Thromboprophylaxis can be omitted in selected patients undergoing varicose vein surgery and hernia repair

Enoch, Stuart; Woon, E; Blair, S. D.

doi:10.1002/bjs.4185

Cited by 47 publications

(30 citation statements)

References 11 publications

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“…Examples of relatively low-risk procedures include laparoscopic cholecystectomy, appendectomy, transurethral prostatectomy, inguinal herniorrhaphy, and unilateral or bilateral mastectomy. [69][70][71][72][73][74][75][76] Openabdominal and open-pelvic procedures are associated with a higher risk of VTE. 75,77 VTE risk appears to be highest for patients undergoing abdominal or pelvic surgery for cancer.…”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,854

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,854

744

View full text Add to dashboard Cite

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“…This becomes important because surgical risk of venous thromboembolic events is low in outpatient procedures and minimally invasive procedures, whereas it is higher in major surgical procedures. (11) The classification of the type of procedure (minor or major surgery) to which the patient will be exposed is the key to the stratification of surgical risk of VTE. The first study on major and minor surgery serum creatinine levels, risk factors for VTE, contraindications to the use of heparin, type of surgery, and type of anesthesia, as well as type of prophylaxis prescribed and dose prescribed.…”

Section: Introductionmentioning

confidence: 99%

Profilaxia para tromboembolia venosa em um hospital geral

et al. 2011

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Objective: To evaluate the use of venous thromboembolism (VTE) prophylaxis in a general hospital. Methods: A cross-sectional cohort study at the Hospital Nossa Senhora da Conceição, located in the city of Porto Alegre, Brazil, involving a random sample of patients admitted between October of 2008 and February of 2009. We included patients over 18 years of age and hospitalized for more than 48 h. The exclusion criteria were anticoagulant use, pregnancy, puerperium, and a history of thromboembolic disease. The adequacy of prophylaxis was evaluated in accordance with a protocol created by the Hospital and principally based on the American College of Chest Physicians guidelines, eighth edition. Results: We included 262 patients. The mean age was 59.1 ± 16.6 years. The most common risk factors were immobilization (in 70.6%), infection (in 44.3%), cancer (in 27.5%), obesity (in 23.3%), and major surgery (in 14.1%). The risk of VTE was classified as high and moderate in 143 (54.6%) and 117 (44.7%) of the patients, respectively. Overall, 46.2% of the patients received adequate prophylaxis, 25% of those with ≥ three risk factors for VTE and 18% of those with cancer, the differences between these last two groups and their counterparts (patients with < three risk factors and those without cancer) being statistically significant (p < 0.001 for both). Conclusions: Our data reveal that nearly all patients at our hospital were at risk for VTE, and that less than half received adequate VTE prophylaxis, which is in agreement with the literature. It is surprising that inadequate prophylaxis is more common in high-risk patients.Keywords: Venous thromboembolism/prevention and control; Venous thrombosis/prevention and control; Heparin. ResumoObjetivo: Avaliar a prática de profilaxia para tromboembolia venosa (TEV) em pacientes em um hospital geral. Métodos: Estudo de coorte transversal conduzido no Hospital Nossa Senhora da Conceição, localizado na cidade de Porto Alegre (RS), com uma amostra constituída de pacientes internados selecionados randomicamente entre outubro de 2008 e fevereiro de 2009. Foram incluídos pacientes maiores de 18 anos e internados por mais de 48 h. Os critérios de exclusão foram pacientes em uso de anticoagulantes, história de doença tromboembólica, gestação e puerpério. A adequação da profilaxia foi avaliada seguindo as recomendações de um protocolo criado pela instituição e tendo como base principal a diretriz da American College of Chest Physician, oitava edição. Resultados:Foram incluídos 262 pacientes com média de idade de 59,1 ± 16,6 anos. Os fatores de risco mais comuns foram imobilização (70,6%), infecção (44,3%), câncer (27,5%), obesidade (23,3%) e cirurgia maior (14,1%). Na avaliação do nível de risco para TEV, 143 (54,6%) e 117 pacientes (44,7%), respectivamente, foram classificados como de risco alto e moderado. No geral, 46,2% dos pacientes tiveram profilaxia adequada, assim como 25% dos pacientes com três ou mais fatores de risco e 18% dos pacientes com câncer, e houve diferenças estatis...

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“…Furthermore, the even more scarce publications about thromboprophylaxis related to this type of surgery report poorly designed studies [7,31,32]. This means that no clear recommendations exist, even in the most recent consensuses [33,34].…”

Section: Discussionmentioning

confidence: 98%

“…However, the available literature, though scarce, suggests that the frequency of post-inguinal hernia surgery VTE is low [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Slow femoral venous flow and venous thromboembolism following inguinal hernioplasty in patients without or with low molecular weight heparin prophylaxis

Lozano

Sánchez-Fernández

González‐Porras

et al. 2015

Hernia

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Thromboprophylaxis can be omitted in selected patients undergoing varicose vein surgery and hernia repair

Abstract: Low-risk patients having hernia and vein surgery do not need thromboprophylaxis.

Cited by 47 publications

References 11 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Profilaxia para tromboembolia venosa em um hospital geral

Slow femoral venous flow and venous thromboembolism following inguinal hernioplasty in patients without or with low molecular weight heparin prophylaxis

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