Improving Adherence Rate of Extended Prophylaxis for Venous Thromboembolic Disease After Abdominal and Pelvic Oncologic Surgery

Vázquez, Fernando Javier; Bilbao, María Soledad; Saimovici, Javier; Vaccaro, Carlos

doi:10.1177/1076029615583348

Cited by 12 publications

(7 citation statements)

References 18 publications

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“…Anecdotal evidence has worried about a higher risk of bleeding post‐operatively with early VTP and eVTP. Our experience mirrors others that the risk of bleeding is not significantly elevated and likely to be outweighed by the protective effect of LMWH against DVT/PE …”

Section: Discussionsupporting

confidence: 83%

Safety, efficacy and compliance of extended thromboprophylaxis in hepatobiliary and upper gastrointestinal surgery

Marley

Navadgi

Banting

et al. 2018

ANZ Journal of Surgery

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Section: Discussionsupporting

confidence: 83%

Safety, efficacy and compliance of extended thromboprophylaxis in hepatobiliary and upper gastrointestinal surgery

Marley

Navadgi

Banting

et al. 2018

ANZ Journal of Surgery

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“…Even now, more than 6 years after publication of highlevel guidelines recommending extended prophylaxis in CRC surgery, 67% of Michigan hospitals continue to not prescribe extended-duration VTE prophylaxis after discharge for any of their patients with CRC. These findings indicate a need for multifaceted, interdisciplinary implementation strategies [15][16][17] to increase awareness of and adherence to recommended prevention. Previous successful examples of effective quality improvement through regional collaboratives [18][19][20] will provide the blueprints for such efforts.…”

Section: Discussionmentioning

confidence: 99%

Population-Based Analysis of Adherence to Postdischarge Extended Venous Thromboembolism Prophylaxis After Colorectal Resection

Mukkamala

Montgomery

Roo

et al. 2020

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Prevention of venous thromboembolism after colorectal surgery remains challenging. National guidelines endorse thromboembolism prophylaxis for 4 weeks after colorectal cancer resection. Expert consensus favors extended prophylaxis after IBD surgery. The actual frequency of prescription after resection remains unknown. OBJECTIVE:This study aimed to assess prescription of extended, postdischarge venous thromboembolism prophylaxis after resection in Michigan.DESIGN: This is a retrospective review of elective colorectal resections within a statewide collaborative receiving postdischarge, extended-duration prophylaxis. SETTING:This study was conducted between October 2015 and February 2018 at an academic center.PATIENTS: A total of 5722 patients (2171 with colorectal cancer, 266 with IBD, and 3285 with other). MAIN OUTCOME MEASURES:We compared the prescription of extended, postdischarge prophylaxis over time, between hospitals and by indication. RESULTS:Of 5722 patients, 373 (6.5%) received extended-duration prophylaxis after discharge. Use was similar between patients undergoing surgery for cancer (282/2171, 13.0%) or IBD (31/266, 11.7%, p = 0.54), but was significantly more common for both patients undergoing surgery for cancer or IBD in comparison with patients with other indications (60/3285, 1.8%, p < 0.001). Use increased significantly among patients with cancer (6.8%-16.8%, p < 0.001) and patients with IBD (0%-15.1%, p < 0.05) over the study period. For patients with other diagnoses, use was rare and did not vary significantly (1.5%-2.3%, p = 0.49). Academic centers and large hospitals (>300 beds) were significantly more likely to prescribe extended-duration prophylaxis

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“…Even though current guidelines recommend extended prophylaxis for highrisk surgical patients, there is little inter-and intrainstitutional consistency in adherence to them. 28,29 Several reasons have been advanced as barriers to the prescription of extended prophylaxis for high-risk patients. Prominent among these is the perceived risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Even though current guidelines recommend extended prophylaxis for high-risk surgical patients, there is little inter- and intrainstitutional consistency in adherence to them. 28,29…”

Section: Discussionmentioning

confidence: 99%

The role of extended/outpatient venous thromboembolism prophylaxis after abdominal surgery for cancer or inflammatory bowel disease

Farrow

Aboagye

Lau

et al. 2018

Journal of Patient Safety and Risk Management

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Background: Current guidelines recommend in-hospital venous thromboembolism prophylaxis for many patients and extended/outpatient prophylaxis in high-risk patients undergoing abdomino-pelvic surgery for cancer. Despite these guidelines, extended venous thromboembolism prophylaxis is not used uniformly at all institutions. This study aimed to evaluate the impact of postdischarge prophylaxis practices at two academic medical centers on the rate of postdischarge venous thromboembolism. Methods: We retrospectively analyzed data from the Brigham and Women's Hospital and the Johns Hopkins Hospital's American College of Surgeons, National Surgical Quality Improvement Program registries from 1 August 2014 to 30 June 2015. Brigham and Women's Hospital patients received four weeks supply of extended/outpatient venous thromboembolism prophylaxis, while Johns Hopkins Hospital patients did not. We determined the proportion of patients in each cohort that developed venous thromboembolism within 30 days of surgery. Results: Four hundred and eighty-nine patients underwent abdominal surgery for cancer and inflammatory bowel disease; 181 (37.0%) patients from Brigham and Women's Hospital and 308 (63.0%) patients from Johns Hopkins Hospital. Fourteen patients developed postoperative venous thromboembolism. Seven patients developed in-hospital venous thromboembolism and seven developed venous thromboembolism postdischarge. All postdischarge venous thromboembolism occurred in the Johns Hopkins group, and this difference was statistically significant (p ¼ 0.0498). There was no difference in postdischarge bleeding rates between the groups. Conclusions: Extended prophylaxis likely prevents postdischarge venous thromboembolism after major abdominal surgery without an increased risk of bleeding.

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Improving Adherence Rate of Extended Prophylaxis for Venous Thromboembolic Disease After Abdominal and Pelvic Oncologic Surgery

Cited by 12 publications

References 18 publications

Safety, efficacy and compliance of extended thromboprophylaxis in hepatobiliary and upper gastrointestinal surgery

Safety, efficacy and compliance of extended thromboprophylaxis in hepatobiliary and upper gastrointestinal surgery

Population-Based Analysis of Adherence to Postdischarge Extended Venous Thromboembolism Prophylaxis After Colorectal Resection

The role of extended/outpatient venous thromboembolism prophylaxis after abdominal surgery for cancer or inflammatory bowel disease

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