Prevention of Venous Thromboembolism in Gynecologic Surgery

doi:10.1097/aog.0000000000004445

Cited by 24 publications

(4 citation statements)

References 82 publications

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“…A total of 22 prospective studies (each directly providing information regarding timing of VTE in dozens of surgical procedures in various fields of surgery) that included thousands of VTE events (high statistical power leading to high precision for the pooled results) were identified. Considering the use of thromboprophylaxis, the timing of postoperative VTE events was pooled up to 28 days (4 weeks) after surgery, a duration of extended prophylaxis frequently used by clinicians 4 , 7 , 53–58 . Studies proved consistent regarding timing of VTE (as well as PE and DVT) and sensitivity analyses yielded results similar to the primary analyses.…”

Section: Discussionmentioning

confidence: 99%

Timing of symptomatic venous thromboembolism after surgery: meta-analysis

Singh

Lavikainen

Halme

et al. 2023

British Journal of Surgery

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Background The timing at which venous thromboembolism (VTE) occurs after major surgery has major implications for the optimal duration of thromboprophylaxis. The aim of this study was to perform a systematic review and meta-analysis of the timing of postoperative VTE up to 4 weeks after surgery. Methods A systematic search of MEDLINE, Scopus, and CINAHL databases was performed between 1 January 2009 and 1 April 2022. Prospective studies that recruited patients who underwent a surgical procedure and reported at least 20 symptomatic, postoperative VTE events by time were included. Two reviewers independently selected studies according to the eligibility criteria, extracted data, and evaluated risk of bias. Data were analysed with a Poisson regression model, and the GRADE approach was used to rate the certainty of evidence. Results Some 6258 studies were evaluated, of which 22 (11 general, 5 urological, 4 mixed, and 2 orthopaedic postoperative surgical populations; total 1 864 875 patients and 24 927 VTE events) were eligible. Pooled evidence of moderate certainty showed that 47.1 per cent of the VTE events occurred during the first, 26.9 per cent during the second, 15.8 per cent during the third, and 10.1 per cent during the fourth week after surgery. The timing of VTE was consistent between individual studies. Conclusion Although nearly half of symptomatic VTE events in first 4 weeks occur during the first postoperative week, a substantial number of events occur several weeks after surgery. These data will inform clinicians and guideline developers about the duration of postoperative thromboprophylaxis.

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Section: Discussionmentioning

confidence: 99%

Timing of symptomatic venous thromboembolism after surgery: meta-analysis

Singh

Lavikainen

Halme

et al. 2023

British Journal of Surgery

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“…Understanding the risk and timing of postoperative bleeding is important for patient care for several reasons. For example, in addition to bleeding, patients undergoing surgery are at risk of thromboembolism and are, therefore, often prescribed thromboprophylaxis . The use of pharmacologic thromboprophylaxis involves a trade-off between a reduction in risk of venous thromboembolism (VTE) and increase in the risk of bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…For example, in addition to bleeding, patients undergoing surgery are at risk of thromboembolism and are, therefore, often prescribed thromboprophylaxis. 5 , 6 , 7 , 8 , 9 , 10 The use of pharmacologic thromboprophylaxis involves a trade-off between a reduction in risk of venous thromboembolism (VTE) and increase in the risk of bleeding. Understanding of the timing of bleeding is critical for making decisions about the starting time and duration of pharmacologic prophylaxis, as well as to anticipate and prevent these complications.…”

Section: Introductionmentioning

confidence: 99%

Timing of Major Postoperative Bleeding Among Patients Undergoing Surgery

Halme,

Roshanov,

Tornberg

et al. 2024

JAMA Netw Open

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ImportanceAlthough major bleeding is among the most common and prognostically important perioperative complications, the relative timing of bleeding events is not well established. This information is critical for preventing bleeding complications and for informing the timing of pharmacologic thromboprophylaxis.ObjectiveTo determine the timing of postoperative bleeding among patients undergoing surgery for up to 30 days after surgery.Design, Setting, and ParticipantsThis is a secondary analysis of a prospective cohort study. Patients aged 45 years or older who underwent inpatient noncardiac surgery were recruited in 14 countries between 2007 and 2013, with follow-up until December 2014. Data analysis was performed from June to July 2023.ExposureNoncardiac surgery requiring overnight hospital admission.Main Outcomes and MeasuresThe primary outcome (postoperative major bleeding) was a composite of the timing of the following bleeding outcomes: (1) bleeding leading to transfusion, (2) bleeding leading to a postoperative hemoglobin level less than 7 g/dL, (3) bleeding leading to death, and (4) bleeding associated with reintervention. Each of the components of the composite primary outcome (1-4) and bleeding independently associated with mortality after noncardiac surgery, which was defined as a composite of outcomes 1 to 3, were secondary outcomes.ResultsAmong 39 813 patients (median [IQR] age, 63.0 [54.8-72.5] years; 19 793 women [49.7%]), there were 5340 major bleeding events (primary outcome) in 4638 patients (11.6%) within the first 30 days after surgery. Of these events, 42.7% (95% CI, 40.9%-44.6%) occurred within 24 hours after surgery, 77.7% (95% CI, 75.8%-79.5%) by postoperative day 7, 88.3% (95% CI, 86.5%-90.2%) by postoperative day 14, and 94.6% (95% CI, 92.7%-96.5%) by postoperative day 21. Within 48 hours of surgery, 56.2% of major bleeding events, 56.2% of bleeding leading to transfusion, 56.1% of bleeding independently associated with mortality after noncardiac surgery, 51.8% of bleeding associated with hemoglobin less than 7 g/dL, and 51.8% of bleeding associated with reintervention had occurred.Conclusions and RelevanceIn this cohort study, of the major postoperative bleeding events in the first 30 days, more than three-quarters occurred during the first postoperative week. These findings are useful for researchers for the planning future clinical research and for clinicians in prevention of bleeding-related surgical complications and in decision-making regarding starting of pharmacologic thromboprophylaxis after surgery.

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“…Various methods are available to reduce the risk of DVT in patients undergoing gynecologic surgery, including pharmacologic and mechanical prophylaxis ( 8 ). The pharmacologic strategies include unfractionated heparin, low molecular weight heparin (LMWH; e.g., enoxaparin), thrombin inhibitors (e.g., argatroban) and factor Xa inhibitors (e.g., apixaban) ( 9 – 11 ). However, these agents are associated with potentially serious adverse effects such as postoperative hemorrhage (for all agents), heparin-induced thrombocytopenia and apixaban-induced liver injury ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Pilot Study of Effects of Intermittent Pneumatic Compression in the Immediate Peri-Operative Period on Hemodynamic Parameters in Patients After Laparoscopic Gynecologic Surgery

et al. 2022

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The randomized controlled study investigated the impacts of immediate peri-operative Intermittent pneumatic compression (IPC) on hemodynamic indicators in patients undergoing laparoscopic gynecologic surgery. Patients scheduled for elective laparoscopic gynecologic surgery were randomized to control (IPC not used), pre-operative IPC, post-operative IPC, and peri-operative IPC (performed both before and after surgery) groups. Systolic blood pressure (SBP), mean blood pressure (MBP) cardiac output (CO), heart rate (HR) and systemic vascular resistance (SVR) were measured at different time points. The results showed that SBP changes not obviously over time in the control and peri-operative IPC group. Compared with values before surgery, the pre-operative IPC group had a lower SBP (P < 0.01) at the end of PACU stay, whereas the post-operative IPC group had a higher SBP (P < 0.01) after surgery. All groups exhibited little or no variation in HR, CO and SVR. Conclusion is peri-operative IPC has no major adverse effects on hemodynamic parameters.

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Prevention of Venous Thromboembolism in Gynecologic Surgery

Cited by 24 publications

References 82 publications

Timing of symptomatic venous thromboembolism after surgery: meta-analysis

Timing of symptomatic venous thromboembolism after surgery: meta-analysis

Timing of Major Postoperative Bleeding Among Patients Undergoing Surgery

Pilot Study of Effects of Intermittent Pneumatic Compression in the Immediate Peri-Operative Period on Hemodynamic Parameters in Patients After Laparoscopic Gynecologic Surgery

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