RESUMEN
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.
Asunto(s)
Aparatos de Compresión Neumática Intermitente , Procedimientos Neuroquirúrgicos/efectos adversos , Trombosis de la Vena/prevención & control , Anciano , Terapia Combinada , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flebografía , Modalidades de Fisioterapia , Presión , Medición de Riesgo , Factores de Riesgo , Medias de Compresión , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiologíaAsunto(s)
Fibrinolíticos/uso terapéutico , Procedimientos Ortopédicos/efectos adversos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Tromboembolia Venosa/prevención & control , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Aspirina/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Moldes Quirúrgicos/efectos adversos , Medicina Basada en la Evidencia , Fibrinolíticos/efectos adversos , Adhesión a Directriz , Heparina/uso terapéutico , Fracturas de Cadera/cirugía , Humanos , Rodilla/cirugía , Extremidad Inferior/lesiones , Extremidad Inferior/cirugía , Hemorragia Posoperatoria/inducido químicamente , Hemorragia Posoperatoria/prevención & control , Resultado del Tratamiento , Tromboembolia Venosa/etiología , Vitamina K/antagonistas & inhibidoresRESUMEN
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.