Timing of symptomatic venous thromboembolism after surgery: meta-analysis

Abstract

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.

Risk of Venous Thromboembolic Events After Surgery for Cancer

“…Similar occurrences of venous thromboembolic events were suggested by a meta-analysis, primarily concentrating on outcomes at 4 weeks and 3 months after surgery, with highest risk for outcomes during the first 4 weeks and an elevated risk throughout the study period. 26 It is, however,…”

Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper-Gastrointestinal and Hepatopancreatobiliary Surgery

“…We used cumulative incidence estimates at 4 weeks postsurgery (28 days) for our procedure-stratified estimates for the incidence of VTE and major bleeding. For the studies that did not report VTE estimates using this interval, to adjust the absolute VTE risk by postoperative day, we used the model developed in our separate systematic review 29 . This review provided estimates of VTE occurrence on each day until 4 weeks postoperatively.…”

“…To gather information on current (2010–present) and earlier (2000–2010) thromboprophylaxis practices, we conducted a web-based survey of practicing abdominal surgeons (Supplemental Digital Content Appendix, pages 301–306, Supplemental Digital Content 1, http://links.lww.com/SLA/E826). To inform the modeling of VTE outcomes for studies with variable lengths of follow-up, we conducted a separate systematic review regarding the risk and time course of VTE by postoperative day 29 …”

Timing of Major Postoperative Bleeding Among Patients Undergoing Surgery

“…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.…”

“…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.…”