This document summarizes deep vein thrombosis (DVT) prophylaxis for orthopedic surgeries. It discusses that without prophylaxis, the risk of DVT is 50% for orthopedic surgeries and the risk of fatal pulmonary embolism is 2.0-2.5% for hip replacement and 2.5-7.5% for fractured hip. It reviews various risk assessment models and prophylaxis methods, including mechanical methods like compression stockings and intermittent pneumatic compression, and pharmacological methods like low molecular weight heparins, warfarin, and newer oral anticoagulants. It provides comparisons of effectiveness and safety between different prophylaxis options. National guidelines for
WALANT -Wide Awake Local Anesthesia No Tourniquet Surgery Technique Abdallah El-Azanki
Local anesthesia mixed with epinephrine and sodium bicarbonate , this mixture is called WIDE AWAKE , and it got an injection technique ...this is in brief called "WALANT" (wide awake local anesthesia no tourniquet) #dr_azanki
WALANT -Wide Awake Local Anesthesia No Tourniquet Surgery Technique Abdallah El-Azanki
Local anesthesia mixed with epinephrine and sodium bicarbonate , this mixture is called WIDE AWAKE , and it got an injection technique ...this is in brief called "WALANT" (wide awake local anesthesia no tourniquet) #dr_azanki
Damage control is a Navy term defined as “the capacity of a ship to absorb damage and maintain mission integrity". Damage Control Orthopaedics (DCO) is a relatively recent concept in orthopaedic practice it means early rapid containment & stabilization of orthopedic injuries without worsening the patient general condition. It is indicated in critically ill polytrauma patient, unfavorable surgical environment, battlefield limb injuries & mass casualties.
POLYTRAUMA AND DAMAGE CONTROL ORTHOPAEDICSDr Slayer
polytrauma is Injury to 2 or more organ systems leading potentially to a life threatening condition
Damage control orthopaedics is an approach to contain and stabilize an orthopaedic injury to improve patient’s physiology which are designed to avoid worsening pt’s condition due to “second hit” phenomenon
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
Damage control is a Navy term defined as “the capacity of a ship to absorb damage and maintain mission integrity". Damage Control Orthopaedics (DCO) is a relatively recent concept in orthopaedic practice it means early rapid containment & stabilization of orthopedic injuries without worsening the patient general condition. It is indicated in critically ill polytrauma patient, unfavorable surgical environment, battlefield limb injuries & mass casualties.
POLYTRAUMA AND DAMAGE CONTROL ORTHOPAEDICSDr Slayer
polytrauma is Injury to 2 or more organ systems leading potentially to a life threatening condition
Damage control orthopaedics is an approach to contain and stabilize an orthopaedic injury to improve patient’s physiology which are designed to avoid worsening pt’s condition due to “second hit” phenomenon
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
Venous Thromboembolism (VTE): Recent Advances in Reducing the Disease BurdenNBCA
The National Center on Birth Defects and Developmental Disabilities, Division of Blood Disorders, hosted an important webinar for health professionals on Thursday, November 6, 2014. During this webinar, Gary Raskob, PhD, Chair of NBCA’s Medical & Scientific Advisory Board, and Dean, College of Public Health, University of Oklahoma Health Science Center, reviewed the disease burden associated with DVT/PE, and discussed strategies to reduce this burden through prevention of both first time and recurrent clots.
This was powerpoint was requested by an attending physician to be shared with the Psychiatric providers regarding DVT prophylaxis in patients who may have been on the unit. They include recommendations as outlined by the ACCP 2012 Guidelines for prevention of venous thromboembolism
Deep Vein Thrombosis is an important and frequently missed out diagnosis that can often lead to sudden death in post operative patients. Did this powerpoint for an O&G seminar. Mainly focusses on DVT in OBG and its management and prevention. Kindly leave a comment and let me know what you think.
Evaluation of Clinical Decision Support Alerts for Medications Contraindicate...Allison McCoy
Computerized provider order entry-based alert systems were created to advise health care providers when prescribing medications to patients. This tool is helpful when ordering medications for cancer patients, due to their intensified risk of experiencing drug interactions with cancer therapies. The purpose of the study was to describe alerts for contraindicated medications of cancer patients to understand reasons for alert overrides and to provide additional information for further study in improving clinical support systems.
Deep Vein Thrombosis prophylaxis for surgeries in General medicine, Gastroenterology, Neurology and Orthopaedics.Virchows triads,risk factors of dvt,dvt assessment tools.
Discusses also the neuraxial guidelines for anticoagulation therapy.
Its a elaborate presentation on deep vein thrombosis by surgery resident.
Inform me if any thing needed to be correction.
thank you.
Dr Syed Aftub Uddin, MBBS,CCCD, MS ( Resident)
email: aftub_16@yahoo.com
Deep vein thrombosis (DVT) & pulmonary embolism (PE). Life-threatening complications following trauma. Incidence of 5 to 63%. Risk factors: Pelvic and lower extremity fractures,Head injury and Prolonged immobilization. DVT prophylaxis is essential in the management of trauma patients.
Physician should have a high suspicion to diagnose patient with pulmonary Embolism, this slides will give you precise Diagnosis, Investigation and guideline directed Treatment.
Similar to DVT PROPHYLAXIS IN ORTHOPEDIC SURGERIES (20)
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
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It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
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Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
3. INTRODUCTION
• WHAT IS VTE ?
• includes spectrum of deep vein thrombosis
(DVT) and pulmonary embolism (PE).
4. NEED OF DVT PROPHYLAXIS
.
common preventable cause of hospital deaths
DVT in traumatic injuries 5 - 63%
Without prophylaxis
venous thrombosis -- 50% Orthopedic surgeries
Fatal PE in 2.0% of total hip arthroplasty
Fatal PE in 2.5-7.5% of Fractured Hip
Ref: Campbell 12th edition
Piotrowski JJ, et al
Am J Surg. 1996 Aug; 172(2):210-3.
5. Indian J Urol. 2009 Jan-Mar; 25(1): 11–16.
doi: 10.4103/0970-1591.45531
INCIDENCE OF DVT IN DIFFERENT SURGERIES
Patient group VTE prevalence (%)
Medical patients 10-20
Cardiac patients 15-40
Neurosurgery 15-40
Stroke 20-30
Hip and knee arthroplasty 40-60
Major trauma 40-50
Spinal cord injury 60-80
Critical care patients 10-20
6. Strong risk factors
1. Hip or leg fracture
2. Hip or knee replacement
3. Major general surgery
4. Major trauma, including spinal cord injury
7. Moderate risk factors
1. Arthroscopic knee surgery
2. Central venous catheterization
3. HRT or OC Pills
4. Malignancy (active or recently treated)
5. Pregnancy
6. Paralytic stroke
7. Prior VTE
8. Thrombophilia (inherited or acquired)
8. Weak risk factors
1. Bed rest > 3d
2. Prolonged immobility
3. Advanced age
4. Laparoscopic surgery
5. Obesity
6. Pregnancy
7. Varicose veins
12. • Homans sign:
pain posterior calf /knee with forced dorsiflexion of foot.
• Moses sign
Gentle squeezing of lower part of calf from side to side.
• Neuhofs sign
Thickening and deep tenderness elicited while palpating deep in calf muscles
13. Wells Clinical Prediction Guide
Variable Wells
Active cancer ( within last 6 months or palliative) 1
Calf swelling >3 cm compared to other 1
Collateral superficial veins 1
Pitting edema 1
Swelling of entire leg 1
14. variable wells
Paralysis, paresis, or recent cast immobilization of lower
extremities
1
Recently bedridden > 3 days, or major surgery 1
Previous DVT 1
Alternative diagnosis at least as likely deep vein thrombosis
-2
Localized pain along distribution of deep venous system 1
15. Interpretation
High probability: ≥ 3 (Prevalence of DVT - 53%)
Moderate probability: 1-2 (Prevalence of DVT - 17%)
Low probability: ≤ 0 (Prevalence of DVT - 5%)
Adapted from Anand SS, et al. JAMA. 1998; 279 [14];1094
16. Over 20 different VTE risk assessment
models
• Individualized point-based scoring models
e.g.:CAPRINI
PADUA
REVISED GENEVA SCORE
• Grouping or “bucket” models:
– NICE / NHS guidelines
– Classic “3 bucket” model
21. • Validated in predicting risk
• Can be difficult to use reliably
Caprini Model
22. 1 point for each risk factors
• Age 41-60
• Swollen legs
• Varicose veins
• Obesity
• Sepsis
• OCP or HRT
• Pregnancy or postpartum
• AMI
• CHF
• Prolonged bed rest
• Prior major surgery
23. 2 points for each risk factors
• Age 61-74 yrs
• Arthroscopic surgery
• Malignancy
• Laparoscopic surgery
• Immobilisation with plaster cast (<1 month)
24. 3 points for each risk factor
• Age >75 yrs
• History of DVT /PE
• Positive factor leiden
• Family history of VTE
• Positive lupus anticoagulant
• HIT
• Elevated anticardiolipin antibodies
25. 5 points for each risk factors
• Stroke (<1 months)
• Elective major lower limb arthroplasty
• Hip ,pelvic , leg fractures(<1 month)
• Spinal cord injury (<1 month)
29. Update of
Elastic compression stockings for prevention of deep vein
thrombosis. [Cochrane Database Syst Rev. 2010]
19 RCTs
1681 individual patients and 1064 individual legs (2745 analytic units).
9 TRIALS- general surgery,
6 TRIALS- orthopaedic surgery,
1 TRIAL- medical patients.
G c s applied on the day before surgery or on the day of surgery . worn up
until discharge or until the patients were fully mobile
30. Treatment group (GCS) of 1391 units -126 developed DVT
control group (without GCS) of 1354 units - 282 developed
DVT
odds ratio was 0.33
(95% CI) 0.26 to 0.41 (P < 0.00001).
32. • At 40 mm Hg -maximum velocities with calf
and/or thigh compression –
Femoral velocity- 35–60 cm/s with augmentations at around 50–250%
popliteal velocities -55 cm/s.
At 120 mm Hg –
peak velocities of >100 cm/s in both popliteal and
femoral veins
33. • Foot compression has produced more modest results
20–40 cm/s -femoral vein
30–55 cm/s - popliteal vein
35. A: Venous blood flow velocity in the posterior tibial vein during compression by a foot cuff (velocity/ time
B: Venous blood flow velocity in the femoral vein during compression by a foot cuff (velocity [cm/s] vs. time [1
second per vertical dotted line]).
36. Problems in IPC
Improperly fitted compression stockings
reversed pressure gradient
higher incidence of VTE
37. CONTRAINDICATION OF IPC
• Severe arteriosclerosis
• Severe CHF
• Known acute DVT
• Gangrene
• Dermatitis
• Skin grafting
38. The Cochrane Peripheral Vascular Diseases Group Trials
RCT with 121 study participants comparing 2 types of IPC devices
• no cases of symptomatic DVT or PE during first 3 weeks after THR.
• calf-thigh pneumatic compression more effective
for reducing thigh swelling during early post-operative stage
Equal evidence regarding both types
39. DVT PUMP
• SET Pressures:
uniform thigh and calf / uniform calf garment 40 mmhg
sequential thigh and calf /sequential calf garment 45 mmhg
foot garment 130 mmhg
40. IVC filters
• FDA approved
• Ideal for young patients with reversible
PE risk factors
41. Indications
• Proven VTE
• Recurrent VTE
• Contraindications to anticoagulation
• Short Term Risk of PE/Short Term contraindication of anticoagulation
:retrievable filter
• Uncertain Risk of PE and/or lack of control for anticoagulation :
Permanent Filter
• Long Term Risk of PE/Recurrent PE/Recurrent DVT: Permanent Filter
42. SIDE EFFECTS
• Device-associated morbidity
• Device migration
• Filter embolization
• Filter fracture
• Insertion-site thrombosis
• Perforation of the vena cava
• Recurrent DVT
• Recurrent PE
• Thrombotic complications
• Vena cava thrombosis
43. Pharmacological:
1. Oral antiplatelet agents
2. Injectable low-molecular-weight heparins
3. Injectable unfractionated heparin
4. Injectable or oral factor Xa inhibitors
5. Injectable or oral direct thrombin inhibitors
6. Oral vitamin K antagonists
45. Aspirin
• Dosage : 75 mg OD
• ACCP and AAOS guidelines do not include aspirin in prevention of VTE
• Present indications:
1.elective TKR
2.elective THR
3.contraindication to other pharmacologic prophylaxis
46. Contraindications to Antiplatelet Therapy
- Recent thoracic, abdominal, or cns surgery
-Recent CVA , trauma, or neoplasm
-Bleeding ulcer
-Hypertension
-Anticipated invasive procedures
-Concurrent hemostatic dysfunction
47. Heparin
• Types :
Un fractionated heparin(UFH) : inhibit factor II and X
Dose for DVT prophylaxis: 5000 u sc every 8 to 12 hours
Monitoring : aPTT
More risk for bleeding and heparin induced thrombocytopenia(8%)
Antidote: Protamine sulphate
48. LMWH
• Examples: enoxaparin, dalteparin, tinzaparin
• Inhibit thrombin only
• Dose in prophylaxis : 40 mg in 0.4 mL SC OD
• Lesser risk of and bleeding HIT
• No need to regular monitoring
• No antidote
49. Baseline Postoperative Risks of VTE Outcomes in the Absence of
Pharmacological Prophylaxis
•Outcome Total Hip
Replacement
Strength of
Evidence
(THR)
Total Knee
Replacement
Strength of
Evidence
(TKR)
Pulmonary
embolism
6% Low 1% Low
Deep vein
thrombosis
39% Low 46% Low
Major
bleeding
1% Moderate 3% Low
Minor
bleeding
5% Low 5% Moderate
Sobieraj DM, et al. Comparative Effectiveness Review No. 49. Available at
www.effectivehealthcare.ahrq.gov/thrombo.cfm
50. Comparative Effectiveness of Pharmacological Prophylaxis
Agents: LMWH Versus UFH
Comparators DVT PE Major
Bleeding
Heparin-induced
Thrombo-cytopenia
LMWH
vs. UFH
Decreased risk by
20%
RR 0.80
Decreased odds
by 52%
OR 0.48
Decreased odds
by 35%
OR 0.57
Decreased odds by
88%
OR 0.12
Sobieraj DM, et al. Comparative Effectiveness Review No. 49. Available at
www.effectivehealthcare.ahrq.gov/thrombo.cfm
51. warfarin
• Vitamin k antagonist
• Cause defective coagulation
• Slow in onset
• Good oral absorption
• Monitor with PT and INR
52. Comparative Effectiveness of Pharmacological
Prophylaxis Agents: LMWH Versus Warfarin
Comparators DVT Proximal
DVT
Symptomatic
VTE
PE
LMWH
vs. warfarin
Decreased risk
by 34%
RR 0.66
No difference;
RR 0.63
No difference;
OR 1.00
No difference;
OR 1.11
Sobieraj DM, et al. Comparative Effectiveness Review No. 49. Available at
www.effectivehealthcare.ahrq.gov/thrombo.cfm
53. Fondaparinux
– Synthetic Factor Xa inhibitor
– FDA approved for prophylaxis, treatment
• Prophylaxis: 2.5/d SC
• Treatment: weight based 5, 7.5 or 10/d SC
– Start warfarin simultaneously, continue 5-7 days as with heparin
• Avoid with GFR < 30
54. Comparative Effectiveness of Pharmacological Prophylaxis
Agents: Enoxaparin Versus Fondaparinux
Comparators DVT Symptomatic
VTE
PE Major
Bleeding
Enoxaparin
vs.
fondaparinux
Relative risk is
higher for
enoxaparin
by 99%
RR 1.99
No difference;
OR 0.70
No difference
OR 3.34
Decreased
odds by 35%
OR 0.65
Sobieraj DM, et al. Comparative Effectiveness Review No. 49. Available at www.effectivehealthcare.ahrq.gov/thrombo.cfm
55. Ximelagatran
• Direct thrombin inhibitors
• Alternative to warfarin
– Oral - fixed dose
• Acute clot or orthopedic prophylaxis: 36 mg bid
• Secondary prevention: 24 mg bid
– No monitoring, no initial heparin
• Safety questions
– No antidote
– Can elevate LFTs
56. NICE Guidelines 2015
Elective hip / knee replacement
Start mechanical VTE prophylaxis at admission
• anti-embolism stockings (GCS)
• foot impulse devices
• intermittent pneumatic compression (IPC)devices
Continue mechanical VTE prophylaxis until the patient no longer has significantly reduced
mobility.
57. If no contraindications, start pharmacological VTE prophylaxis after surgery
• dabigatran etexilate 1–4 hours after surgery
• fondaparinux sodium 6 hours after
• LMWH 6–12 hours after
• Rivaroxaban 6–10 hours after
• UFH (for renal failure patients) 6–12 hours after
Continue pharmacological VTE prophylaxis for 28–35 days in hip replacements
Continue pharmacological VTE prophylaxis for 10-14 days in knee replacements
58. • Hip fractures:
Start mechanical VTE prophylaxis at admission
•Anti-embolism stockings
•Foot impulse devices
•Intermittent pneumatic compression devices (thigh or knee length).
Continue mechanical VTE prophylaxis until the patient no longer has significantly
reduced mobility.
59. If no contraindications, start pharmacological VTE prophylaxis after surgery
• fondaparinux sodium not recommnded pre op,
can be given 6 hrs post op
• LMWH start at admission,
stop 12 hr before restart 6–12 hours after surgery
• Rivaroxaban 6–10 hours after
• UFH (for CRF) start at admission
stop 12 hr before Restart 6–12 hours after surgery
• Continue pharmacological VTE prophylaxis for 28–35 days
60. Other orthopaedic surgery
Start mechanical VTE prophylaxis at admission.
• Anti-embolism stockings
• Foot impulse devices
• Intermittent pneumatic compression devices (thigh or knee length).
Continue mechanical VTE prophylaxis until the patient no longer has
significantly reduced mobility.
61. Pharmacological VTE prophylaxis 6–12 hours after
surgery.
• LMWH
• UFH (for renal failure).
• Continue pharmacological VTE prophylaxis until patient no longer has
significantly reduced mobility.
62. DVT prophylaxis : ORTHOPEDICS SURGERY
• Low risk
– Early ambulation
• Moderate risk
– UFH 5000 u sc bid or LMWH, IPC
• High risk
– LMWH - may combine with IPC
AAOS Clinical Practice Guideline
63. Schematic of estimated incidence rates for LMWH and no prophylaxis for major orthopaedic
surgery
• Ref:Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American
College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
• Falck-Ytter Y1, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr;
64. Systematic Review – Regarding DVT Prophylaxis
Meta regression analysis
Compare other therapies to enoxaparin for prevention of
VTE following THR
Dranitsaris 2011
http://www.aaos.org/
65.
66. Low-molecular-weight heparin and intermittent pneumatic compression for
thromboprophylaxis in critical patients
BING WAN, et al Oct 13. 2015 PMC
• 500 patients were divided into four groups
• IPC( int. Pneumatic compression) 95
• LMWH 185
• LMWH + IPC 75
• control 145
Doppler study diagnosis done
67. Incidence of DVT, PE and complications of treatment in
the four groups.
Group No. of patients DVT cases PE cases Bleeding cases
IPC 95 9 28 0
LMWH 185 31 4 18
LMWH + IPC 75 0 0 3
Control 145 49 29 0
68. conclusion
• LMWH combined with IPC exhibited an excellent prophylactic
effect against DVT and PE.
• RR : 0.281 for IPC,
• RR: 0.49 for LMWH.
69. Comparative efficacy and safety of anticoagulants and aspirin for
extended treatment of venous thromboembolism: A network
meta-analysis
Diana M. Sobieraj et al
systematic literature search and searching of reference lists
identify RCT of patients completed initial anticoagulant treatment for VTE
randomized for the extension study
comparison of anticoagulant treatment to placebo
70. .• Ten trials (n = 11,079) were included.
• Apixaban ,dabigatran, rivaroxaban, idraparinux and vitamin
K antagonists (VKA) reduced risk of VTE recurrence
compared to placebo.
71. COMPARATIVE EFFICACY AND SAFETY OF NEW ORAL ANTICOAGULANTS(NOAC)
VERSUS WARFARIN FOR LONG-TERM TREATMENT OF VENOUS THROMBOEMBOLISM:
A META-ANALYSIS
Ajay Vallakati et al
• We searched PubMed, Cochrane library and Embase for RCTs comparing
NOACs (dabigatran, apixaban, rivaroxaban, and edoxaban) with placebo or
warfarin for long-term treatment of VTE
72. 5 RCTs (n=16117) compared
NOACs (n=8484)
with either placebo (n=2085)
or warfarin (n=5548).
NOACs significantly reduced the risk of VTE
when compared to placebo/ warfarin (OR: 0.33; 95% CI, 0.13 −0.87)
• .