Killewich LA, Aswad MA, Sandager GP, Lilly MP, Flinn WR.
A randomized, prospective trail of deep venous thrombosis prophylaxis in aortic
surgery.

Arch Surg 1997 May;132(5):499-504

Department of Surgery, University of Maryland School of Medicine, Baltimore, USA.

OBJECTIVES: To study the incidence of postoperative deep venous thrombosis (DVT)
in patients undergoing elective aortic reconstruction and to determine if
aggressive DVT prophylaxis would reduce the incidence of DVT in these patients.
DESIGN: Randomized, prospective trial. SETTING: University hospital and Veterans
Affairs hospital. PATIENTS: One hundred patients undergoing aortic reconstruction
for aneurysmal or occlusive disease randomized to receive DVT prophylaxis
(treatment group) or no prophylaxis (control group). Exclusion criteria included
a history of DVT, long-term anticoagulant use, or a malignant neoplasm. During
the study period, 12 patients were ineligible for follow-up. Ninety-eight
patients completed the trial, including 50 patients in the treatment group and 48
patients in the control group. Two patients in the control group died
postoperatively of unrelated causes. INTERVENTION: Patients in the treatment
group received DVT prophylaxis using a combination of low-dose heparin sodium
therapy (5000 U every 12 hours) and calf-length intermittent mechanical
compression devices. Control patients received no DVT prophylaxis. MAIN OUTCOME
MEASURES: The occurrence of acute lower extremity DVT diagnosed by interval
venous duplex ultrasound scan surveillance performed on postoperative days 1, 3,
and 7. RESULTS: The overall incidence of proximal DVT in this study was 2%. One
case of DVT occurred in the treatment group, and the other one occurred in the
control group. There was no statistically significant difference (P = .99) in the
incidence of DVT between the 2 groups. One patients in the control group had a
nonfatal pulmonary embolus (1% of the patients overall). CONCLUSIONS: The
incidence of proximal DVT in patients undergoing elective aortic reconstruction
is low compared with patients undergoing other major intraabdominal general
surgical procedures. The use of aggressive DVT prophylaxis did not reduce the
risk of postoperative proximal DVT in this study. The selective use of DVT
prophylaxis in patients undergoing elective aortic surgery should be based on
associated concomitant or evolving risk factors.