Perioperative venous thromboembolism in the elderly : prevention and treatment
(2019) Perioperative Care of the Elderly — ISBN: [9781316488782], p. 245-255, published
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- Pulmonary embolism remains the most common preventable cause of death in hospital. M.T. Morrel and M.S. Dunnil (Br J Surg. 1968) Introduction A number of conditions encountered frequently in the elderly, such as atrial fibrillation (AF), coronary stent placement, mechanical heart valve or cancer, predispose the older patient to thromboembolic events and require long-term prophylactic treatment; when surgery is necessary, this treatment should be adequately adjusted. Surgery itself is accompanied by an intrinsic thromboembolic risk, strictly related to direct vascular damage, inflammation, activation of coagulation factors, blood stasis and tissue trauma. Global risk is influenced by the patient’s basal conditions (older patients being at increased risk), type of surgery and perioperative management. In these patients, the risk of thromboembolic complications (TC) can be significantly reduced by adopting adequate preventive measures. This chapter investigates the optimal perioperative management of antithrombotic drugs, preventive measures toward TC and their treatment in the elderly surgical patient. Pending the publication of the European Society of Anaesthesiology Guideline on prevention of thromboembolism in anesthesia and intensive care, the American College of Chest Physicians’ Guideline on perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis is taken as the reference guidance (ACCP 2012). However, this guideline refers to the adult population, and no specific guidelines for the elderly surgical patient are currently available. Thromboembolism: Definition, Pathogenesis and Risk Factors Deep Venous Thrombosis Deep vein thrombosis (DVT) frequently occurs in the veins of the lower limbs, but is also possible in upper limb, mesenteric, pelvic and cerebral veins. Pain, swelling, tenderness, redness or skin discoloration, and warmness may manifest in the affected area; however, these signs are not always present. After one DVT episode, patients remain at increased risk of further episodes, mostly linked to surgery. Venous thromboembolism (VTE) is frequent in the elderly. It is the third most common cardiovascular condition after acute coronary infarction and stroke, affecting both hospitalized and non-hospitalized patients. It has frequent recurrence, is often overlooked and may have lethal consequences. The impact of VTE is increasing with the growing aging population; risk rises from 1/10 000 at birth to 1/100 in individuals older than 80 years (Silverstein et al. 1998).
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Thienpont, E., & Samama, C. M. (2019). Perioperative venous thromboembolism in the elderly : prevention and treatment. In Bettelli, Gabriella (ed.), Perioperative Care of the Elderly (p. p. 245-255). Cambridge university press. https://doi.org/10.1017/9781316488782.040