ABSTRACT
BACKGROUND: Patients undergoing neurosurgical procedures are at risk of venous thromboembolism (VTE), but often have contraindications for anticoagulant prophylaxis. OBJECTIVES: To assess the efficacy and tolerability of a new, lightweight, portable, battery-powered, intermittent calf compression device, Venowave, for the prevention of VTE in neurosurgical inpatients. PATIENTS/METHODS: We performed an open randomized controlled trial comparing Venowave with control for the prevention of VTE in patients undergoing neurosurgery. The primary outcome was the composite of asymptomatic deep vein thrombosis (DVT) detected by screening venography or compression ultrasound performed on day 9 (± 2 days) and symptomatic VTE. RESULTS: We randomized 75 patients to receive Venowave devices and 75 to the control group. All patients were prescribed graduated compression stockings and physiotherapy. VTE occurred in three patients randomized to Venowave and in 14 patients randomized to control (4.0% vs. 18.7%, relative risk 0.21; 95% confidence interval 0.05-0.75, P = 0.008). Similar reductions were seen for proximal DVT (2.7% vs. 8.0%) and symptomatic VTE (0% vs. 2.7%), and the results were consistent in all subgroups examined. CONCLUSIONS: Venowave devices are effective in preventing VTE in high-risk neurosurgical patients.
Subject(s)
Intermittent Pneumatic Compression Devices , Neurosurgical Procedures/adverse effects , Venous Thrombosis/prevention & control , Aged , Combined Modality Therapy , Equipment Design , Female , Humans , Male , Middle Aged , Phlebography , Physical Therapy Modalities , Pressure , Risk Assessment , Risk Factors , Stockings, Compression , Time Factors , Treatment Outcome , Ultrasonography , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiologySubject(s)
Fibrinolytic Agents/therapeutic use , Orthopedic Procedures/adverse effects , Practice Guidelines as Topic , Practice Patterns, Physicians' , Venous Thromboembolism/prevention & control , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Aspirin/therapeutic use , Blood Loss, Surgical/prevention & control , Casts, Surgical/adverse effects , Evidence-Based Medicine , Fibrinolytic Agents/adverse effects , Guideline Adherence , Heparin/therapeutic use , Hip Fractures/surgery , Humans , Knee/surgery , Lower Extremity/injuries , Lower Extremity/surgery , Postoperative Hemorrhage/chemically induced , Postoperative Hemorrhage/prevention & control , Treatment Outcome , Venous Thromboembolism/etiology , Vitamin K/antagonists & inhibitorsABSTRACT
In some mild haemophilia A patients (discrepant phenotype), coagulation FVIII levels by one-stage assay (FVIII-1st) are more than double those by classical two-stage coagulation assay (FVIII-2st), and may fall within the normal range. Our aim was to assess automated two-stage chromogenic FVIII assays (FVIII-chr) for diagnosis of mild discrepant haemophilia A. Three chromogenic FVIII kits (Biophen, Coamatic and Dade-Behring) were evaluated, using recommended and extended incubation times. Samples were tested from patients with discrepant haemophilia (n = 7) and equivalent mild haemophilia (agreement between FVIII-1st and FVIII-2st, n = 4). For equivalent haemophilia, FVIII-chr were consistent with FVIII-1st and FVIII-2st for all kits at all incubation times. For discrepant haemophilia, using recommended incubation times, mean FVIII-chr using Biophen reagents was 22 IU/dl (range 13-31), with Coamatic 26 (17-34) and with Dade-Behring 41 (33-47), compared with 36 (27-44) for FVIII-1st and 8 (6-9) for FVIII-2st. FVIII-chr decreased as incubation time was increased with Biophen and Coamatic, but decreased less with Dade-Behring. FVIII-chr using the Dade-Behring kit gave similar results to FVIII-1st and is not suitable for diagnosis of mild discrepant haemophilia A. FVIII-chr by Biophen and Coamatic kits is suitable for diagnosis of these patients, especially with an extended incubation time.
