Incidence of Venous Thromboembolism in Patients with Sickle Cell Disease Undergoing Non-Cardiovascular Surgery.

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Journal of Vascular Surgery. Venous and Lymphatic Disorders


OBJECTIVE: Patients with sickle cell disease (SCD) exhibit a baseline hypercoagulable state and are at increased risk for venous thromboembolism (VTE). There is little data on the efficacy of standard prophylaxis in preventing VTE following non-cardiovascular surgery in this patient population. Our objective was to investigate the incidence of VTE in patients with SCD undergoing non-cardiovascular surgery.

METHODS: We performed a retrospective chart review for 352 patients with SCD who underwent non-cardiovascular surgery from August 2009 to August 2019 at Beaumont Hospitals. An equal number of controls without SCD were propensity-matched for age, gender, race, body mass index (BMI), and specific surgery. Data collected included demographics, comorbidities, VTE prophylaxis used, the occurrence of deep venous thrombosis and pulmonary embolism (PE), hospital length of stay, and 30-day mortality.

RESULTS: There was no difference in age, race, sex, ethnicity, operative time, or hospital length of stay between SCD and propensity-matched control patients. Deep vein thrombosis (DVT) prophylaxis was used more frequently in SCD patients than in controls (96.3% vs 88.6%, P.999); one patients in each group developed a pulmonary embolism (PE) 0.3%, P>.999). There was no difference in 30-day mortality among SCD patients vs controls (1, 0.3% vs 3, 0.9%, P=.312). Of those diagnosed with VTE within 30 days postoperatively, there were no differences in age, sex, race, BMI, or procedure type. DVT was diagnosed significantly later in SCD patients than in controls (median post-operative day 12 vs 5, P=.014). None of the five SCD patients with VTE was a smoker, whereas four of the six non-SCD patients with VTE were current or former tobacco users (P=.061). All patients who developed VTE had received DVT prophylaxis at the time of surgery.

CONCLUSION: There appears to be no difference in the perioperative rates of DVT, PE, or mortality in SCD patients undergoing non-cardiovascular surgery compared with matched controls. Vigilant attention to routine venous prophylaxis seems to effectively reduce the VTE risk in these hypercoagulable patients. SCD patients may need VTE prophylaxis for a longer period postoperatively than those without SCD.





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