Abstract
Deep vein thrombosis [DVT] is one of the most dreaded complications in post-operative patients as it is associated with considerable morbidity and mortality. Majority of patients with postoperative DVT are asymptomatic. The pulmonary embolism, which is seen in 10% of the cases with proximal DVT, may be fatal. Therefore it becomes imperative to prevent DVT rather than to diagnose and treat. Only one randomized trial has been reported from India to assess the effectiveness of low molecular weight heparin in preventing post-operative DVT. To assess the risk of DVT in North Indian patients following major abdominal operations and to evaluate the effectiveness of Nadroparin, A Low Molecular Weight Heparin (LMWH) therapy in preventing post-operative DVT. Sixty five patients were randomised preoperatively into Group-I; Nadroparin prophylaxis and Group-II: No prophylaxis. The primary outcome was the occurrence of DVT, diagnosed by bilateral lower limb venogram performed, seven to ten days after operation. Secondary outcome measures included adverse effects of radio-opaque dye, intra-operative blood loss, operating time, postoperative platelet count, intraoperative blood transfusion requirements and the total duration of postoperative bed rest. No case of DVT occurred in either group. There was no statistical difference in the risk of secondary outcome measures in the two groups. DVT was not observed in any of the patients, even with several high risk factors indicating a possible protective mechanism in the North Indian population.
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References
Hirsh J, Hoak J (1996) Management of deep vein thrombosis and pulmonary embolism: a statement for healthcare professionals from the council on thrombosis (in consultation with the council on cardiovascular radiology). Am Heart Assoc Circ 93:2212–2245
Bergqvist D, Lindblad B (1985) A 30-year survey of pulmonary embolism verified at autopsy: an analysis of 1274 surgical patients. Br J Surg 72(2):105–8
Sandler DA, Martin JF (1989) Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med 82(4):203–5
Tinkler LF (1964) Absence of pulmonary embolism in Asians. Br Med J 1:502, letter
Nandi P, Wong KP, Wei WI, Ngan H, Ong GB (1980) Incidence of postoperative deep vein thrombosis in Hong Kong Chinese. Br J Surg 67(4):251–3
Lee HM, Suk KS, Moon SH, Kim DJ, Wang JM, Kim NH (2000) Deep vein thrombosis after major spinal surgery: incidence in an East Asian population. Spine 25(14):1827–30
Lee FY, Chu W, Chan R, Leung YF, Liu KH, Ng SM, Lai PB, Metreweli C, Lau WY (2001) Incidence of deep vein thrombosis after colorectal surgery in a Chinese population. ANZ J Surg 71(11):637–40
Pookarnjanamorakot C, Sirisriro R, Eurvilaichit C, Jaovisidha S, Koysombatolan I (2004) The incidence of deep vein thrombosis and pulmonary embolism after total knee arthroplasty: the screening study by radionuclide venography. J Med Assoc Thai 87(8):869–76
Nathan S, Aleem MA, Thiagarajan P, De Das S (2003) The incidence of proximal deep vein thrombosis following total knee arthroplasty in an Asian population: a Doppler ultrasound study. J Orthop Surg (Hong Kong) 11(2):184–9
Wille-Jorgensen P, Rasmussen MS, Andersen BR, Borly L (2003) Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev (4):CD001217
Handoll HH, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ (2002) Abstract Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev (4):CD000305
Srivastava A, Dash T, Chumber S, Saxena R, Thulkar S, Khazanchi RK, Misra MC, Goyal A (2003) Detection of deep vein thrombosis (DVT) in lower limbs following major operations and evaluation of enoxaparin in reducing post operative DVT. Ann Natl Acad Med Sci (India) 36(1):31–5
Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, and Ray JG (2004) Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest 126: 338S–400S
Oates-Whitehead RM, D’Angelo A, Mol B (2003) Anticoagulant and aspirin prophylaxis for preventing thromboembolism after major gynaecological surgery. Cochrane Database Syst Rev (4):CD003679
Ho YH, Seow-Choen F, Leong A, Eu KW, Nyam D, Teoh MK (1999) Randomized, controlled trial of low molecular weight heparin vs. no deep vein thrombosis prophylaxis for major colon and rectal surgery in Asian patients. Dis Colon Rectum 42(2):196–202
Sawczuk S, Williams D, Chang DT (2002) Low molecular weight heparin for venous thromboembolism prophylaxis in urologic oncologic surgery. Cancer Invest 20(7–8):889
Kakkar VV, Cohen AT, Edmonson RA, Phillips MJ, Cooper DJ, Das SK, Maher KT, Sanderson RM, Ward VP, Kakkar S (1993) Low molecular weight versus standard heparin for prevention of venous thromboembolism after major abdominal surgery. The Thromboprophylaxis Collaborative Group. Lancet 341(8840):259–65
Sharrock NE, Haas SB, Hargett MJ, Urquhart B, Insall JN, Scuderi G (1991) Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty. J Bone Joint Surg Am 73(4):502–6
Ahmed MM, Akbar DH, Al-Shaikh AR (2000) Deep vein thrombosis at King Abdul Aziz University Hospital. Saudi Med J 21(8):762–4
Comerota AJ, White JV, Katz ML (1985) Diagnostic methods for deep vein thrombosis: venous Doppler examination, phleborheography, iodine-125 fibrinogen uptake, and phlebography. Am J Surg 150(4A):14–24
Le Gagneux F, Steg A, Le Guillon M (1987) Subcutaneous enoxaparin versus placebo for prevention of deep vein thrombosis after transurethral prostatectomy. Thr Hemost 58:116–8
Valle F, Sula G, Origone A (1988) Controlled clinical study of efficacy of new low molecular weight heparin to prevent post operative deep vein thrombosis. Curr Med Res Opin 11:80–6
Gazzaniga GM, Angelini G, Pastorino G, Santoro E, Lucchini M, Dal Pra ML (1993) Enoxaparin in the prevention of deep venous thrombosis after major surgery: multicentric study. The Italian Study Group. Int Surg 78(3):271–5
Monsuez JJ, Bouali H, Serve E, Boissonnas A, Alhenc-Gelas M (2003) Deep venous thrombosis associated with factor V Leiden, G20210A mutation, and protein S deficiency. Am J Med 114(5):421–2
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Murugesan, A., Srivastava, D.N., Ballehaninna, U.K. et al. Detection and Prevention of Post-Operative Deep Vein Thrombosis [DVT] Using Nadroparin Among Patients Undergoing Major Abdominal Operations in India; a Randomised Controlled Trial. Indian J Surg 72, 312–317 (2010). https://doi.org/10.1007/s12262-010-0067-7
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DOI: https://doi.org/10.1007/s12262-010-0067-7