Prevalence and Prevention of Deep Venous Thrombosis of the Lower Extremities in High-Risk Pulmonary Patients

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Abstract
Information is lacking about the prevalence of, and the best method of pre venting deep venous thrombosis (DVT) of the lower extremities in patients forty years or older with pulmonary disease that keeps them in bed for three consecu tive days or more and who are thus at high risk of developing DVT or pulmo nary embolism (PE). In this study, 192 high-risk patients, aged forty to ninety-two, received 125I fibrinogen and had daily radioactive scans, venous Doppler, and strain gauge plethysmography. Four preventive methods were used until patients became ambulatory: graded compression stockings (GCS) in 39, elastic bandages (EB) in 33, subcutaneous administration of 5,000 USP units of heparin (HEP) bid in 39, and oral administration of 0.5 g of acetylsalicyclic acid (ASA) bid in 35. Results were compared with those in 46 patients in a control group (CG). Twelve patients in CG, none in GCS, 4 in EB, 1 in HEP, and 2 in ASA developed DVT proved by contrast venography. There was a statistically significant difference between GCS and CG (P < 0.0003), HEP and CG (P < 0.0022), and ASA and CG (P < 0.0148) but not between EB and CG (P > 0.10); no significant differences were found between any pair of prophy laxis groups. The significant differences could not be attributed to differences in age, sex, or length of stay in bed. PE occurred in 3 patients in CG and 1 in EB. Hemorrhagic complications occurred in 7 patients in HEP and 4 in ASA, re quiring exclusion of 2 patients and 1 patient, respectively, from the study. GCS, HEP, and ASA are effective methods of preventing DVT in high-risk pulmonary patients, in whom the disease is highly prevalent (26%). Effectiveness, invasive ness, simplicity of use, side effects, and price should be considered in choosing among them.