Comparing the impact of supine and leg elevation positions during coronary artery bypass graft on deep vein thrombosis occurrence: A randomized clinical trial study

• Published in: Journal of vascular nursing 2013-06, Vol.31 (2), p.64-67
• Main Authors: Ayatollahzade-Isfahani, Farah, Pashang, Mina, Omran, Abbas Salehi, Saadat, Soheil, Shirani, Shapour, Fathollahi, Mahmood Sheikh
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - nursing; Coronary artery bypass surgery; Deep vein thrombosis; Drug Therapy, Combination; Elevation; Female; Follow-Up Studies; Harvest; Heparin - therapeutic use; Humans; Leg; Male; Middle Aged; Nursing; Patient Positioning - nursing; Physical Therapy Modalities - nursing; Postoperative Care; Preoperative Care; Risk Factors; Supine Position; Surgery; Treatment Outcome; Ultrasonography; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - etiology; Venous Thrombosis - nursing; Venous Thrombosis - prevention & control
• ISSN: 1062-0303; 1532-6578
• DOI: 10.1016/j.jvn.2012.08.003

Deep vein thrombosis (DVT) is a common preoperative complication that occurs in patients who undergoing coronary artery bypass grafting surgery (CABG). Early ambulation, elastic stockings, intermittent pneumatic compression, and leg elevation, before and after surgery, are among preventative interventions. The goal of the study was to compare the effect of supine position with that of leg elevation on the occurrence of DVT during CABG and after, until ambulation. Between October, 2008, and May, 2011, a total of 185 eligible CABG patients admitted to the Cardiac Surgery Unit were randomly assigned to groups designated as the supine group (n = 92) or the leg-elevation group (n = 93). Of this total, 92 patients were assigned to the supine group and 93 to the leg-elevation group. Doppler ultrasonography of the superficial and deep veins in the lower extremities was performed for each patient before and after surgery. Logistic regression analysis was conducted to investigate the possible independent factors associated with DVT. DVT was detected in 25 (13.5%) patients: 17 (18.4%) patients in the supine position group and 8 (8.6%) in the leg-elevation group (P value = .065). After adjustment for confounding factors there was no effect of position on the presence of DVT (P = .126).Clots were often localized in legs ipsilateral to the saphenous vein harvest. The authors conclude that a positive, albeit not statistically significant, trend was evident toward higher incidence of silent DVT in supine position during and after CABG in comparison with leg elevation. Future studies with larger sample sizes are required to confirm this result.