Frequency of Deep Vein Thrombosis and/or Pulmonary Embolism After Coronary Artery Bypass Grafting Investigation Regardless of Clinical Suspicion

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• 作者：Vitor B. Viana ; MD ; Emanoel R. Melo ; MD ; Mario Terra-Filho ; MD ; PhD ; Luis A. Dallan ; MD ; PhD ; Maria M. Gonzalez ; MD ; PhD ; Ludhmila A. Hajjar ; MD ; PhD ; Fabio B. Jatene ; MD ; PhD ; Luiz A. Cesar ; MD ; PhD ; Caio B. Vianna ; MD ; PhD ; ^{caio.vianna@incor.usp.br}
• 刊名：The American Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：119
• 期：2
• 页码：237-242
• 全文大小：300 K
• 卷排序：119

文摘

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Many surgeons and clinicians believe that VTE after coronary artery bypass grafting (CABG) has little clinical significance because it is seldom diagnosed. This study aimed to identify VTE after CABG, independent of clinical suspicion. In this prospective, observational, single-center study, 100 patients underwent computed tomographic pulmonary angiography (multidetector-64) and lower extremity venous compressive ultrasound after elective CABG. Patients with high risk for VTE were excluded. Aspirin was maintained throughout the preoperative and postoperative periods, and early ambulation was encouraged. Postoperatively, no mechanical or heparin prophylaxis was used in any patients. At the discretion of the surgeons, 83 surgeries were on-pump, and 17 were off-pump. On average, tomography and ultrasound were performed 7 ± 3 days after CABG. Isolated PE was observed in 13 of 100 patients (13%), simultaneous PE and DVT in 8 of 100 (8%), and isolated DVT in 4 of 100 (4%), thus totaling 25/100 VTEs (25%). Of the 21 PEs, 3 of 21 (14%) involved subsegmental, 15 of 21 (71%) segmental, 1 of 21 (5%) lobar, and 2 of 21 (10%) central pulmonary arteries. Of the 12 DVTs, all were distal (below the popliteal vein), and 2 of 12 (17%) were also proximal; 5 of 12 (42%) were unilateral, of which 3 of 5 (60%) on the contralateral saphenous vein-harvested leg. No VTE caused hemodynamic instability, and none was clinically suspected. In conclusion, VTEs were frequent, some extensive proximal VTEs occurred, but most were distally localized. Many patients in this series would have been discharged without diagnosis of and treatment for PE and/or DVT.