[HSF] DVT in cardiac sugery

[Donald Ross]

tea,
No subject is complete without an anecdote from me.
I was, not surprisingly, alarmed to see three pulmonary emboli in my  
first 100 opcabs.
I figured it may have been due the absence of well documented  
hypocoagulability following a pump run.
My subsequent experience since the adoption of intra and post op calf  
compression devices has been free from  diagnosed pulmonary embolism.  
I even put them on immediately after rare svg harvest but think the  
most vulnerable period is between heparin reversal and when the  
patient is fully awake and leg kicking.
The PE patients had early post op heparin, aspirin and clopidogrel.
Don
On 21/04/2008, at 5:57 AM, Tea Acuff wrote:

> One of the peculiarities of our new heart hospital is that we are  
> partnered which a local hospital system (Baylor). One of the  
> "benefits" of such arrangement is that for reasons that are  
> somewhat mysterious we get some (all?) of the best practice  
> formulations developed by the flagship hospital (medical) staff. At  
> least that is my take on what suddenly appears on my patients chart.
>
> One of these efforts is a 3 page DVT work sheet which we check the  
> boxes and sign an assessment page, a throw away page that explains  
> the graded risks, and a third full page for selection of various  
> prophylaxis options. Interestingly, despite many categories for  
> risk and contra indications no where on this document is there  
> mention of other procedure but no specific mention of cardiac  
> surgery, which is obviously the bulk of what we do at the heart  
> hospital.
>
> As a bias my present practice is not to rountinely prophylax except  
> for the dubious TED hose. Before I start (rather before it becomes  
> noticable) that i am markedly out of step, does anyone have  
> information or comments on these following points?
>
> 1) Is there specific data on the risk and benefits of DVT  
> prophylaxis for cardiac patients or any particular subset of  
> rountine CV patients?
>
> 2) If there is data, does it break out effects for on and off pump,  
> ASA, plavix, aprotonin, fast track (aggressive mobilization and  
> discharge) and other relevant variables?
>
> 3) If there are studies of mechanical compression devices for these  
> patients, are there comparisons of fast track verses immobility  
> (the default nursing solution for all the insulin drips, bladder  
> and invasive lines, etc)? IE does a device that has to be hooked up  
> and taken off repeatedly help or hurt with DVT compared to  
> mobilization?
>
> 4) If there is no data how do others stratify their patients at  
> risk? Is just being in the hospital ipso facto a risk, one that  
> favors treatment? Does LOS not really matter?
>
> tea
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