Is Extended-Duration (Post-Hospital Discharge) Venous Thromboembolism Chemoprophylaxis Safe and Efficacious in High-Risk
- PDF / 347,411 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 68 Downloads / 147 Views
SCIENTIFIC REVIEW
Is Extended-Duration (Post-Hospital Discharge) Venous Thromboembolism Chemoprophylaxis Safe and Efficacious in High-Risk Surgery Patients? A Systematic Review Saamia Shaikh1,2 • Melanie Reddy1,2 • Mark McKenney1,2 • Adel Elkbuli1,2
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The risk of venous thromboembolism (VTE) persists beyond hospitalization in surgical patients, yet post-hospital discharge chemoprophylaxis regimens are not common. The purpose of this study is to systematically review the literature regarding extended-duration (post-hospital discharge) venous thromboembolism chemoprophylaxis and to determine whether it is warranted in high-risk surgical patients, as determined by its safety and efficacy. Method We searched four online databases for articles evaluating extended-duration (post-hospital discharge) VTE chemoprophylaxis regimens in surgical patients between the years January 2000 and February 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. GRADE methodology and the Cochrane Risk of Bias Assessment Tool for Randomized Controlled Trials were used to grade the quality of evidence and assess risk of bias. Results Nineteen studies with 10,544 patients were analyzed. The duration for extended-duration VTE chemoprophylaxis ranged from 7 to 42 days. In our study cohort, high-risk patients not prescribed extended-duration VTE chemoprophylaxis had a mean VTE incidence rate of 12.23%, while patients receiving 28–30 days of chemoprophylaxis had a mean VTE incidence rate of 4.37% (p = 0.006). The risk of bleeding events did not correlate with the duration of chemoprophylaxis. Conclusion Extended-duration VTE chemoprophylaxis in high-risk surgical patients decreased the incidence of thrombotic complications without increasing the risk of bleeding events. Further research is needed to establish guidelines for the optimal duration of VTE chemoprophylaxis in high-risk surgical patients. Level of evidence III.
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05638-4) contains supplementary material, which is available to authorized users. & Adel Elkbuli [email protected] 1
Department of Surgery, Division of Trauma and Acute Care Surgery, Kendall Regional Medical Center, 11750 Bird Road, Miami, FL 33175, USA
2
University of South Florida, Tampa, FL, USA
Deep vein thrombosis (DVT) and pulmonary embolism (PE) when discussed together constitute venous thromboembolism (VTE) and continue to be a leading source of morbidity and mortality in high-risk surgical patients with over 900,000 cases reported yearly [1]. Studies have reported VTE development in high-risk settings ranging from 21 to 90 days after hospital discharge [2, 3] with a 25% incidence rate even 4–6 weeks after some high-risk surgical procedures [4]. Despite this, it is not common
123
World J Surg
practice to discharge patients with extended-duration posthospital discha
Data Loading...
