Perioperative Management of Venous Thromboembolism: Role of Anesthesiologists
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Published:
May 1, 2018
Keywords:
Deep vein thrombosis, pulmonary embolism venous thromboembolism anesthetic management
Main Article Content
Abstract
Venous thromboembolism (VTE), consisting of deep vein thrombosis and pulmonary embolism, is a severe condition in hospitalized patients. The patients, who have inherited or acquired risk factors of deep vein thrombosis and pulmonary embolism, may present for surgery. Choice of anesthesia may be considered based on history of receiving prophylactic or therapeutic anticoagulants, type and exigency of surgery. Anesthesiologists need to improve their knowledge of prevention, accurate diagnosis and proper management for this fatal situation in order to reduce morbidity and mortality.
Article Details
How to Cite
Saiwaew, K., & Plailaharn, N. (2018). Perioperative Management of Venous Thromboembolism: Role of Anesthesiologists. Vajira Medical Journal : Journal of Urban Medicine, 62(2), 145–158. Retrieved from https://he02.tci-thaijo.org/index.php/VMED/article/view/195729
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References
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12. Tapson VF. Acute Pulmonary Embolism. New Engl J Med. 2008;358:1037-52.
13. Anderson FA, Jr., Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107:I9-16.
14. Huisman MV, Klok FA. Diagnostic management of acute deep vein thrombosis and pulmonary embolism. J Thromb Haemost. 2013;11:412-22.
15. Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350:1795-8.
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17. Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998; 129:997-1005.
18. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135:98-107.
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20. Buller HR, Decousus H, Grosso MA, Mercuri M, Middeldorp S, Prins MH, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 2013; 369:1406-15.
21. Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363:2499-510.
22. Buller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF, Minar E, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366:1287-97.
23. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369:799-808.
24. Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of Pulmonary Embolism. An Update. J Am Coll Cardiol. 2016;67:976-90.
25. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123:1788-830.
26. Asher S DD. Acute pulmonary embolism. In: Butz S, editor. Perioperative Drill-Based Crisis Management. Cambridge: Cambridge University;2015. p. 42-8.
27. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuunemann HJ. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:7s-47s.
28. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e227S-e77S.
29. Rogers SO, Jr., Kilaru RK, Hosokawa P, Henderson WG, Zinner MJ, Khuri SF. Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007;204:1211-21.
30. Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F. Clinical assessment of venous thromboembolic risk in surgical patients. Semin Thromb Hemost. 1991;17 Suppl 3:304-12.
31. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. 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. Chest. 2012;141:e278S-e325S.
32. Rechenmacher SJ, Fang JC. Bridging Anticoagulation: Primum Non Nocere. J Am Coll Cardiol. 2015;66:1392-403.
33. Huisman MV, Lip GYH, Diener HC, Brueckmann M, van Ryn J, Clemens A. Dabigatran etexilate for stroke prevention in patients with atrial fibrillation: Resolving uncertainties in routine practice. Thrombosis and Haemostasis. 2012;107:838-47.
34. Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-507.
35. Klein SM, Slaughter TF, Vail PT, Ginsberg B, El-Moalem HE, Alexander R, et al. Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations. Anesth Analg. 2000;91:1091-5.
36. Narani KK. Thromboelastography in the perioperative period. Indian J Anaesth. 2005;49:89-95.
37. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ.. 2000;321:1493.
38. van Beek EJ, Kuyer PM, Schenk BE, Brandjes DP, ten Cate JW, Buller HR. A normal perfusion lung scan in patients with clinically suspected pulmonary embolism. Frequency and clinical validity. Chest 1995;108:170-3.
39. Hatipoglu ON, Hanci E, Tabakoglu E, Altiay G, Cermik TF, Caglar T. A new clinical model in pulmonary embolism and its correlation with V/P scan results. Clin Appl Thromb Hemost. 2006;12:344-51.
40. National Clinical Guideline Centre A, Chronic C. National Institute for Health and Clinical Excellence: Guidance. Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital. London: Royal College of Physicians (UK) National Clinical Guideline Centre - Acute and Chronic Conditions.; 2010.
41. HT B. Anticoagulants and neuraxial injections. In: Benzon HT RS, Molloy RE, Liu SS, Fishman FM, editor. Essentials of Pain Medicine and Regional Anesthesia. New York: Elsevier/Churchill Livingstone; 2005. p. 708-20.
42. Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy:American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med. 2010;35:64-101.
43. Davies G, Checketts MR. Regional anaesthesia and antithrombotic drugs. Continuing Education in Anaesthesia Critical Care & Pain. 2012;12:11-6.
44. Horlocker TT, Heit JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative prophylaxis regimens, and guidelines for regional anesthetic management. Anesth Analg. 1997;85:874-85.
45. Makris M, Greaves M, Phillips WS, Kitchen S, Rosendaal FR, Preston EF. Emergency oral anticoagulant reversal: the relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopathy. Thromb Haemost. 1997;77:477-80.
46. Enriquez A, Lip GY, Baranchuk A. Anticoagulation reversal in the era of the non-vitamin K oral anticoagulants. Europace. 2016;18:955-64.
47. Knauf F, Chaknos CM, Berns JS, Perazella MA. Dabigatran and kidney disease: a bad combination. Clin J Am Soc Nephrol. 2013;8:1591-7.
48. Hu TY, Vaidya VR, Asirvatham SJ. Reversing anticoagulant effects of novel oral anticoagulants: role of ciraparantag, andexanet alfa, and idarucizumab. Vasc Health Risk Manag. 2016;12:35-44.
2. Kearon C. Natural history of venous thromboembolism. Circulation. 2003; 107:I22-30.
3. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107:I4-8.
4. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 2008;28:370-2.
5. Righini M, Paris S, Le Gal G, Laroche JP, Perrier A, Bounameaux H. Clinical relevance of distal deep vein thrombosis. Review of literature data. Thromb Haemost. 2006;95:56-64.
6. Hull RD, Hirsh J, Sackett DL, Stoddart GL. Costeffectiveness of primary and secondary prevention of fatal pulmonary embolism in high-risk surgical patients. Can Med Assoc J. 1982;127:990-5.
7. Stein PD, Matta F, Musani MH, Diaczok B. Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review. Am J Med. 2010;123:426-31.
8. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ, 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158:585-93.
9. Aniwan S, Rojnuckarin P. High incidence of symptomatic venous thromboembolism in Thai hospitalized medical patients without thromboprophylaxis. Blood Coagul Fibrinolysis. 2010;21:334-8.
10. Arcelus JI, Caprini JA, Motykie GD, Reyna JJ. Matching risk with treatment strategies in deep vein thrombosis management. Blood Coagul Fibrinolysis. 1999;10 Suppl 2:S37-43.
11. Anning ST. The historical aspects of venous thrombosis. Med Hist. 1957;1:28-37.
12. Tapson VF. Acute Pulmonary Embolism. New Engl J Med. 2008;358:1037-52.
13. Anderson FA, Jr., Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107:I9-16.
14. Huisman MV, Klok FA. Diagnostic management of acute deep vein thrombosis and pulmonary embolism. J Thromb Haemost. 2013;11:412-22.
15. Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350:1795-8.
16. Goodacre S, Sutton AJ, Sampson FC. Metaanalysis: The value of clinical assessment in the diagnosis of deep venous thrombosis. Ann Intern Med. 2005;143:129-39.
17. Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998; 129:997-1005.
18. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135:98-107.
19. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315-52.
20. Buller HR, Decousus H, Grosso MA, Mercuri M, Middeldorp S, Prins MH, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 2013; 369:1406-15.
21. Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363:2499-510.
22. Buller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF, Minar E, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366:1287-97.
23. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369:799-808.
24. Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of Pulmonary Embolism. An Update. J Am Coll Cardiol. 2016;67:976-90.
25. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123:1788-830.
26. Asher S DD. Acute pulmonary embolism. In: Butz S, editor. Perioperative Drill-Based Crisis Management. Cambridge: Cambridge University;2015. p. 42-8.
27. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuunemann HJ. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:7s-47s.
28. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e227S-e77S.
29. Rogers SO, Jr., Kilaru RK, Hosokawa P, Henderson WG, Zinner MJ, Khuri SF. Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007;204:1211-21.
30. Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F. Clinical assessment of venous thromboembolic risk in surgical patients. Semin Thromb Hemost. 1991;17 Suppl 3:304-12.
31. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. 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. Chest. 2012;141:e278S-e325S.
32. Rechenmacher SJ, Fang JC. Bridging Anticoagulation: Primum Non Nocere. J Am Coll Cardiol. 2015;66:1392-403.
33. Huisman MV, Lip GYH, Diener HC, Brueckmann M, van Ryn J, Clemens A. Dabigatran etexilate for stroke prevention in patients with atrial fibrillation: Resolving uncertainties in routine practice. Thrombosis and Haemostasis. 2012;107:838-47.
34. Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-507.
35. Klein SM, Slaughter TF, Vail PT, Ginsberg B, El-Moalem HE, Alexander R, et al. Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations. Anesth Analg. 2000;91:1091-5.
36. Narani KK. Thromboelastography in the perioperative period. Indian J Anaesth. 2005;49:89-95.
37. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ.. 2000;321:1493.
38. van Beek EJ, Kuyer PM, Schenk BE, Brandjes DP, ten Cate JW, Buller HR. A normal perfusion lung scan in patients with clinically suspected pulmonary embolism. Frequency and clinical validity. Chest 1995;108:170-3.
39. Hatipoglu ON, Hanci E, Tabakoglu E, Altiay G, Cermik TF, Caglar T. A new clinical model in pulmonary embolism and its correlation with V/P scan results. Clin Appl Thromb Hemost. 2006;12:344-51.
40. National Clinical Guideline Centre A, Chronic C. National Institute for Health and Clinical Excellence: Guidance. Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital. London: Royal College of Physicians (UK) National Clinical Guideline Centre - Acute and Chronic Conditions.; 2010.
41. HT B. Anticoagulants and neuraxial injections. In: Benzon HT RS, Molloy RE, Liu SS, Fishman FM, editor. Essentials of Pain Medicine and Regional Anesthesia. New York: Elsevier/Churchill Livingstone; 2005. p. 708-20.
42. Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy:American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med. 2010;35:64-101.
43. Davies G, Checketts MR. Regional anaesthesia and antithrombotic drugs. Continuing Education in Anaesthesia Critical Care & Pain. 2012;12:11-6.
44. Horlocker TT, Heit JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative prophylaxis regimens, and guidelines for regional anesthetic management. Anesth Analg. 1997;85:874-85.
45. Makris M, Greaves M, Phillips WS, Kitchen S, Rosendaal FR, Preston EF. Emergency oral anticoagulant reversal: the relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopathy. Thromb Haemost. 1997;77:477-80.
46. Enriquez A, Lip GY, Baranchuk A. Anticoagulation reversal in the era of the non-vitamin K oral anticoagulants. Europace. 2016;18:955-64.
47. Knauf F, Chaknos CM, Berns JS, Perazella MA. Dabigatran and kidney disease: a bad combination. Clin J Am Soc Nephrol. 2013;8:1591-7.
48. Hu TY, Vaidya VR, Asirvatham SJ. Reversing anticoagulant effects of novel oral anticoagulants: role of ciraparantag, andexanet alfa, and idarucizumab. Vasc Health Risk Manag. 2016;12:35-44.