JTCVS Open (Feb 2024)

A comprehensive deep venous thrombosis prophylaxis regimen in isolated coronary artery bypass graftingCentral MessagePerspective

  • John Eisenga, MD,
  • Jennie Hocking, MPAS,
  • Austin Kluis, MD,
  • J. Michael DiMaio, MD,
  • Emily Shih, MD,
  • Justin Schaffer, MD,
  • David O. Moore, MD,
  • William Ryan, MD,
  • Kelley Hutcheson, MD,
  • Radhika Vaishnav, BS,
  • Allison Lanfear, MS,
  • Rachel Dahl, NP,
  • Alexis Hayes, BA,
  • Ghadi Moubarak, MD,
  • Jonathan Ladner, BS,
  • Kyle McCullough, MD,
  • Jasjit Banwait, PhD

Journal volume & issue
Vol. 17
pp. 145 – 151

Abstract

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Objectives: Deep venous thrombosis (DVT) is a known surgical complication that can lead to pulmonary embolism with subsequent morbidity and mortality. The incidence of DVT following coronary artery bypass grafting is unclear. Prophylaxis regimens vary and some guidelines advocate against use of routine chemoprophylaxis in patients at low-moderate risk for venous thromboembolism. We utilized postoperative lower extremity venous ultrasound to determine the incidence of DVT following coronary artery bypass grafting in patients with low- to moderate-risk of venous thromboembolism receiving aggressive postoperative DVT prophylaxis. Methods: This is a single-center, retrospective study of all patients who underwent coronary artery bypass grafting between April 2022 and January 2023. All patients who completed postoperative venous ultrasound of the bilateral lower extremities were initially included. Patients who underwent concurrent valve or aortic surgery, were at high risk of venous thromboembolism, or were receiving anticoagulation therapy for nonvenous thromboembolism indications were excluded. The primary outcome was in-hospital incidence of DVT. Secondary outcomes were rates of mortality, postoperative bleeding, and thromboembolic events from discharge to 30 days postoperatively and from 30 days to 3 months postoperatively. Results: No DVTs were observed in 211 included patients. In hospital, there were 3 significant bleeding events and 1 stroke. Following discharge there were 3 additional bleeding events, 1 death, 1 transient ischemic attack, and 1 pulmonary embolism. Conclusions: We observed a 0% rate of DVT in low- to moderate-risk patients undergoing isolated coronary artery bypass grafting and receiving a comprehensive DVT prophylaxis regimen. In hospital bleeding and other thromboembolic event rates were 2.84% and 0.47% respectively.

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