Towards standardized perioperative chemoprophylaxis in major elective abdominal surgery

Abstract

Hospital-acquired venous thromboembolism (VTE) incurs significant morbidity and mortality. 1 Chemoprophylaxis is proven to reduce the risk of VTE and is recommended by guidelines. However, chemoprophylaxis increases the risk of bleeding. 2 Therefore, chemoprophylaxis prescription requires balancing the risk of bleeding with thromboembolic protection. Currently, chemoprophylaxis usage is associated with the following issues 3-11 :(1) Guidelines are outdated, unclear or poorly utilized.(2) Compliance is suboptimal, increasing the risk of VTE.(3) The optimal timing of perioperative administration is unclear leading to significant variations in practice. ( 4) The lack of standardization of chemoprophylaxis may adversely affect bleeding and/or VTE risks. The Perioperative Timing of Elective Chemical Thromboprophylaxis in General surgery (PROTECTinG) investigators, through the Victorian collaborative for Education, Research, Innovation, Training and Audit by Surgical trainees (VERITAS) has recently addressed these issues. PROTECTinG has delivered seven