Advertisement

Risk of Venous Thromboembolism in Surgical Elderly Patients

  • Anna Falanga
  • Viola Milesi
Chapter

Abstract

Venous thromboembolism (VTE) is a complex disease, involving clinical and genetic risk factors and environmental interactions. Advanced age and surgery are well-known VTE risk factors. In fact, this risk increases in all patients undergoing surgery, in particular in elderly patients. Preventing VTE is a relevant task in decreasing the morbidity and mortality associated with this complication. Much evidence exists showing the efficacy of prophylactic strategies to prevent VTE in surgical patients. Indications for VTE prophylaxis vary according to the individual risk of VTE and the surgical procedure (i.e., minor or major surgery).

The chapter will focus on the risk of VTE, especially in elderly patients, the risk stratification models in patients undergoing surgery, and the different forms of perioperative thromboprophylaxis according to the individual risk level.

Keywords

Venous thromboembolism (VTE) Elderly patients VTE risk factors Thromboprophylaxis Major surgery Oncological surgery Orthopedic surgery Risk stratification models Heparins Direct oral anticoagulants 

References

  1. 1.
    Heit JA. Venous thromboembolism: disease burden, outcomes and risk factors. J Thromb Haemost. 2005;3(8):1611–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER). Lancet. 1999;353(9162):1386–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Janata K, Holzer M, Domanovits H, Mullner M, Bankier A, Kurtaran A, et al. Mortality of patients with pulmonary embolism. Wien Klin Wochenschr. 2002;114(17–18):766–72.PubMedGoogle Scholar
  4. 4.
    Heit JA, Mohr DN, Silverstein MD, Petterson TM, O'Fallon WM, Melton LJ 3rd. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med. 2000;160(6):761–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Baglin T, Luddington R, Brown K, Baglin C. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet. 2003;362(9383):523–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT study. Arch Intern Med. 1991;151(5):933–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(3 Suppl):338S–400S.CrossRefPubMedGoogle Scholar
  8. 8.
    Falanga A, Russo L. Epidemiology, risk and outcomes of venous thromboembolism in cancer. Hamostaseologie. 2012;32(2):115–25.CrossRefPubMedGoogle Scholar
  9. 9.
    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(6):585–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Engbers MJ, van Hylckama VA, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost. 2010;8(10):2105–12.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Johnson SA, Eleazer GP, Rondina MT. Pathogenesis, diagnosis, and treatment of venous thromboembolism in older adults. J Am Geriatr Soc. 2016;64(9):1869–78.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Larsson L, Grimby G, Karlsson J. Muscle strength and speed of movement in relation to age and muscle morphology. J Appl Physiol Respir Environ Exerc Physiol. 1979;46(3):451–6.Google Scholar
  13. 13.
    Gensini GF, Rostagno C, Caciolli S. Treatment options for acute venous thromboembolism in the older patient. Geriatrics. 1998;53(1):34–6. 9–40, 6–7Google Scholar
  14. 14.
    White RH, Gettner S, Newman JM, Trauner KB, Romano PS. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med. 2000;343(24):1758–64.CrossRefGoogle Scholar
  15. 15.
    Bozzato S, Galli L, Ageno W. Thromboprophylaxis in surgical and medical patients. Semin Respir Crit Care Med. 2012;33(2):163–75.CrossRefGoogle Scholar
  16. 16.
    White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost. 2003;90(3):446–55.Google Scholar
  17. 17.
    Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005;51(2–3):70–8.CrossRefGoogle Scholar
  18. 18.
    Treasure T, Hill J. NICE guidance on reducing the risk of venous thromboembolism in patients admitted to hospital. J R Soc Med. 2010;103(6):210–2.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    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(2 Suppl):e227S–77S.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Falanga A, Russo L, Milesi V. The coagulopathy of cancer. Curr Opin Hematol. 2014;21(5):423–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Thodiyil PA, Kakkar AK. Variation in relative risk of venous thromboembolism in different cancers. Thromb Haemost. 2002;87(6):1076–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Sorensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000;343(25):1846–50.CrossRefPubMedGoogle Scholar
  23. 23.
    Rickles FR, Levine MN. Epidemiology of thrombosis in cancer. Acta Haematol. 2001;106(1–2):6–12.CrossRefPubMedGoogle Scholar
  24. 24.
    Mismetti P, Laporte S, Darmon JY, Buchmuller A, Decousus H. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg. 2001;88(7):913–30.CrossRefPubMedGoogle Scholar
  25. 25.
    Kakkar AK, Haas S, Wolf H, Encke A. Evaluation of perioperative fatal pulmonary embolism and death in cancer surgical patients: the MC-4 cancer substudy. Thromb Haemost. 2005;94(4):867–71.PubMedGoogle Scholar
  26. 26.
    Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002;346(13):975–80.CrossRefPubMedGoogle Scholar
  27. 27.
    Rasmussen MS, Jorgensen LN, Wille-Jorgensen P, Nielsen JD, Horn A, Mohn AC, et al. Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost. 2006;4(11):2384–90.CrossRefPubMedGoogle Scholar
  28. 28.
    Kakkar VV, Balibrea JL, Martinez-Gonzalez J, Prandoni P, Group CS. Extended prophylaxis with bemiparin for the prevention of venous thromboembolism after abdominal or pelvic surgery for cancer: the CANBESURE randomized study. J Thromb Haemost. 2010;8(6):1223–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(17):2189–204.CrossRefGoogle Scholar
  30. 30.
    Farge D, Debourdeau P, Beckers M, Baglin C, Bauersachs RM, Brenner B, et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost. 2013;11(1):56–70.CrossRefPubMedGoogle Scholar
  31. 31.
    Siragusa S, Armani U, Carpenedo M, Falanga A, Fulfaro F, Imberti D, et al. Prevention of venous thromboembolism in patients with cancer: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET) (1). Thromb Res. 2012;129(5):e171–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I22–30.PubMedPubMedCentralGoogle Scholar
  33. 33.
    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(2 Suppl):e278S–325S.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Hull RD, Pineo GF, Stein PD, Mah AF, MacIsaac SM, Dahl OE, et al. Extended out-of-hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review. Ann Intern Med. 2001;135(10):858–69.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Pengo V, Crippa L, Falanga A, Finazzi G, Marongiu F, Palareti G, et al. Questions and answers on the use of dabigatran and perspectives on the use of other new oral anticoagulants in patients with atrial fibrillation. A consensus document of the Italian Federation of Thrombosis Centers (FCSA). Thromb Haemost. 2011;106(5):868–76.Google Scholar
  36. 36.
    Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet. 2007;370(9591):949–56.CrossRefGoogle Scholar
  37. 37.
    Eriksson BI, Dahl OE, Huo MH, Kurth AA, Hantel S, Hermansson K, et al. Oral dabigatran versus enoxaparin for thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II*). A randomised, double-blind, non-inferiority trial. Thromb Haemost. 2011;105(4):721–9.CrossRefGoogle Scholar
  38. 38.
    Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost. 2007;5(11):2178–85.CrossRefGoogle Scholar
  39. 39.
    Committee R-MW, Ginsberg JS, Davidson BL, Comp PC, Francis CW, Friedman RJ, et al. Oral thrombin inhibitor dabigatran etexilate vs north American enoxaparin regimen for prevention of venous thromboembolism after knee arthroplasty surgery. J Arthroplast. 2009;24(1):1–9.CrossRefGoogle Scholar
  40. 40.
    Eriksson BI, Quinlan DJ, Eikelboom JW. Novel oral factor Xa and thrombin inhibitors in the management of thromboembolism. Annu Rev Med. 2011;62:41–57.CrossRefPubMedGoogle Scholar
  41. 41.
    Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med. 2008;358(26):2765–75.CrossRefPubMedGoogle Scholar
  42. 42.
    Kakkar AK, Brenner B, Dahl OE, Eriksson BI, Mouret P, Muntz J, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet. 2008;372(9632):31–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Lassen MR, Ageno W, Borris LC, Lieberman JR, Rosencher N, Bandel TJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med. 2008;358(26):2776–86.CrossRefPubMedGoogle Scholar
  44. 44.
    Turpie AG, Lassen MR, Davidson BL, Bauer KA, Gent M, Kwong LM, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet. 2009;373(9676):1673–80.CrossRefPubMedGoogle Scholar
  45. 45.
    Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Portman RJ. Apixaban or enoxaparin for thromboprophylaxis after knee replacement. N Engl J Med. 2009;361(6):594–604.CrossRefPubMedGoogle Scholar
  46. 46.
    Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Hornick P, et al. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet. 2010;375(9717):807–15.CrossRefPubMedGoogle Scholar
  47. 47.
    Lassen MR, Gallus A, Raskob GE, Pineo G, Chen D, Ramirez LM, et al. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med. 2010;363(26):2487–98.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Anna Falanga
    • 1
  • Viola Milesi
    • 1
  1. 1.Division of Immunohematology and Transfusion MedicineThrombosis & Hemostasis Center, Hospital Papa Giovanni XXIIIBergamoItaly

Personalised recommendations