Venous Thromboembolism Prophylaxis in Surgical Patients-References

References

Pdf Summary

The document compiles extensive references (2012–2023) regarding venous thromboembolism (VTE) prophylaxis in surgical patients, emphasizing evidence-based guidelines, risk assessment, and prophylactic strategies for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) post-surgery.

Key insights include:

1. <strong>Guidelines and Risk Assessment:</strong> Foundational guidelines (American Society of Hematology 2019, American College of Chest Physicians 2012) provide structured VTE prevention recommendations for nonorthopedic and orthopedic surgical patients. Risk assessment models, such as the Caprini score, guide individualized prophylaxis based on patient and procedural risk factors.

2. <strong>Pharmacological Prophylaxis:</strong> The references extensively evaluate anticoagulants including low-molecular-weight heparin (enoxaparin), vitamin K antagonists, direct oral anticoagulants (apixaban, rivaroxaban, dabigatran), and aspirin. Multiple randomized controlled trials and meta-analyses demonstrate efficacy and safety of these agents for thromboprophylaxis following hip/knee arthroplasty and other surgeries. Aspirin appears effective for extended prophylaxis after orthopedic procedures, presenting a balance in efficacy and bleeding risk.

3. <strong>Mechanical Prophylaxis:</strong> Intermittent pneumatic compression and graduated compression stockings are studied for their role alone or combined with pharmacologic agents. Evidence suggests combined mechanical and pharmacologic prophylaxis is more effective in high-risk patients. Mechanical methods are especially relevant where anticoagulation is contraindicated.

4. <strong>Special Populations:</strong> Recommendations for cancer patients, bariatric surgery, trauma, and lower extremity fractures highlight the need for tailored prophylaxis. Extended thromboprophylaxis benefits cancer and bariatric surgery patients. The role of inferior vena cava (IVC) filters remains controversial, offering no clear survival advantage and associated with risks.

5. <strong>Epidemiology and Economic Impact:</strong> Studies confirm significant VTE incidence post-surgery and related healthcare costs, underscoring the importance of prevention. National calls to action and policy changes reflect VTE's public health impact.

Overall, the document underscores personalized thromboprophylaxis using validated risk assessments and a combination of pharmacologic and mechanical strategies to optimize safety and efficacy across diverse surgical populations.

Keywords

venous thromboembolism

VTE prophylaxis

deep vein thrombosis

pulmonary embolism

risk assessment

Caprini score

pharmacological prophylaxis

mechanical prophylaxis

orthopedic surgery

thromboprophylaxis