Postoperative chemoprophylaxis in elective abdominal surgery may minimize bleeding risk without compromising VTE protection

A recent study published in the Annals of Surgery recommends initiating chemoprophylaxis postoperatively in elective abdominal surgery cases to reduce bleeding risk while maintaining venous thromboembolisms (VTE) protection.

Venous thromboembolism is a frequent complication in surgical patients. The most prevalent cause of avoidable mortality in individuals hospitalized for surgical operations is pulmonary embolism (PE). The risk of VTE in surgical patients is dictated by a combination of individual predisposing factors and surgical aspects.

Morbidity, mortality, and healthcare expenses are associated with postoperative bleeding and venous thromboembolisms. Chemoprophylaxis is commonly used to prevent VTEs, however it raises the risk of bleeding. The time of chemoprophylaxis initiation during surgery may impact both VTE and hemorrhage risks. The best time to start chemoprophylaxis in the perioperative phase is unknown. As a result, Christopher Klonis and colleagues undertook this study to look at the influence of chemoprophylaxis timing on VTE and bleeding rates in patients awaiting major abdominal surgery.

PRISMA principles were used to search the databases EMBASE, MEDLINE, Cochrane Library, and Web of Science. Meta-analysis was performed on randomized trials and cohort studies published between 01 January 2000 and 10 May 2022 that reported on chemoprophylaxis timing as well as the incidence of VTE and hemorrhage following elective abdominal surgery.

The key findings of this study were:

1. 14 studies (24,922 patients) were chosen from 6,175 total. The studies comprised bariatric (4 studies), colorectal (1 study), anti-reflux (1 study), ventral hernia (1 study), hepato-pancreatic-biliary (5 studies), and major intra-abdominal procedures (2 studies).

2. Chemoprophylaxis was started before skin closure in 10,403 patients and afterward in 14,519.

3. The incidence of symptomatic and total VTE were equal among study groups.

4. Early use increased the incidence of all hemorrhage, severe bleeding, blood transfusion, and reintervention as compared to postoperative chemoprophylaxis.

Reference: 

Klonis, C., Ashraf, H., Cabalag, C. S., Wong, D. J., Stevens, S. G., & Liu, D. S. (2022). Optimal Timing of Perioperative Chemical Thromboprophylaxis in Elective Major Abdominal Surgery: A Systematic Review and Meta-analysis. In Annals of Surgery: Vol. Publish Ahead of Print. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/sla.0000000000005764