Girish R. Mood, MD, Heather L. Gornik, MD, MHS, Vidyasagar Kalahasti, MD, Donald Hammer, MD, W. H. Wilson Tang, MD, FAHA.

1
High Incidence of Venous Thrombosis following
Cardiac Surgery
Girish R. Mood, MD, Heather L. Gornik, MD, MHS,
Vidyasagar Kalahasti, MD, Donald Hammer, MD, W.
H. Wilson Tang, MD, FAHA.
2
Background
Absolute risk of DVT in hospitalized patients
General Surgery 15-40
Major gynecologic surgery 15-40
Major urologic surgery 15-40
Neurosurgery 15-40
Hip or Knee surgery 40-60
Spinal cord surgery 60-80
Critical care patients 10-80
Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen
MR, Colwell CW, Ray JG. Prevention of venous
thromboembolism the Seventh ACCP Conference on
Antithrombotic and Thrombolytic Therapy. Chest.
2004 Sep126(3 Suppl)338S-400S
3
Deep venous thrombosis after open heart surgery
DeLaria GA, Hunter JA. Deep venous thrombosis.
Implications after open heart surgery. Chest.
1991 Feb99(2)284-8
4
Deep venous thrombosis following hospital
discharge
Ambrosetti M, Salerno M, Zambelli M, Mastropasqua
F, Tramarin R, Pedretti RF. Deep vein thrombosis
among patients entering cardiac rehabilitation
after coronary artery bypass surgery. Chest
2004125191-6
5
Aim of the study

• To evaluate incidence of symptomatic venous
  thrombosis after contemporary open heart surgery
• To evaluate the relative time course and
  presenting locations of venous thrombosis

6
Inclusion criteria

• All patients who underwent cardiac surgery
  (emergent and non emergent) during the year
  01/2004 to 12/2006
• Patients evaluated with imaging studies for
  clinical suspicion of venous thrombosis
• - Swelling, warmth, redness, pain related to
  the extremity
• - Heparin induced thrombocytopenia
• Exclusion criteria
• Patients with known venous thrombosis prior to
  the surgery

7
Methods

• Detailed post-operative data prospectively
  collected via Cleveland Clinic Cardiovascular
  Information Registry database (CVIR)
• Vascular study information up to 30 days post-op
  reviewed
• Stratified according to location of venous
  thrombosis superficial venous thrombosis or deep
  venous thrombosis

8
Definitions

• Early venous thrombosis was defined as positive
  results between 0-15 days from the surgery
• Late venous thrombosis was defined as positive
  results between 16-30 days after the surgery

9
Results
10
Site of venous thrombosis
11
Time to thrombosis (Deep venous thrombosis)
Time in Days
12
Time to thrombosis (superficial and deep venous
thrombosis)
Time in days
13
Deep venous thrombosis in CABG and valve surgery
only
16.3
14.9
14
9.7
14
Limitation

• Single center, registry based study
• May not include the studies performed outside the
  central vascular lab
• Details of venous access site were not available
• Selection bias of clinically indicated vascular
  studies

15
Conclusion

• Symptomatic venous thrombosis was found in 12 of
  patients undergoing open heart surgery in the
  contemporary era
• Incidence of deep venous thrombosis was 8.2
• Over 3/4th of venous thrombosis were detected
  within 15 days post-operatively
• Internal jugular (45.5) and calf vein thromboses
  (34.9) being the most common sites.