Timing and characteristics of venous thromboembolism after noncancer surgery
Por:
Exposito-Ruiz, M, Arcelus, JI, Caprini, JA, Lopez-Espada, C, Bura-Riviere, A, Amado, C, Loring, M, Mastroiacovo, D and Monreal, M
Publicada:
1 jul 2021
Ahead of Print:
1 jun 2021
Resumen:
Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperatively. The use of pharmacologic prophylaxis is effective in reducing the incidence of VTE. However, the prophylaxis is often discontinued at hospital discharge, especially for those with benign disease. The implications of this practice are not known. We assessed the data from a large, ongoing registry regarding the time course of VTE and outcomes after noncancer surgery.
Methods: We analyzed the RIETE (Computerized Registry on Venous Thromboembolism) registry, which includes data from consecutive patients with symptomatic confirmed VTE. In the present study, we focused on general surgical patients who had developed symptomatic postoperative VTE in the first 8 weeks after noncancer surgery. The main objective was to assess the interval between surgery and the occurrence of VTE. Additional variables included the clinical presentation associated with the event, the use of thrombosis prophylaxis, and unfavorable outcomes.
Results: The data from 3296 patients were analyzed. The median time from surgery to the detection of VTE was 16 days (interquartile range, 8-30 days). Of the VTE events, 77% were detected after the first postoperative week and 27% after 4 weeks. Overall, 43.9% of the patients with VTE had received pharmacologic prophylaxis after surgery for a median of 8 days (interquartile range, 5-14 days), and three quarters of the VTE events were detected after pharmacologic prophylaxis had been discontinued. Overall, 54% of the patients with VTE had presented with pulmonary embolism. For 15% of the patients, the clinical outcome was unfavorable, including 4% who had died within 90 days.
Conclusions: The risk of VTE after noncancer general surgery remains high for #2 months. More than one half of the patients had presented with symptomatic PE as the VTE event, and 15% had had unfavorable outcomes. Only 44% of these patients had received pharmacologic prophylaxis for around 1 week.
Filiaciones:
Exposito-Ruiz, M:
Univ Granada, Sch Med, Dept Stat, Unit Biostat, Granada, Spain
Arcelus, JI:
Univ Granada, Hosp Univ Virgen de las Nieves, Dept Gen Surg, Granada, Spain
Caprini, JA:
NorthShore Univ, HealthSyst Emeritus, Evanston, IL USA
Univ Chicago, Pritzker Sch Med, Chicago, IL 60637 USA
Lopez-Espada, C:
Hosp Univ Virgen de las Nieves, Dept Angiol & Vasc Surg, Granada, Spain
Bura-Riviere, A:
Hop Rangueil, Dept Vasc Med, Toulouse, France
Amado, C:
Hosp Sierrallana, Dept Internal Med, Santander, Spain
Loring, M:
Hosp Comarcal Axarquia, Dept Internal Med, Malaga, Spain
Mastroiacovo, D:
Osped SS Filippo & Nicola, Dept Angiol, Avezzano, Italy
:
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Barcelona, Spain
Univ Catolica Murcia, Dept Med, Murcia, Spain
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