PURPOSE: Patients who undergo surgery are highly susceptible to acute deep vein thrombosis (DVT). Therefore, we studied the clinical presentation, prophylaxis prior to DVT, and initial therapy after DVT diagnosis in a large cohort of surgical patients.
METHODS: 1,375 patients were hospitalized for nonorthopedic surgery within 3 months prior to developing DVT. They participated in the U.S. DVT Registry of 5,451 consecutive patients with ultrasound confirmed DVT.
RESULTS: Surgical patients were younger (median age 66 years vs. 67 years; p=0.048) and had a lower body mass index (27.6 kg/m2 vs. 28.6 kg/m2; p=0.0001) than nonsurgical patients. Gastrointestinal surgery (29.1%) and vascular surgery (15.9%) were the most common types of surgery. Compared to nonsurgical DVT patients, surgical patients had less extremity edema (67.9% vs. 73.7%; p=0.0001), less extremity discomfort (44.9% vs. 56.4%; p<0.0001), and less difficulty walking (6.6% vs. 11.2%; p<0.0001). Surgical patients had received prophylaxis at a rate of only 43.9% prior to developing DVT. Male gender (OR=1.4, 95% CI=1.1-2.0; p=0.03), history of stroke (OR=2.7, 95% CI=1.17-6.1; p=0.02), gastrointestinal bleeding (OR=2.7, 95% CI=1.4-5.4; p=0.004), and immobilization within 30 days prior to DVT diagnosis (OR=1.9, 95% CI=1.4-2.7; p<0.001) were independent predictors of surgical patients’ receiving prophylaxis. Inferior vena caval (IVC) filters were inserted more often in surgical than nonsurgical patients (20.0% vs. 14.1%; p<0.0001; adjusted OR=1.49, 95% CI=1.17-1.92; p<0.001).
CONCLUSION: Hospitalized surgical patients are highly susceptible to postoperative DVT. VTE prophylaxis is especially important because surgical patients’ DVT symptoms and signs are not classic, and the diagnosis may be overlooked. Yet, VTE prophylaxis continues to be underutilized in this population.
CLINICAL IMPLICATIONS: Future studies should focus on ways to improve VTE prophylaxis and on the long term safety and efficacy of IVC filters in this high risk group.
DISCLOSURE: Ali Seddighzadeh, No Product/Research Disclosure Information; Grant monies (from industry related sources) This study was funded, in part, by Sanofi Aventis.