Risk of Venous Thromboembolism in Surgical Elderly Patients
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.
KeywordsVenous thromboembolism (VTE) Elderly patients VTE risk factors Thromboprophylaxis Major surgery Oncological surgery Orthopedic surgery Risk stratification models Heparins Direct oral anticoagulants
- 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
- 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.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
- 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
- 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
- 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
- 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
- 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.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.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
- 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