Risk of postoperative venous thromboembolic complication development in elderly patients

Aim. To evaluate venous thromboembolic complication risk in elderly patients admitted to trauma and orthopedics departments, prevalence of comorbidity, its impact on the risk of thrombotic events, efficacy and safety of prophylactic anticoagulant therapy.

Materials and methods. Authors performed a retrospective analysis of medical records of 120 patients aged 65 years and over. Analyzed data included demographic data, main diagnosis, co-existing pathology according to International Classification of Diseases X, type of surgery and anticoagulant prophylaxis. Risk of development of venous thromboembolic complications was assessed by the Caprini scale. Potential drug-drug interactions were checked using Drug Interaction Checker available, created by company Cerner Multum according to FDA recommendations.

Results. The most frequent causes of hospitalization were destructive large joint arthritis (40%) and fractures of lower extremities (21.7%). Surgeries with an average duration of 87 ± 31.4 min were performed in 85% of patients, of which major surgery – 68.6%, minor – 31.4%. Comorbidity was detected in 90% of elderly patients admitted to hospital because of pathology of the musculoskeletal system. Pathology of musculoskeletal system most often was combined with cardiovascular diseases (81.7%). A moderate risk of venous thromboembolic complications was detected in 10% patients, high risk in 75%. Anticoagulant prophylaxis with a direct factor Xa inhibitor rivaroxaban or low-molecular weight heparin enoxaparine sodium was performed in 80% of patients.

Conclusion. The study demonstrated that 75% of elderly patients with pathology of the musculoskeletal system are at high risk for the development of venous thromboembolic complications. The main risk factors include the type and duration of surgery and comorbidity.

1. Gazizov R.M. Foundations of drug therapy in elderly and senile age. Prakticheskaya meditsina – Practical Medicine. 2010; 41 (2): 11–14 (in Russ.).

2. Shlyafer S.I. Morbidity of working age population in Russian Federation. Sovremennye problemy zdravookhraneniya i meditsinskoy statistiki – Current Problems of Health Care and Medical Statistics. 2014; 1: 16–27 (in Russ.).

3. Yarygin V.N., Melent’ev A.S. Manual for gerontology and geriatrics in 4 volumes. Vol. 1. M.: GEOTAR-Media Publ., 2010: 720 (in Russ.).

4. Naughton C., Feneck R.O. The impact of age on 6-month survival in patients with cardiovascular risk factors undergoing elective non-cardiac surgery. Int. J. Clin. Pract. 2007; 61 (6): 768–776. DOI: 10.1111/j.17421241.2007.01304.x.

5. Ovechkin A.M. Surgical stress-response, its pathophysiological significance and methods of modulation. Regionarnaya anesteziya i lechenie ostroy boli – Regional Anesthesia and Acute Pain Management. 2008; 2 (2): 49–62 (in Russ.).

6. Kavalerskiy G.M., Chenskiy A.D., Katunyan P.I., Petrov N.V., Prokhorova M.Yu. Analysis of the risk of thromboembolic complications in early postoperative period after arthroplasty replacement in elderly. Moskovskiy khirurgicheskiy zhurnal – Moscow Surgical Journal. 2015; 44 (4): 9–14 (in Russ.).

7. Zubkov V.I., Tkhorevskiy A.V., Lazarchuk N.D. Choice of optimal method of thromboprophylaxis in traumatology. Travma – Trauma. 2011; 12 (1): 39–41 (in Russ.).

8. Firsov S.A., Vereshchagin N.A., Matveev R.P., Lyuboshevskiy P.A., Fedotov E.A. Rational thromboprophilaxis in trauma of the lower limbs: prioritize. Sovremennye problemy nauki i obrazovaniya – Modern Problems of Science and Education. 2016; 5: 67 (in Russ.).

9. Kopenkin S.S., But-Gusaim A.B., Skoroglya- dov A.V. System of prophylaxis of venous thromboembolic complications in trauma-orthopedic departments of the hospital. Vestnik Rossiyskogo universiteta druzhby narodov. Seriya: Meditsina – Annals of People’s Friendship University of Russia. Series: Medicine. 2008; 6 (1): 141–150 (in Russ.).

10. Momot A.P., Barkagan Z.S. Investigation of hemostasis in elderly patients: main aims and methods. Klinicheskaya gerontologiya – Clinical Gerontology. 2007; 4 (1): 44–49 (in Russ.).

11. ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur. Heart J. 2014; 35 (43): 3033–3073. DOI: 10.1093/eurheartj/ehu283.

12. Jimйnez D., de Miguel-Dнez J., Guijarro R., Trujillo-Santos J., Otero R., Barba R., Muriel A., Meyer G., Yusen R., Monreal M. Trends in the management and outcomes of acute pulmonary embolism: analysis from the RIETE registry. J. Am. Coll. Cardiol. 2016; 67 (2): 162–170. DOI: 10.1016/j.jacc.2015.10.060.

13. Sulimov V.A., Belentsov S.M., Golovina N.I., Dubrovnaya N.P., Zhilkov K.P., Eliseeva K.V., Kazanchan P.O., Red’kin A.V., Rodoman G.V., Fitileva T.V., Fridman I.L., Shershnev V.N. ENDORSE: International study to detect hospital patients at risk of venous thromboembolism. Results of the Russian register of surgical patients. Flebologiya – Phlebology. 2009; 3 (1): 54–62 (in Russ.).

14. Caprini J.A. Thrombotic risk assessment: A hybrid approach. URL: http://www.venousdisease.com. DOI: 10.1016/b978-012369515-4/50044-2.

15. Drug Interaction Checker. URL: http://www.drugs.com.

16. Russian clinical guidelines for the diagnosis, treatment and prophylaxis of venous thromboembolic complications. Flebologiya – Phlebology. 2015; 9 (4–2): 1–52 (in Russ.).

17. Mishustina N.N. Analysis of prevalence of venous thromboembolic complications in trauma and orthopedics patients and methods for predicting its development. Aktual’nye napravleniya nauchnykh issledovaniy: ot teorii k praktike – Current Ways of Scientific Research: From Theory to Practice. 2016; 2 (2–1): 81–85 (in Russ.).

18. Ershov D.S., Kopenkin S.S., Skoroglyadov A.V. Prophylaxis and treatment of deep vein thrombosis of lower extremities at total hip replacement. Vestnik RGMU – Bulletin of Russian State Medical University. 2015; 3: 14–19 (in Russ.).

19. Griffin F.A., Resar R.K. IHI global trigger tool for measuring adverse events. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2009. URL: http://www.IHI.org.

20. Zharinova V.Yu. Pulmonary embolism in the geriatric patients: peculiarities of diagnosis and treatment. Problemy stareniya i dolgoletiya – Problems of Аging and Longevity. 2015; 24 (3–4): 327–339 (in Russ.).

21. Mendel’ O.I. Osteoarthritis and cardiovascular pathology in older persons: clinical and pathogenesis relationship. Uspekhi gerontologii – Advances in Gerontology. 2010; 23 (2): 304–313 (in Russ.).

22. Suprun E.V. Comorbidity in osteoarthritis in older patients: the choice of treatment. Ratsional’naya farmakoterapiya – Rational Рharmacotherapy. 2013; 28 (3): 47–52 (in Russ.).

23. Abraham N.S., Singh S., Alexander G.C., Heien H., Haas L.R., Crown W., Shah N.D. Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban and warfarin: population based cohort study. BMJ. 2015: 350 (4): h1857. DOI: 10.1136/bmj.h1857.

24. Moiseev S.V. Oral anticoagulants in the very elderly patients with atrial fibrillation. Klinicheskaya farmakologiya i terapiya – Clinical Pharmacology and Therapy. 2017; 26 (4): 5–14 (in Russ.).

25. Glushkov N.I., Zhane A.K., Openchenko S.V. Results of intermittent pneumatic compression of lower extremities in complex preventive of postoperative venous thrombotic complications in patients of elderly and senile age. Kubanskiy nauchnyy meditsinskiy vestnik – Kuban Scientific Medical Bulletin. 2010; 123 (9): 60–63 (in Russ.).