Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE...Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.展开更多
Background The objective of this study was to assess the clinical safety and efficacy of vena cava filter （VCF） placement, with particular emphasis on the incidence and risk factors of inferior vena cava thrombosis ...Background The objective of this study was to assess the clinical safety and efficacy of vena cava filter （VCF） placement, with particular emphasis on the incidence and risk factors of inferior vena cava thrombosis （VCT） after VCF placement. Methods Clinical data of patients with venous thromboembolism （VTE）, with or without placement of VCF, were analyzed in a retrospective single-center audit of medical records from January 2005 to June 2009. The collected data included demographics, procedural details, filter type, indications, and complications. Results A total of 168 cases of VTE （82 with VCF; 86 without VCF） were examined. Over a median follow-up of 24.2 months, VCT occurred in 18 of 82 patients with VCFs （11 males, 7 females, mean age 55.4 years）. In 86 patients without VCFs, VCT occurred in only 6 individuals （4 males, 2 females） during the study period. VCT was observed more frequently in patients fitted with VCFs than in those without VCFs （22% vs. 7.0%）. Conclusions The incidence of VCT in patients with VTE after VCF implantation was 22% approximately. Anticoagulation therapy should be continued for all patients with VCF placement, unless there is a specific contraindication. Almost all instances of VCT in patients with VCF implants in our study occurred after stopping anticoagulation treatment. The use of VCFs is increasing, and more trials are needed to confirm their benefit and accurately assess their safety.展开更多
OBJECTIVE: To evaluate the safety and value of preoperative transarterial embolization of hypervascular vertebral tumors. METHODS: Sixteen patients with hypervascular vertebral tumors underwent transarterial embolizat...OBJECTIVE: To evaluate the safety and value of preoperative transarterial embolization of hypervascular vertebral tumors. METHODS: Sixteen patients with hypervascular vertebral tumors underwent transarterial embolization before surgery. The lesions were located between the middle cervical and lower lumbar spine. Forty-one arteries were embolized with permanent particles injected through a microcatheter, including polyvinyl alcohol (PVA) particles (150 - 500 micro m) in 25 arteries and Dextran particles (150 - 350 micro m) in 16. Of these, 31 had pieces of gelatin sponge added for proximal pedicled embolization. The criteria for judging the effectiveness of embolization were completeness of tumor removal and estimated blood loss during surgery. RESULTS: The particles were injected into the tumor feeders through superselection in 17 arteries or flow control in 24. Tumor embolization was defined as 'total' in five patients, 'nearly total' in eight, 'subtotal' in two, and 'partial' in another. There were no symptomatic complications associated with embolization. Tumors were entirely removed in all patients. The average estimated blood loss during surgery was 1510 ml (range of 200 - 6000 ml) for all 16 patients. CONCLUSION: Preoperative embolization of hypervascular vertebral tumors is safe and effective. It can make complete resection of a tumor possible and can make a previously unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and to avoid complications.展开更多
文摘Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.
文摘Background The objective of this study was to assess the clinical safety and efficacy of vena cava filter （VCF） placement, with particular emphasis on the incidence and risk factors of inferior vena cava thrombosis （VCT） after VCF placement. Methods Clinical data of patients with venous thromboembolism （VTE）, with or without placement of VCF, were analyzed in a retrospective single-center audit of medical records from January 2005 to June 2009. The collected data included demographics, procedural details, filter type, indications, and complications. Results A total of 168 cases of VTE （82 with VCF; 86 without VCF） were examined. Over a median follow-up of 24.2 months, VCT occurred in 18 of 82 patients with VCFs （11 males, 7 females, mean age 55.4 years）. In 86 patients without VCFs, VCT occurred in only 6 individuals （4 males, 2 females） during the study period. VCT was observed more frequently in patients fitted with VCFs than in those without VCFs （22% vs. 7.0%）. Conclusions The incidence of VCT in patients with VTE after VCF implantation was 22% approximately. Anticoagulation therapy should be continued for all patients with VCF placement, unless there is a specific contraindication. Almost all instances of VCT in patients with VCF implants in our study occurred after stopping anticoagulation treatment. The use of VCFs is increasing, and more trials are needed to confirm their benefit and accurately assess their safety.
文摘OBJECTIVE: To evaluate the safety and value of preoperative transarterial embolization of hypervascular vertebral tumors. METHODS: Sixteen patients with hypervascular vertebral tumors underwent transarterial embolization before surgery. The lesions were located between the middle cervical and lower lumbar spine. Forty-one arteries were embolized with permanent particles injected through a microcatheter, including polyvinyl alcohol (PVA) particles (150 - 500 micro m) in 25 arteries and Dextran particles (150 - 350 micro m) in 16. Of these, 31 had pieces of gelatin sponge added for proximal pedicled embolization. The criteria for judging the effectiveness of embolization were completeness of tumor removal and estimated blood loss during surgery. RESULTS: The particles were injected into the tumor feeders through superselection in 17 arteries or flow control in 24. Tumor embolization was defined as 'total' in five patients, 'nearly total' in eight, 'subtotal' in two, and 'partial' in another. There were no symptomatic complications associated with embolization. Tumors were entirely removed in all patients. The average estimated blood loss during surgery was 1510 ml (range of 200 - 6000 ml) for all 16 patients. CONCLUSION: Preoperative embolization of hypervascular vertebral tumors is safe and effective. It can make complete resection of a tumor possible and can make a previously unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and to avoid complications.
