Venous thromboembolism prevention in surgery and obstetrics

Abstract

Apart from answering the above questions, the guidelines provide a summary table for each discipline. This table stratifies types of surgery into the three risk categories, specifies the recommended prophylaxis for venous thromboembolism (pharmacological and/or mechanical) and grades each recommendation. In addition, whenever appropriate, the recommended prophylaxis is adjusted to low- and high-risk patients.

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

“…A limited number and quality of studies on this issue hinder elaboration of final guidelines on VTE prophylaxis in patients undergoing urologic oncological surgeries [14,179]. Because of that fact, many up-to-date guidelines extrapolate results of the studies conducted on patients undergoing abdominal and pelvic surgery [14,21,23,30].…”

“…the VTE risk, when no prophylaxis is given, corresponds to the risk observed for extensive procedures in general surgery (VTE risk at 10-30%, pulmonary embolism risk at 1-10%) [14,179,[181][182][183]. Symptomatic venous thromboembolism occurs on average in 1-5% of patients after extensive urologic surgeries within the pelvis [14].…”

“…This risk seems to be even higher in some extensive urologic intraabdominal oncological surgeries. Radical oncological cystectomy with ileal conduit urinary diversion is an example of such a procedure [14,179,184]. In the study published in 2015 based on retrospective analysis of 27,455 patients, who underwent extensive urologic oncological surgeries, symptomatic VTE was diagnosed in 2.93% of cases [185].…”

“…anti-androgen treatment), and, as in other medical fields, clinically significant concomitant disease presence [14,[205][206][207][208]. The presence of cancer also increases the risk for symptomatic VTE occurrence after upper urinary tract surgeries up to 1-5% [14,179,12,183]. California Patient Discharge Data Set retrospective analysis estimated the incidence of symptomatic VTE at 2% after nephrectomy preformed because of malignancy [190].…”

Prophylaxis of venous thromboembolism in general and gynecologic day surgery in the Netherlands

“…In the USA [14,15], Germany [16], and France [17], guidelines recommend individualized TP based on the risk factors of the patient, which can be categorized as ÔlowÕ-, ÔmoderateÕ-, and Ôhigh riskÕ. Patients under the age of 40 years who undergo procedures, which are performed in an ambulatory setting are mostly Ôlow riskÕ, in which case no prophylaxis, other than early mobilization, is recommended.…”