Perioperative venous thromboembolism prophylaxis: European guidelines

European Society of Anaesthesiology has released European guidelines on  Perioperative venous thromboembolism prophylaxis. The Guidelines have been published in the European Journal of Anaesthesiology.

In Perioperative period the patient is not ambulatory and is, therefore, more prone to venous thromboembolism( VTE) In order to prevent venous thromboembolism (VTE), early ambulation, pharmacological thromboprophylaxis using anticoagulants and mechanical thromboprophylaxis by means of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) have been advocated.

Mechanical thromboprophylaxis or compression therapy reduces the risk of deep venous thrombosis (DVT) but its impact on symptomatic VTE and in particular PE remains unclear and varies in different clinical settings. Intermittent pneumatic compression appears to reduce the risk of DVT by approximately 50% but considerable heterogeneity exists in the choice of device, with most of the included studies combining IPC with GCS. Thus, there is currently no conclusive evidence on the impact of IPC for the prevention of PE.

The guidelines recommend against the use of GCS alone without pharmacological thromboprophylaxis for prevention of VTE in patients at intermediate and high risk. For patients at high risk of VTE with contraindications for pharmacological thromboprophylaxis, we recommend the use of mechanical prophylaxis and suggest the use of IPC over GCS.

Major Recommendations are-

• We recommend an institution-wide protocol for the prevention of VTE that integrates early ambulation, pharmacological thromboprophylaxis with anticoagulants and mechanical thromboprophylaxis (Grade IB).

• We recommend against the routine use of GCS without pharmacological thromboprophylaxis to prevent VTE in patients at intermediate and high risk (Grade IB).

• In patients with contraindications to pharmacological thromboprophylaxis, we recommend the use of mechanical prophylaxis with IPC or GCS (Grade IB) and suggest the use of IPC over GCS (Grade 2B).

• In patients with contraindications to pharmacological thromboprophylaxis who are not at high-risk for VTE, we suggest no prophylaxis over GCS alone (Grade 2C).

• In patients receiving pharmacological thromboprophylaxis who are not at very high risk for VTE, we recommend against the routine use of mechanical thromboprophylaxis with GCS or IPC (Grade IB).

• We suggest combined mechanical and pharmacological prophylaxis in selected patients at very high-risk for VTE (grade 2B). We suggest the use of IPC rather than GCS in selected high-risk patients in addition to pharmacological thromboprophylaxis (Grade 2B).

For further reference log on to :

European Journal of Anaesthesiology (EJA) DOI: 10.1097/EJA.0000000000000726