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Perioperative Venous Thromboembolism: A Review
Ronald J Gordon1, Frederick W Lombard
1From the *Department of Anesthesiology, University of California, UC San Diego School of Medicine, La Jolla, California; and †Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Anesthesia and Analgesia
|June 23, 2017
Summary
Current venous thromboembolism (VTE) prophylaxis is insufficient, necessitating novel strategies. Understanding thrombogenesis pathophysiology reveals potential for multimodal treatments to improve patient outcomes and reduce VTE risks.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Surgical Outcomes
Background:
- Venous thromboembolism (VTE) poses significant perioperative risks, despite prophylaxis guidelines.
- Morbidity from VTE has remained unchanged for two decades, indicating insufficient current prophylaxis.
- Enhanced understanding of thrombogenesis pathophysiology is crucial for improving VTE prevention.
Purpose of the Study:
- To review current limitations in VTE prophylaxis.
- To explore recent advancements in understanding venous thrombogenesis.
- To propose future directions for VTE prevention strategies.
Main Methods:
- Literature review of VTE pathophysiology and prophylaxis.
- Analysis of traditional coagulation cascade and novel thrombotic pathways.
- Discussion of endothelial dysfunction and risk stratification tools.
Main Results:
- Current anticoagulants may increase bleeding and infection risks.
- Tissue factor, immune cells, and platelets play key roles in thrombus formation.
- Endothelial dysfunction in venous valves is a critical factor in VTE origination.
Conclusions:
- Multimodal treatment regimens are likely to be more effective for VTE prevention.
- Individualized prophylaxis requires better VTE risk prediction tools.
- Lower, safer doses of hemostatic therapies may be achievable with combined approaches.
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