1. Girish R. Mood, MD, Heather L. Gornik, MD, MHS, Vidyasagar Kalahasti, MD, Donald Hammer, MD, W. H. Wilson Tang, MD, FAHA. High Incidence of Venous Thrombosis following Cardiac Surgery

2. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 2 Background: General Surgery15-40% Major gynecologic surgery15-40% Major urologic surgery15-40% Neurosurgery15-40% Hip or Knee surgery40-60% Spinal cord surgery60-80% Critical care patients10-80% Absolute risk of DVT in hospitalized patients Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):338S-400S

3. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 3 Deep venous thrombosis after open heart surgery: 10,638 patients (1975-1988) 7,979 (75%) had CABG 2,659 had valve ± CABG 77 (0.7%) had DVT 36 patients had DVT without PE 41 patients had PE 16 patients had DVT being treated with heparin 25 patients without DVT Patients with LE edema, pain, ↑ temp underwent Imaging studies DeLaria GA, Hunter JA. Deep venous thrombosis. Implications after open heart surgery. Chest. 1991 Feb;99(2):284-8

4. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 4 Deep venous thrombosis following hospital discharge: 270 patients entering cardiac rehabilitation after CABG 47 (17.4%) patients had DVT 2 (0.7%) patients with DVT had PE Excluded patients with prior DVT, Concomitant non coronary or valve surgery 171 (63%) were on heparin prophylaxis Ambrosetti M, Salerno M, Zambelli M, Mastropasqua F, Tramarin R, Pedretti RF. Deep vein thrombosis among patients entering cardiac rehabilitation after coronary artery bypass surgery. Chest 2004;125:191-6

5. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 5 Aim of the study: To evaluate incidence of symptomatic venous thrombosis after contemporary open heart surgery To evaluate the relative time course and presenting locations of venous thrombosis

6. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 6 Inclusion criteria: All patients who underwent cardiac surgery (emergent and non emergent) during the year 01/2004 to 12/2006 Patients evaluated with imaging studies for clinical suspicion of venous thrombosis - Swelling, warmth, redness, pain related to the extremity - Heparin induced thrombocytopenia Exclusion criteria: Patients with known venous thrombosis prior to the surgery

7. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 7 Methods: Detailed post-operative data prospectively collected via Cleveland Clinic Cardiovascular Information Registry database (CVIR) Vascular study information up to 30 days post-op reviewed Stratified according to location of venous thrombosis; superficial venous thrombosis or deep venous thrombosis

8. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 8 Definitions: Early venous thrombosis was defined as positive results between 0-15 days from the surgery Late venous thrombosis was defined as positive results between 16-30 days after the surgery

9. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 9 Results: 10,588 (01/2004-12/2006) 1,667 (15.7%) Underwent imaging studies 1,272 (12.0%) All positive venous thrombosis 870 (8.2%) DVT positive 152 Excluded for known venous thrombosis prior to surgery

10. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 10 Site of venous thrombosis: 870 DVT positive 428 (49.2%) Positive LE DVT 442 (50.8%) Positive UE DVT 304 (34.9%) Calf vein DVT 396 (45.5%) IJ vein DVT

11. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 11 Time to thrombosis (Deep venous thrombosis): Time in Days

12. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 12 Time to thrombosis (superficial and deep venous thrombosis): Time in days

13. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 13 Deep venous thrombosis in CABG and valve surgery only: 14.9% 14% 9.7% 16.3%

14. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 14 Limitation: Single center, registry based study May not include the studies performed outside the central vascular lab Details of venous access site were not available Selection bias of clinically indicated vascular studies

15. High Incidence of Venous Thrombosis following Cardiac Surgery l November 7, 2007 l 15 Conclusion: Symptomatic venous thrombosis was found in 12% of patients undergoing open heart surgery in the contemporary era Incidence of deep venous thrombosis was 8.2% Over 3/4 th of venous thrombosis were detected within 15 days post-operatively Internal jugular (45.5%) and calf vein thromboses (34.9%) being the most common sites.