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

Abstract

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.

Is Extended‐Duration (Post‐Hospital Discharge) Venous Thromboembolism Chemoprophylaxis Safe and Efficacious in High‐Risk Surgery Patients? A Systematic Review

“…Nineteen studies with a total of 10,544 patients were included in the final analysis-nine randomized controlled trials [8,[20][21][22][23][24][25][26][27], four prospective studies [7,15,28,29], four retrospective studies [30][31][32][33], and two prospective experimental cohorts compared with historic cohorts [34,35] (Table 1). All but two studies had comparator groups [15,32].…”

Are We Really Supposed to Start Giving Venous Thromboembolism Prophylaxis for a Month After Outpatient Surgery?

“…Venous thromboembolism (VTE) remains a significant cause of postoperative morbidity, and inpatient postoperative VTE prophylaxis remains standard of care . For select procedures, there is a well-recognized risk of VTE that extends beyond hospital discharge, and numerous guidelines support extended prophylaxis for 4-6 weeks following discharge for high-risk surgical subgroups …”