Preoperative vs Postoperative Initiation of Low-Molecular-Weight Heparin Prophylaxis Against Venous Thromboembolism in Patients Undergoing Elective Hip Replacement

“…These different regimens have made it difficult to compare the results of trials from North America and Europe, and no direct comparisons of the two approaches have yet been undertaken. A recently published meta-analysis reviewed the inpatient phase of thromboprophylactic studies using enoxaparin [22]. Comparisons were made across trials, and may thus have been influenced by factors other than timing, but the results indicate that preoperative thromboprophylaxis may offer a significant advantage over a post-operative start (see table 8).…”

Section: Timing Of Thromboprophylaxismentioning

confidence: 99%

Extended Prophylaxis against Venous Thromboembolism following Total Hip and Knee Replacement

Hull¹,

Pineo²

1999

Pathophysiol Haemos Thromb

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The recently reported reductions in the incidence of post-operative venous thromboembolism (VTE) are related to the widespread use of prophylactic anticoagulants. Many uncertainties remain with regard to the most effective ways to use thromboprophylaxis, however. The trend towards shorter hospital stays means that patients may receive less than the recommended 7–10 days of prophylaxis. Prolonged periods of thromboprophylaxis may be beneficial for patients at high risk of post-operative VTE, such as those undergoing major orthopaedic surgery. The relative rarity of symptomatic deep vein thrombosis and pulmonary embolism means that very large patient populations are required for studies that rely on clinical endpoints, but studies using venographic endpoints have shown 28–35 days of prophylaxis with low-molecular-weight heparin to be more effective than 10–14 days. Other factors that may influence the efficacy of thromboprophylaxis include the timing of the first injection and the choice of agent.

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“…Evidence is available in support of both preoperative and postoperative initiation, but almost all studies and meta-analyses are directed specifically toward major orthopedic procedures. [13][14][15] Evidence for which approach is appropriate in thyroid surgery patients is to our knowledge nonexistent. Our survey found that 44% of surgeons give prophylaxis postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Surgery and Anticoagulation: Survey of Practice of Endocrine Surgeons in Australia

Verma¹,

Gorelik²,

Miller³

2013

World Journal of Endocrine Surgery

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Few studies specifically address management of venous thromboembolism (VTE) prophylaxis and bridging anticoagulation therapy in patients undergoing thyroid surgery. A survey about perioperative management of thromboprophylaxis was sent to Australian Endocrine Surgeons. Responses were tabulated and graphed; a p-value of < 0.05 was considered statistically significant. Survey responses showed a large broad spectrum of practice regarding thromboprophylaxis, bridging therapy and cessation of anticoagulant medication. While anticoagulant prophylaxis in thyroid surgery appears to be relatively safe, there is a theoretical risk of catastrophic bleeding complications; according to this survey of Australian Endocrine Surgeons, thromboembolic events are uncommon complications of thyroid surgery.

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Preoperative vs Postoperative Initiation of Low-Molecular-Weight Heparin Prophylaxis Against Venous Thromboembolism in Patients Undergoing Elective Hip Replacement

Cited by 84 publications

References 43 publications

Low-Molecular-Weight Heparin Prophylaxis Using Dalteparin in Close Proximity to Surgery vs Warfarin in Hip Arthroplasty Patients

Low-Molecular-Weight Heparin Prophylaxis Using Dalteparin in Close Proximity to Surgery vs Warfarin in Hip Arthroplasty Patients

Extended Prophylaxis against Venous Thromboembolism following Total Hip and Knee Replacement

Thyroid Surgery and Anticoagulation: Survey of Practice of Endocrine Surgeons in Australia

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