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High Incidence of Venous Thrombosis following Cardiac Surgery. Girish R. Mood, MD , Heather L. Gornik, MD, MHS, Vidyasagar Kalahasti, MD, Donald Hammer, MD, W. H. Wilson Tang, MD, FAHA. Background:. Absolute risk of DVT in hospitalized patients.
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High Incidence of Venous Thrombosis following Cardiac Surgery Girish R. Mood, MD, Heather L. Gornik, MD, MHS, Vidyasagar Kalahasti, MD, Donald Hammer, MD, W. H. Wilson Tang, MD, FAHA.
Background: Absolute risk of DVT in hospitalized patients Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):338S-400S High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 2
Deep venous thrombosis after open heart surgery: DeLaria GA, Hunter JA. Deep venous thrombosis. Implications after open heart surgery. Chest. 1991 Feb;99(2):284-8 High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 3
Deep venous thrombosis following hospital discharge: Ambrosetti M, Salerno M, Zambelli M, Mastropasqua F, Tramarin R, Pedretti RF. Deep vein thrombosis among patients entering cardiac rehabilitation after coronary artery bypass surgery. Chest 2004;125:191-6 High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 4
Aim of the study: • To evaluate incidence of symptomatic venous thrombosis after contemporary open heart surgery • To evaluate the relative time course and presenting locations of venous thrombosis High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 5
Inclusion criteria: • All patients who underwent cardiac surgery (emergent and non emergent) during the year 01/2004 to 12/2006 • Patients evaluated with imaging studies for clinical suspicion of venous thrombosis - Swelling, warmth, redness, pain related to the extremity - Heparin induced thrombocytopenia Exclusion criteria: • Patients with known venous thrombosis prior to the surgery High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 6
Methods: • Detailed post-operative data prospectively collected via Cleveland Clinic Cardiovascular Information Registry database (CVIR) • Vascular study information up to 30 days post-op reviewed • Stratified according to location of venous thrombosis; superficial venous thrombosis or deep venous thrombosis High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 7
Definitions: • Early venous thrombosis was defined as positive results between 0-15 days from the surgery • Late venous thrombosis was defined as positive results between 16-30 days after the surgery High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 8
Results: High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 9
Site of venous thrombosis: High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 10
Time to thrombosis (Deep venous thrombosis): Time in Days High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 11
Time to thrombosis (superficial and deep venous thrombosis): Time in days High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 12
Deep venous thrombosis in CABG and valve surgery only: 16.3% 14.9% 14% 9.7% High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 13
Limitation: • Single center, registry based study • May not include the studies performed outside the central vascular lab • Details of venous access site were not available • Selection bias of clinically indicated vascular studies High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 14
Conclusion: • Symptomatic venous thrombosis was found in 12% of patients undergoing open heart surgery in the contemporary era • Incidence of deep venous thrombosis was 8.2% • Over 3/4th of venous thrombosis were detected within 15 days post-operatively • Internal jugular (45.5%) and calf vein thromboses (34.9%) being the most common sites. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 15