High DVT Rate Seen in Rehab Patients After CABG
In a new study of patients entering cardiac rehabilitation after coronary artery bypass grafting (CABG), the incidence of deep vein thrombosis (DVT) was 17.4%. This high rate suggests that more could be done to improve DVT prophylaxis after cardiac surgery, the authors note.
The new findings, which are reported in the January issue of Chest, are based on a study of 270 patients who entered one of three rehab facilities in Italy after undergoing CABG. Serial leg venous ultrasound was performed on all patients beginning on admission to the centers.
Except for 10 patients with absolute contraindications to anticoagulant therapy, all of the patients were taking antiplatelet drugs on admission, lead author Dr. Marco Ambrosetti, from IRCCS Fondazione Salvatore Maugeri in Tradate, Italy, and colleagues note.
Sixty-three percent of patients received heparin prophylaxis after surgery, which, in most cases, did not extend beyond postoperative day 3, the results show.
Of the 47 DVTs (17.4%) that were detected, 40 were isolated distal DVTs and 7 were proximal DVTs. In two cases, the DVTs were associated with symptomatic pulmonary embolism, resulting in one fatality. All but four of the DVTs were detected at admission.
On multivariate analysis, female gender and length of stay in the surgery unit were identified as significant predictors of DVT in the rehabilitation setting. In contrast, heparin prophylaxis until hospital discharge was associated with a reduced risk of DVT after excluding bedridden patients (p < 0.05). Wearing compression stockings on the leg from which the saphenous vein was harvested did little to prevent DVTs, as clots often occurred in the contralateral leg, the investigators note. “Our findings agree with previous studies showing a relatively high rate of DVT after CABG…in most cases without clinical significant symptoms,” the authors state. Further research is needed to “indicate the best prophylactic approach with respect to efficacy and safety,” they add. Chest 2004;125:191-196.
