A RANDOMIZED, PROSPECTIVE TRIAL OF DEEP VENOUS THROMBOSIS PROPHYLAXISIN AORTIC-SURGERY

Objectives: To study the incidence of postoperative deep venous thromb osis (DVT) in patients undergoing elective aortic reconstruction and t o determine if aggressive DVT prophylaxis would reduce the incidence o f DVT in these patients.Design: Randomized, prospective trial. Setting : University hospital and Veterans Affairs hospital. Patients: One hun dred patients undergoing aortic reconstruction for aneurysmal or occlu sive disease randomized to receive DVT prophylaxis (treatment group) o r no prophylaxis (control group). Exclusion criteria included a histor y of DVT, long-term anticoagulant use, or a malignant neoplasm. During the study period, 12 patients were ineligible for follow-up. Ninety-e ight patients completed the trial, including 50 patients in the treatm ent group and 48 patients in the control group. Two patients in the co ntrol group died postoperatively of unrelated causes. intervention: Pa tients in the treatment group received DVT prophylaxis using a combina tion of low-dose heparin sodium therapy (5000 U every 12 hours) and ca lf-length intermittent mechanical compression devices. Control patient s received no DVT prophylaxis. Main Outcome Measures: The occurrence o f acute lower extremity DVT diagnosed by interval venous duplex ultras ound scan surveillance performed on postoperative days 1, 3, and 7. Re sults: The overall incidence of proximal DVT in this study was 2%. One case of DVT occurred in the treatment group, and the other one occurr ed in the control group. There was no statistically significant differ ence (P=.99) in the incidence of DVT between the 2 groups. One patient in the control group had a nonfatal pulmonary embolus (1% of the pati ents overall). Conclusions: The incidence of proximal DVT in patients undergoing elective aortic reconstruction is low compared with patient s undergoing other major intra-abdominal general surgical procedures. The use of aggressive DVT prophylaxis did not reduce the risk of posto perative proximal DVT in this study. The selective use of DVT prophyla xis in patients undergoing elective aortic surgery should be based on associated concomitant or evolving risk factors.