China
Africa
Explore chapters and articles related to this topic
Practical Approaches for Preventing Venous Thromboembolism
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Gary E. Raskob, Russell D. Hull
Patients having a transurethral resection of the prostate have a 7 to 10% risk of developing 125I fibrinogen leg scan-detected venous thrombosis; the risk is higher in those having retropubic prostatectomy or an equivalent operation (25 to 50%). Low-dose heparin is of limited effectiveness in these patients. Intermittent pneumatic compression is effective and is the method of choice.49
Lymph Stasis After Lymph Node Dissection
Published in Waldemar L. Olszewski, Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
Terence P. Wade, Michael T. Lotze
Since 1980, the use of intermittent pneumatic compression garments (see Figure 2) has been recommended because of better devices and wider availability. These devices produce a graded, programmable, segmental compression of the limb, with controlled pressures and times for each of the compartments of the sheath.15 This controlled and variable compression allows the use of pressures in the compartments which exceed systolic blood pressure, since the time of compression is short (20 s). Used under close supervision over prolonged periods of time, these devices have been successful in improving previously refractory edema.16
Coagulopathy and blood transfusions
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Lamia Nayeb, Matthew A. Kirkman
TBI is a significant risk factor for the development of VTE, but no popular guidelines exist to guide decision making on the initiation and timing of VTE prophylaxis. Although there exists no clear evidence of efficacy, it is generally recommended that graduation compression stockings or intermittent pneumatic compression stockings are used, unless lower limb trauma prevents their use or until the patient is ambulatory. Low molecular weight heparin or low-dose unfractionated heparin can reduce the rates of deep vein thrombosis (DVT) and mortality, respectively, but the optimal time to commence chemoprophylaxis is unclear. It is crucial to strike a balance between the associated risks of intracranial hemorrhage and the significantly higher risk of DVT if chemoprophylaxis is withheld for 7 days after injury. Based on evidence from over 5000 TBI patients, one study recommended that chemoprophylaxis should be started after 72 hours in patients at medium or high risk of hematoma expansion, and after 48 hours in those with low risk of hematoma expansion and absence of expansion (see Table 31.4 for a description of the risk groupings).57,58
Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome
Published in Expert Review of Cardiovascular Therapy, 2021
M Machin, S Salim, M Tan, S Onida, AH Davies, J Shalhoub
Newer technologies have been developed in order to aid venous return and ease symptoms of PTS. Venous assist devices and pneumatic compression are therapies that lack a significant body of evidence. Intermittent pneumatic compression devices consist of a pneumatic pump and an inflatable sleeve worn on the limb. The segments of the inflatable sleeve are inflated to apply a desired pressure to the limb compartments and the deep venous system within. Ginsberg et al. undertook a small randomized crossover trial, published in 1996, that assigned 15 participants to either a therapeutic intervention pressure (50 mm Hg) or a placebo pressure (15 mm Hg) for 4 weeks, with subsequent crossover [47]. It was reported that symptom scores were significantly better in the intervention arm in comparison to the control arm (16.5 vs. 14.4, p = 0.007). This symptom score pre-dates validation of the Villalta scale.
Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years
Published in Acta Orthopaedica, 2020
Martin Lindberg-Larsen, Pelle Baggesgaard Petersen, Christoffer Calov Jørgensen, Søren Overgaard, Henrik Kehlet
The study period for the current updated detailed analysis was from January 2010 until August 2017. All collaborating centers adhered to similar fast-track protocols, including use of spinal anesthesia (≈90%), multi-modal opioid-sparing analgesia, early mobilization, and discharge to own home based on functional discharge criteria. Thromboprophylaxis was prescribed according to local guidelines including thromboprophylaxis administered 6–8 hours after surgery, consisting of either rivaroxaban (Xarelto, Bayer Pharma, Berlin, Germany) 10 mg/day, enoxaparin (Klexane, Sanofi-Aventis, Paris, France) 4,000 IU/day, dalteparin (Fragmin, Pfizer Health Care, New York, USA) 5,000 IU/day, or fondaparinux (Arixtra, GlaxoSmithKline, London, UK) 2.5 mg/day. Thromboprophylaxis was used only during hospitalization if LOS was ≤ 5 day. If LOS > 5 days recommendations on duration varied in the study period. From 2010 to 2016 international guidelines with thromboprophylaxis for up to 35 days for THA were recommended and from 2016 the Danish recommendation changed to 6–10 days (RADS 2016). Compression stockings or intermittent pneumatic compression devices were not used. Pulsatile lavage was used as a standard procedure in cemented THA surgery in the participating centers.
Effects of Intermittent Pneumatic Compression on Leg Vascular Function in People with Spinal Cord Injury: A Pilot Study
Published in The Journal of Spinal Cord Medicine, 2019
Daniel P. Credeur, Lena M. Vana, Edward T. Kelley, Lee Stoner, David R. Dolbow
The lower limbs in persons with SCI can be stimulated via electrical simulation, which can be effective in improving leg vascular health.15,16 However, this technology can be expensive and difficult to administer for some, thus, making this treatment not widely available outside of a clinical setting. Alternatively, recent evidence demonstrates that intermittent pneumatic compression therapy (IPC) can acutely increase shear stress in lower limb arteries of AB individuals.17,18 IPC is a non-invasive FDA approved therapy commonly used to treat individuals with symptoms of venous insufficiency and claudication pain in peripheral arterial disease.17–24 This therapy is performed by inflating and deflating pneumatic cuffs, which are secured around the calf and foot region, in regular intervals for a period of time (i.e., 1 hour, 3 inflation cycles/minute) to simulate the mechanical compression of muscle contractions. While the use of IPC in clinical AB populations has been extensively tested, the efficacy of its use for improving vascular health outcomes in people with SCI is currently unknown.