A survey of thrombosis experts evaluating practices and opinions regarding venous thromboprophylaxis in patients post major abdominal surgery

Bader Al Rawahi,Grégoire Le Gal,Rebecca Auer,Marc Carrier

doi:10.1186/s12959-016-0126-9

Abstract

BackgroundPatients undergoing major abdominal surgery are at high risk for developing venous thromboembolism in the post-operative period. Current evidence-based guidelines recommend routine pharmacological venous thromboembolism prophylaxis in patient at moderate to high risk post major abdominal surgery. However, the type of agent, dose and duration of thromboprophylaxis remain unclear. We sought to survey current clinical practice and assess for potential clinical equipoise regarding pharmacological thromboprophylaxis post major abdominal surgery.MethodsAn electronic survey targeting thrombosis expert members of Thrombosis Canada was conducted.ResultsThe total response rate was 52.3% (45/86). All thrombosis experts recommended pharmacological thromboprophylaxis for high risk patients post major abdominal surgery. Over 68% of the thrombosis experts recommended thromboprophylaxis during hospitalization only. The majority of the participants recommended using LMWH (85.9%) over UFH (10.1%). Approximately a third of the surveyed thrombosis experts estimated the incidence of overall VTE at 7 to 10 days post-operatively in patients who do not receive thromboprophylaxis post major abdominal surgery to be between 4 and 6%. A total of 55.3% of the thrombosis experts estimated the incidence of PE to be between 0.5 and 1.0% for the same patient population. The risk of major bleeding episode was estimated to be between 0.5 and 1% in patients receiving 7 to 10 days of pharmacological thromboprophylaxis in the post-operative period by a majority of the thrombosis experts (68.4%). However, approximately 80% of thrombosis experts believed that there is still some clinical equipoise around the use of thromboprophylaxis post discharge (up to 7 to 10 days) in high risk adult patients post major abdominal surgery.ConclusionsThrombosis experts recommend LMWH prophylaxis post major abdominal surgery. There is still, however, significant clinical equipoise regarding the duration of thromboprophylaxis (hospitalization only vs. total to 7–10 days). The result of the survey might not be generalizable to non-academic centers and to other countries.

Highlights

Patients undergoing major abdominal surgery are at high risk for developing venous thromboembolism in the post-operative period
Venous thromboembolism (VTE) is a condition associated with an increased morbidity and mortality among hospitalized medical and post-surgical patients
The American College of Chest Physician (ACCP) Evidence-based consensus guidelines published in 2012 [2] recommend that patients undergoing non-orthopedic surgery at moderate or high risk for VTE receive routine pharmacological thromboprophylaxis (Low molecular weight heparin (LMWH), unfractionated heparin (UFH) or fondaparinux)

Summary

Introduction

Patients undergoing major abdominal surgery are at high risk for developing venous thromboembolism in the post-operative period. Current evidence-based guidelines recommend routine pharmacological venous thromboembolism prophylaxis in patient at moderate to high risk post major abdominal surgery. The American College of Chest Physician (ACCP) Evidence-based consensus guidelines published in 2012 [2] recommend that patients undergoing non-orthopedic surgery at moderate or high risk for VTE (general, abdominal-pelvic or thoracic surgeries) receive routine pharmacological thromboprophylaxis (Low molecular weight heparin (LMWH), unfractionated heparin (UFH) or fondaparinux). We sought to establish the current clinical practice of Canadian thrombosis experts, assess for potential clinical equipoise regarding pharmacological thromboprophylaxis in this patient population and evaluate the potential participation in a future randomized clinical trial

Methods

Results

Conclusion