Prescription des héparines de bas poids moléculaire en chirurgie vasculaire : résultats de l'enquête Ephebe

Abstract

Objectives. – Despite the fact that there are no approved indications by the French regulatory agency and despite the absence of recommendations, low molecular weight heparins (LMWH) are frequently used in vascular surgery, an area at both high risk of perioperative arterial and venous thrombosis as well as of bleeding. The aim of this study was to investigate medical practice in vascular surgery, using a survey of prescribers of antithrombotic agents. Study design. – Survey of physicians from different specialities involved in patient care before, during, and after vascular surgery. Patients and methods. – Between March and June 2003, 301 physicians filled a questionnaire providing information about their antithrombotic regimens depending on the type of vascular surgery. These physicians are involved in an important part of vascular surgery activity in France. Results. – The survey confirmed the use of LMWH in near 80% of patients scheduled for vascular surgery. The prescribed LMWH is frequently associated with antiplatelets agents. During patient's hospitalization, LMWH prescription is guided by numerous factors, making the prescription protocol rather complex. Major risk factors favoring continued prophylaxis after patient's hospital discharge include surgery with a high risk of thromboembolic events and limited ambulation. Analysis of the data also showed that the surgeon and the referring physician are both implicated in the majority of the postoperative care following patient's discharge, and therefore, in prescribing the antithrombotic drug. Conclusion. – This survey gives information on practical use of LMWH in the vascular surgery setting. This information could lead to prospective studies of LMWH in situations other than venous thromboembolic disease.