PMID- 10688420
OWN - NLM
STAT- MEDLINE
DCOM- 20000405
LR  - 20161124
IS  - 0392-9590 (Print)
IS  - 0392-9590 (Linking)
VI  - 18
IP  - 3
DP  - 1999 Sep
TI  - Duplex screening as a method of quality assurance of perioperative 
      thromboembolism prophylaxis.
PG  - 210-9
AB  - BACKGROUND: Improvements in thrombosis prophylaxis in both the operative and 
      non-operative fields aim to reduce further the not inconsiderable residual risk 
      of suffering a deep vein thrombosis or embolism. The goal of the study was to 
      establish the part played in a quality assurance strategy by early diagnosis of a 
      thrombosis and by knowledge of the hospital's internal patient-risk profile in 
      order to counter the unpredictability of thromboembolic complications and make 
      rational decisions about thromboembolism prophylaxis. METHODS: Duplex 
      ultrasonography has been used routinely in trauma surgical patients in Krefeld 
      Hospital since September 1991 as a screening method for diagnosing deep leg and 
      pelvic vein thrombosis prior to mobilisation of the patients. 778 patients were 
      investigated up to March 1997. In the period from September 1991 to September 
      1994, patients received standardised low-dose prophylaxis with unfractionated 
      heparin (UFH). In October 1994, the prophylaxis regimen was modified by changing 
      the anti-embolism stockings from bidirectional elastic stockings to transverse 
      elastic graduated compression stockings (TED) and by adapting the dosage of the 
      heparin prophylaxis to patient risk, with the use of low molecular weight heparin 
      (LMWH) Certoparin (Mono-Embolex NM) since April 1995. All patients with a deep 
      vein thrombosis were treated immediately with APTT-monitored full heparinisation 
      and immobilisation. RESULTS: In the period from September 1991 to March 1997, an 
      asymptomatic deep vein thrombosis of the lower limbs was diagnosed in 68 cases 
      (8.7%) out of 778 trauma surgical patients by means of routine duplex ultrasound. 
      Using a strategy of duplex screening and immediate 
      anticoagulation/immobilisation, no clinically significant pulmonary emboli 
      occurred in this period. At the same time, the antithrombotic efficacy of the 
      prophylaxis could be improved and assessed objectively by means of duplex 
      screening: with optimal compression stockings and consistent use of risk-adapted 
      UFH prophylaxis, it was possible to reduce the residual thrombosis rate, which 
      was 11.5% (95% CI 7.7-15.2%) with standard UFH prophylaxis, to 8.7 % (95% CI 
      4.5-12.9%) and ultimately, using the combination of optimal anti-embolism 
      stockings and LMWH prophylaxis, to 6.0% (95% CI 3.0-8.9%) which was significant 
      (p<0.05). The cost-effectiveness analysis resulted in a cost-relation per 
      successfully treated patient of about 1:100 for the diagnosis of a deep vein 
      thrombosis using duplex ultrasound and subsequent heparin treatment compared to 
      the diagnosis and intensive care treatment of a massive pulmonary embolism. 
      CONCLUSIONS: Duplex ultrasound screening for asymptomatic deep vein thrombosis 
      thus proves to be a suitable instrument for internal hospital quality control in 
      thrombosis prophylaxis. Its routine use can be recommended at least in high-risk 
      patients, not only from the medicolegal aspect but also from the purely economic 
      aspect.
FAU - Van Den Berg, E
AU  - Van Den Berg E
AD  - Medical Department I, Krefeld Hospital, Germany.
FAU - Bathgate, B
AU  - Bathgate B
FAU - Panagakos, E
AU  - Panagakos E
FAU - Lambrechts, R
AU  - Lambrechts R
FAU - Hani, M
AU  - Hani M
FAU - Meissner, A
AU  - Meissner A
FAU - Schroder, M
AU  - Schroder M
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - Italy
TA  - Int Angiol
JT  - International angiology : a journal of the International Union of Angiology
JID - 8402693
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/administration & dosage
MH  - Cost-Benefit Analysis
MH  - Female
MH  - Heparin, Low-Molecular-Weight/administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Preoperative Care
MH  - Pulmonary Embolism/prevention & control
MH  - *Quality Assurance, Health Care
MH  - Quality Control
MH  - Risk
MH  - Thromboembolism/*diagnostic imaging/*prevention & control
MH  - Thrombolytic Therapy
MH  - *Ultrasonography, Doppler, Duplex
MH  - Wounds and Injuries/surgery
EDAT- 2000/02/25 00:00
MHDA- 2000/02/25 00:01
CRDT- 2000/02/25 00:00
PHST- 2000/02/25 00:00 [pubmed]
PHST- 2000/02/25 00:01 [medline]
PHST- 2000/02/25 00:00 [entrez]
PST - ppublish
SO  - Int Angiol. 1999 Sep;18(3):210-9.