Related Experiment Video
Updated: Jun 14, 2025
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Venous Thromboembolism Prophylaxis Practice Patterns, Outcomes, and Risk Stratification After Surgery for IBD: A
Stefan D Holubar1, Samuel Eisenstein2, Liliana Bordeianou3
1Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio.
Background:
The optimal venous thromboembolism chemoprophylaxis strategy after surgery for IBD is not defined.
Objective:
To investigate the real-world efficacy of chemoprophylaxis strategies after surgery for IBD in a retrospective cohort.
Design:
Retrospective analysis of medical records from the National Surgical Quality Improvement Program IBD Collaborative of patients treated between July 2020 to October 2023.
Setting:
Seventeen medical centers.
Patients:
Patients with IBD undergoing colectomy and/or proctectomy were included.
Interventions:
Chemoprophylaxis.
Main Outcome Measures:
Thirty-day venous thromboembolism (clot) rates.
Results:
During 3 years, 1797 patients were eligible for chemoprophylaxis and included in the analysis, of whom 44 (2.4%) developed a clot within 30 days: 50% before and after discharge, respectively. Clots were diagnosed a median of 9 days postoperatively. The most common clots were portomesenteric (39%), pulmonary embolism (27%), and upper extremity (18%). Before discharge, clot rates differed by chemoprophylaxis strategy: enoxaparin (0.57%) versus unfractionated heparin (2.1%, p = 0.006). Any extended chemoprophylaxis was used in 50.5%, and clot rates differed by strategy: no extended chemoprophylaxis (1.4%), enoxaparin (0.63%), and others (3.5%, p = 0.01). Chemoprophylaxis strategies were not associated with bleeding complications. Multivariable analysis revealed that preoperative systemic inflammatory response syndrome ( p = 0.0005) and extended resections ( p < 0.0001) were independent risk factors for postoperative clots. Patients with 0, 1, or 2 risk factors had clot rates of 1.2%, 4.0%, and 13.5%, respectively ( p < 0.0001). Inpatient and extended prophylaxis with enoxaparin were independently associated with a lower risk of clots both before and after discharge ( p = 0.002 and p = 0.02, respectively), with relative risk reductions of 74.8% and 72.6%. For a clot rate of 2.5%, the estimated number needed to treat with enoxaparin in-hospital and postdischarge was 54 and 55 patients, respectively.
Limitations:
The limitations to this study were generalizability and selection bias.
Conclusions:
After IBD surgery, venous thromboembolism chemoprophylaxis with enoxaparin was associated with a decreased risk of clot formation before and after discharge. Patients at highest risk may benefit the most from extended chemoprophylaxis. See Video Abstract .
Patrones De Prctica, Resultados Y Estratificacin Del Riesgo En La Profilaxis De La Tromboembolia Venosa Tras Ciruga Por Enfermedad Inflamatoria Intestinal Estudio Colaborativo Del Programa Nacional De Mejora De La Calidad Quirrgica Sobre Eii:
ANTECEDENTES:No se ha definido la estrategia óptima de quimioprofilaxis de la tromboembolia venosa tras la cirugía por enfermedad inflamatoria intestinal.OBJETIVO:Investigar la eficacia real de las estrategias de quimioprofilaxis tras la cirugía por enfermedad inflamatoria intestinal en una cohorte retrospectiva.DISEÑO:Entre julio de 2020 y octubre de 2023, la Colaboración sobre Enfermedad Inflamatoria Intestina deel Programa Nacional de Mejora de la Calidad Quirúrgica.ENTORNO:Diecisiete centros médicos.PACIENTES:Pacientes con enfermedad inflamatoria intestinal sometidos a colectomía y/o proctectomía.INTERVENCIONES:Quimioprofilaxis.PRINCIPALES MEDIDAS DE RESULTADO:Tasas de tromboembolia venosa (coágulos) a 30 días.RESULTADOS:Durante tres años, 1797 pacientes fueron elegibles para quimioprofilaxis y fueron analizados, de los cuales 44 (2.4 %) desarrollaron un coágulo en un plazo de 30 días: el 50 % antes y después del alta, respectivamente. Los coágulos se diagnosticaron una mediana de 9 días después de la operación. Los coágulos más frecuentes fueron portomesentéricos (39 %), embolia pulmonar (27 %) y extremidades superiores (18 %). Antes del alta, las tasas de coágulos difirieron según la estrategia de quimioprofilaxis: enoxaparina (0.57 %) frente a heparina no fraccionada (2.1 %), p = 0.006. Se utilizó una quimioprofilaxis prolongada en el 50.5 % de los casos y las tasas de coágulos difirieron según la estrategia: sin quimioprofilaxis prolongada (1.4 %), enoxaparina (0.63 %) y otras (3.5 %) p = 0.01. Las estrategias de quimioprofilaxis no se asociaron con complicaciones hemorrágicas. El análisis multivariable reveló que el síndrome de respuesta inflamatoria sistémica preoperatoria ( p = 0.0005) y las resecciones extendidas ( p < 0.0001) eran factores de riesgo independientes para los coágulos postoperatorios. Los pacientes con 0, 1 o 2 factores de riesgo tuvieron tasas de coágulos del 1.2 %, 4.0 % y 13.5 %, respectivamente ( p < 0.0001). La profilaxis hospitalaria y prolongada con enoxaparina se asoció de forma independiente con un menor riesgo de coágulos antes y después del alta ( p = 0.002 y p = 0.02, respectivamente), con reducciones del riesgo relativo del 74.8 % y el 72.6 %. Para una tasa de coágulos del 2.5 %, el número estimado de pacientes que debían recibir tratamiento con enoxaparina durante la hospitalización y después del alta fue de 54 y 55, respectivamente.LIMITACIONES:Generalización; sesgo de selección.CONCLUSIONES:Tras la cirugía por enfermedad inflamatoria intestinal, la quimioprofilaxis de la tromboembolia venosa con enoxaparina se asoció con una disminución del riesgo de coágulos antes y después del alta. Los pacientes con mayor riesgo pueden beneficiarse más de una quimioprofilaxis prolongada. (Traducción-Dr. Jorge Silva Velazco ).
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