Section of Vascular Surgery, Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI.
Section of Vascular Surgery, Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI; Section of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI.
J Vasc Surg Venous Lymphat Disord. 2023 May;11(3):543-552. doi: 10.1016/j.jvsv.2022.11.004. Epub 2022 Dec 24.
Patients with sickle cell disease (SCD) will have a baseline hypercoagulable state and an increased risk of venous thromboembolism (VTE). Few data are available regarding the efficacy of standard prophylaxis in preventing VTE after noncardiovascular surgery for patients with SCD. Our objective was to investigate the incidence of VTE in patients with SCD who had undergone noncardiovascular surgery.
We performed a retrospective medical record review of 352 patients with SCD who had undergone noncardiovascular surgery from August 2009 to August 2019 at Beaumont Hospitals. An equal number of control patients without SCD were propensity matched for age, sex, race, body mass index, and specific surgery. The data collected included demographics, comorbidities, VTE prophylaxis used, occurrence of deep vein thrombosis (DVT) and pulmonary embolism (PE), hospital length of stay, and 30-day mortality.
We found no differences in age, race, sex, ethnicity, operative time, or hospital length of stay between the SCD and propensity-matched control patients. DVT prophylaxis was used more frequently for the SCD patients than for the controls (96.0% vs 88.6%; P < .001). Four SCD patients (1.1%) had developed DVT vs five control patients (1.4%; P > .999). One patient in each group had developed PE (0.3%; P > .999). No difference was found in 30-day mortality between the SCD group and the control group (1 [0.3%] vs 3 [0.9%]; P = .312). Of those with a diagnosis of VTE ≤30 days postoperatively, no differences were present in age, sex, race, BMI, or procedure type. DVT had been diagnosed significantly later in the SCD patients than in the controls (median, postoperative day 12 vs 5; P = .014). None of the five SCD patients with VTE was a smoker compared with four of the six non-SCD patients with VTE, who were current or former tobacco users (P = .061). All the patients who had developed VTE had received DVT prophylaxis at surgery.
We found no differences in the perioperative rates of DVT, PE, or mortality between the SCD patients and matched control patients after noncardiovascular surgery. Vigilant attention to routine VTE prophylaxis seemed to effectively reduce the VTE risk for these hypercoagulable patients. SCD patients might need VTE prophylaxis for a longer period postoperatively compared with those without SCD.
镰状细胞病（SCD）患者存在基线高凝状态和静脉血栓栓塞（VTE）风险增加。关于 SCD 患者非心血管手术后标准预防措施预防 VTE 的疗效数据很少。我们的目的是调查接受非心血管手术的 SCD 患者中 VTE 的发生率。
我们对 2009 年 8 月至 2019 年 8 月在 Beaumont 医院接受非心血管手术的 352 例 SCD 患者进行了回顾性病历审查。选择了数量相等的无 SCD 的对照患者进行年龄、性别、种族、体重指数和特定手术的倾向匹配。收集的数据包括人口统计学、合并症、使用的 VTE 预防措施、深静脉血栓形成（DVT）和肺栓塞（PE）的发生、住院时间和 30 天死亡率。
SCD 组和倾向匹配对照组患者在年龄、种族、性别、种族、手术时间或住院时间方面无差异。SCD 患者比对照组更频繁地使用 DVT 预防措施（96.0% vs 88.6%；P<0.001）。4 例 SCD 患者（1.1%）发生 DVT，5 例对照组患者（1.4%）发生 DVT（P>.999）。每组各有 1 例患者发生 PE（0.3%；P>.999）。SCD 组和对照组 30 天死亡率无差异（1[0.3%] vs 3[0.9%]；P=.312）。术后≤30 天诊断为 VTE 的患者在年龄、性别、种族、BMI 或手术类型方面无差异。SCD 患者的 DVT 诊断明显晚于对照组（中位数，术后第 12 天 vs 第 5 天；P=.014）。在发生 VTE 的 5 例 SCD 患者中，无吸烟者，而在发生 VTE 的 6 例非 SCD 患者中，有 4 例是当前或曾经的烟草使用者（P=.061）。所有发生 VTE 的患者在手术时均接受了 DVT 预防措施。
我们发现非心血管手术后 SCD 患者与匹配对照组患者的 DVT、PE 或死亡率无差异。对这些高凝患者常规进行 VTE 预防措施的密切关注似乎有效地降低了 VTE 风险。与无 SCD 的患者相比，SCD 患者可能需要更长时间的术后 VTE 预防。
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