Chemoprophylaxis Plus Early Ambulation
Chemoprophylaxis Plus Early Ambulation
Pulmonary embolism (PE) can be a devastating postoperative complication and the leading cause
 of mortality after thoracic surgery. PE together with deep venous thrombosis (DVT) is called
 venous thromboembolism (VTE), whereas PE caused much more serious situation than DVT. Huge
 amount of data have demonstrated that thromboprophylaxis after surgery is very important to
 prevent postoperative VTE, especially after orthopedic surgery and plaster surgery. Moreover,
 for thoracic surgery, American College of Chest Physicians (ACCP) has published prevention
 guidelines of VTE in non-orthopedic surgical patients and has been used widely, but
 unfortunately prophylaxis measures had often been underused in China. However, to be honest,
 there could be a big difference between Chinese and western populations, for example, what
 guidelines recommended thrombolysis therapy in diagnosed massive or sub-massive PE patients
 is tissue type plasminogen activator (t-PA) 100 mg, while in China 50 mg has the same effect.
 So investigators wanted to establish if the prophylaxis measures what they were using
 currently are suitable for Chinese thoracic surgical patients.
Investigators enrolled 598 patients who were sent to thoracic postoperative intensive care
 unit (ICU) ward right after surgery from August 8 to September 12 of 2017 and those patients
 stayed in ICU for at least 24 hours. Excluded non-lung surgery there were 581 lung surgery
 cases. Investigators adopted the Caprini VTE risk assessment model from Boston Medical Center
 (BMC) in United States of America (USA). According to different risk level, participants
 received different thromboprophylaxis strategies. Early ambulation alone was for patients at
 low risk (Caprini 0-4), early chemoprophylaxis plus early ambulation was for patients at
 moderate (Caprini 5-8) or high risk (Caprini ≥9). Early chemoprophylaxis means low-molecular
 weight heparin (LMWH) 3075 IU (WHO Units) injection subcutaneously QD no later than 24 hours
 after surgery. Early ambulation means activity out of bed no later than 24 hours after
 surgery. Thromboprophylaxis contraindication included chest tube drainage more than 500 ml or
 major bleeding during operation or surgeons refusing to use thromboprophylaxis because they
 thought that patients would benefit more from not performing early ambulation or
 chemoprophylaxis. Some patients received chemoprophylaxis after they moved back to regular
 ward out of ICU which was called late chemoprophylaxis which means more than 24 hours after
 surgery. All chemoprophylaxis were used only during hospitalization. When participants were
 discharged, no extended treatment prescribed. However, they were followed up twice on 30 days
 and 60 days after surgery by phone call.
Inclusion Criteria:

 -  Lung surgical patients who were sent to thoracic postoperative intensive care unit
 (ICU) ward right after surgery and stayed in ICU for at least 24 hours.

 Exclusion Criteria:

 -  Cases received inferior vena filter and anti-coagulation treatment history.