Clinical signs and risk factors of acute deep vein thrombosis of lower extremities in patients after abdominal surgery for cancer: efficiency and safety of different types of anticoagulant therapy

Introduction

The background of our research was to conduct a retrospective analysis of clinical signs and risk factors for acute deep vein thrombosis (ADVT) of lower extremities, and to compare the effectiveness and safety of therapy of LMWH bemiparin and UFH in patients after abdominal surgery for cancer.

Methods

For the period from 2008 to 2009 the diagnosis of ADVT was set for 362 patients, among them 179 (49.4%) men and 183 (50.6%) women. Among patients with ADTV with primary localization in ileofemoral and popliteal segments treated in the department of vascular surgery, senior persons more than 60 years old prevailed (63.9%). All patients with ADVT received therapy with anticoagulants. Bemiparin sodium was prescribed in 257 (70.9%) cases, UFH in 71 (19.6%) and in 34 (9.5%) others LMWH. We analysed efficiency and complications after antithrombotic therapy in a hospital period. A complete coagulation screen, activated clotting time, thromboelastography and low-frequency haemoviscoelastography (HVG) were performed to reveal coagulation disturbances.

Results

In 83.7% of cases the most frequent symptoms of disease are edema of an extremity (in 78.1%) and pain syndrome 74.7%, which at a monosymptomal variant (39.4% patients) are marked in 66.3% and 44.4% accordingly. The most frequent risk factors (RF) were prolonged (more than 8 days) immobilization and malignant tumors. Therapy of UFH and LMWH was effective enough (on average, a good result obtained in more than in 77% cases). Bemiparin treatment was related to considerably less hemorrhagic complications than treatment of UFH (P < 0.05), which concerned all of types of such complications.

Conclusions

Treatment of with bemiparin as compared with UFH accompanied reduced frequency of all hemorrhagic complications by 2.1 times, serious 2.7 times and moderate 3.1 times. HVG is an effective point-of-care monitor for routine clinical practice and clinical research.