45; p = 0.030) were associated with an increased risk of postoperative VTE. Fifty-three patients (8.47%, 95% CI 6.41-10.93) experienced any bleeding, with 23 patients (3.67%, 95% CI 2.34-5.46) having major bleeding. The incidence of postoperative mortality was 6.55%, with a 95% CI of 4.74-8.78. This study revealed that elderly patients, those with cancer, or those experiencing postoperative paraparesis/paralysis were at higher risk of VTE. These patients were likely to benefit from VTE prophylaxis ⁹⁾.