Is There a Need for Long-Term Thromboprophylaxis following General Surgery?

Abstract

Thromboprophylaxis to surgical patients is generally accepted, and used in the perioperative period by many surgeons as effective means of reducing postoperative thromboembolic complications. Often the prophylaxis is stopped at the time of mobilization or discharge of the patient, although late thromboembolic complications after cessation of the postoperative prophylaxis are known to occur up to 7 weeks after surgery. By scrutinizing thromboprophylactic studies performed in general surgery during the last 20 years, we found the incidence of late thromboembolic complications reported to be about 1 % when clinical diagnostics was applied. In studies where the patients were screened for late thromboembolic complications using paraclinical diagnostic methods the incidence is 10 times higher. The clinical relevance of these late postoperative thromboembolic complications is still uncertain, as is the value of long-term prophylaxis.

Optimal Duration for Prophylaxis of Deep Vein Thrombosis: The New Focus?

“…The same type of findings has been reported for cases of DVT occurring after patients were dis-charged from the hospital (2,4). The frequency of the latter may be as high as 67% of all cases of thrombotic complications as reported in the classical study by Scurr et al (21).…”

“…Yet prophylaxis is usually stopped when the patient is discharged. A few investigators have questioned this seemingly illogical practice (1)(2)(3)(4).…”

Low molecular weight heparin for the prevention of venous thromboembolism after abdominal surgery

“…However, there is now evidence that late thrombotic events can occur up to 6-7 weeks after operation. A literature review on the frequency of late VTE suggests that clinically diagnosed late DVT and/or PE (outside the normal period of hospitalization) occur in approximately 1 per cent of patients 44 . Studies that used objective screening methods, however, reported an incidence ten times higher 44 .…”

“…A literature review on the frequency of late VTE suggests that clinically diagnosed late DVT and/or PE (outside the normal period of hospitalization) occur in approximately 1 per cent of patients 44 . Studies that used objective screening methods, however, reported an incidence ten times higher 44 . A longer period of perioperative thromboprophylaxis may therefore be required, particularly after prolonged highrisk surgery or in patients with cancer.…”

Low Risk of Thromboembolic Complications After Fast-Track Abdominal Surgery With Thrombosis-Prophylaxis Only During Hospital Stay

“…Prophylaxis for 7 - 10 days after knee and hip arthroplasty had a 3.5 - 4% incidence of symptomatic VTE three months after surgery [8, 14]. Extended prophylaxis reduced this incidence to 1.3% [3, 25]. This strategy, however, does not eliminate the occurrence of fatal PE, and the reduction of symptomatic DVT was statistically significant in only two out of nine randomized controlled trials [3].…”