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Starting prophylaxis for venous thromboembolism postoperatively

C Kearon1, J Hirsh

  • 1McMaster University, Hamilton, Ontario.

Archives of Internal Medicine
|February 27, 1995
PubMed
Summary
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Postoperative initiation of venous thromboembolism (VTE) prophylaxis is effective in preventing VTE. Deferring prophylaxis until after surgery is unlikely to significantly reduce efficacy, though direct comparisons are needed.

Area of Science:

  • Medical research
  • Clinical trials
  • Thrombosis prevention

Background:

  • Venous thromboembolism (VTE) is a significant risk for hospitalized patients.
  • Many high-risk patients do not receive VTE prophylaxis.
  • Fear of bleeding complications often leads to reluctance in initiating preoperative prophylaxis.

Purpose of the Study:

  • To evaluate the effectiveness of initiating VTE prophylaxis postoperatively.
  • To compare the efficacy of VTE prophylaxis started before versus after surgery.

Main Methods:

  • Systematic literature review of randomized controlled trials.
  • Inclusion criteria: blind assessment of VTE outcomes and postoperative initiation of prophylaxis.
  • Focus on pharmacologic and nonpharmacologic prophylaxis methods.

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Main Results:

  • Prophylaxis for VTE is effective when initiated postoperatively, with relative risks ranging from 0.16 to 0.49.
  • Noncontrolled trials with postoperative prophylaxis also showed low VTE rates.
  • Direct comparisons between pre- and postoperative initiation are lacking, but indirect evidence suggests minimal efficacy loss.

Conclusions:

  • Postoperative VTE prophylaxis is an effective strategy.
  • Deferring prophylaxis until after surgery likely results in minimal loss of efficacy.
  • Further randomized trials are needed to directly compare pre- and postoperative prophylaxis, particularly for low-molecular-weight heparin in orthopedic surgery.