May 21, 2018

Nationwide Cohort Assesses Risk of Extended VTE Prophylaxis After Surgery for IBD Patients and Produces Nomogram-Based Predictive Tool

Physicians can easily calculate risk

18-DDI-408-VTE-CQD

A nomogram constructed by Cleveland Clinic colorectal surgeons will make it possible for clinicians to better evaluate the risk of postsurgical venous thromboembolism (VTE) in patients with inflammatory bowel disease (IBD). The nomogram, as well as the research that informed its design, was presented Monday at the American Society of Colon and Rectal Surgeons (ASCRS) Annual Meeting in Nashville.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“IBD puts patients at a higher risk of VTE following abdominopelvic surgery ― in some cases, as high a risk as colorectal cancer,” according to Scott R. Steele, MD, Colorectal Chairman and senior author of the study, which examined the incidence of in-hospital and post-discharge VTE (including DVT or PE) within 30 days of abdominopelvic surgery.

“An accurate prediction of VTE before and after discharge using the nomogram can facilitate better decision-making for individualized extended thromboprophylaxis,” says Dr. Steele.

With the nomogram, physicians can easily calculate the risk of VTE for their patients through a scoring system that considers a range of factors, including patient age, steroid use, bleeding disorders, type of surgery, ASA 3-4, postoperative transfusion, pelvic and enterocutaneous fistula surgery, history of hypertension, length of operation and preoperative hospitalization.

Advertisement

Nomogram for Risk of DVT Before Discharge chart

“VTE occurs in less than 5 percent of patients,” Dr. Steele acknowledges, “but these cases can result in significant complications, including motality,” he says. “The goal is to push VTE rates to zero, or as close to zero as we can get.”

The study looked at 24,182 patients who met the inclusion criteria. Thirty-day total and post-discharge rates of VTE were 2.5 percent (N = 614) and 1 percent (N = 252), respectively, and 41 percent (252/614) of VTE events occurred after hospital discharge.

Advertisement

“As clinicians, we have to do everything we can to mitigate the risk of VTE,” says Dr. Steele. “We think this nomogram will be a valuable tool for all those who care for patients with IBD, even those interacting with the patient well after surgery.”

Dr. Steele indicated he and his research team intend to continue their study of high-risk VTE patients. The team, in addition to Dr. Steele, includes research fellow Cigdem Benlice, MD (lead author); Stefan D. Holubar, MD, MS; Emre Gorgun, MD; Jeremy Lipman, MD; Matthew Kalady, MD; and Bradley Champagne, MD.

Related Articles

IV drip attached to hand
March 27, 2024
What Is the Role for Terlipressin in Hepatorenal Syndrome?

Reviewing how the drug can be incorporated into care

Physician speaking with surgeon
March 22, 2024
Study Findings Support Bariatric Surgery as a Superior Treatment Option to Medical Management for Type 2 Diabetes

Largest, longest analysis to date shows greater weight loss and fewer diabetes medications needed

Impostor phenomenon
February 6, 2024
Recognizing the Impact of Impostor Phenomenon and Microaggressions in Gastroenterology

The importance of raising awareness and taking steps to mitigate these occurrences

Koji Hashimoto, MD, and team
February 2, 2024
Combined Cardiac Surgery and Liver Transplant Is a New Option for Highly Selected Patients

New research indicates feasibility and helps identify which patients could benefit

liver
December 8, 2023
MILU Improves Outcomes Among Critically Ill Patients with Advanced Liver Disease

Standardized and collaborative care improves liver transplantations

alcohol
November 17, 2023
Younger Patients with Alcohol-Associated Hepatitis Present to the ED More Often, Research Shows

Caregiver collaboration and patient education remain critical

food allergies
October 26, 2023
What Gastroenterologists Need to Know About Managing Food Allergies in Clinical Practice

Beyond recognizing and treating food allergies, GIs also have a responsibility to address common food allergy misconceptions

chatgpt
October 25, 2023
ChatGPT “Pretty Good” at Basic IBS Info, but Misses Details

Important to recognize limitations when it comes to healthcare and research

Ad