Background: Patients undergoing major abdominal surgery are at high risk for developing venous thromboembolism in the post-operative period. Current evidence-based guidelines recommend routine pharmacological venous thromboembolism prophylaxis in patient at moderate to high risk post major abdominal surgery. However, the type of agent, dose and duration of thromboprophylaxis remain unclear. We sought to survey current clinical practice and assess for potential clinical equipoise regarding pharmacological thromboprophylaxis post major abdominal surgery.
Methods: An electronic survey targeting thrombosis expert members of Thrombosis Canada was conducted.
Results: The total response rate was 52.3% (45/86). All thrombosis experts recommended pharmacological thromboprophylaxis for high risk patients post major abdominal surgery. Over 68% of the thrombosis experts recommended thromboprophylaxis during hospitalization only. The majority of the participants recommended using LMWH (85.9%) over UFH (10.1%). Approximately a third of the surveyed thrombosis experts estimated the incidence of overall VTE at 7 to 10 days post-operatively in patients who do not receive thromboprophylaxis post major abdominal surgery to be between 4 and 6%. A total of 55.3% of the thrombosis experts estimated the incidence of PE to be between 0.5 and 1.0% for the same patient population. The risk of major bleeding episode was estimated to be between 0.5 and 1% in patients receiving 7 to 10 days of pharmacological thromboprophylaxis in the post-operative period by a majority of the thrombosis experts (68.4%). However, approximately 80% of thrombosis experts believed that there is still some clinical equipoise around the use of thromboprophylaxis post discharge (up to 7 to 10 days) in high risk adult patients post major abdominal surgery.
Conclusions: Thrombosis experts recommend LMWH prophylaxis post major abdominal surgery. There is still, however, significant clinical equipoise regarding the duration of thromboprophylaxis (hospitalization only vs. total to 7-10 days). The result of the survey might not be generalizable to non-academic centers and to other countries.