Prevention of venous thromboembolism in the Enhanced Recovery After Surgery (ERAS) setting: an evidence-based review

• Published in: Canadian journal of anesthesia Vol. 62; no. 2; pp. 194 - 202
• Main Authors: Bell, Benjamin R., Bastien, Pascal E., Douketis, James D.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.02.2015; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anesthesiology; Anticoagulants; Body mass index; Bone surgery; Cancer; Cardiology; Cardiovascular disease; Compression therapy; Critical Care Medicine; Disease prevention; Embolisms; Evidence-Based Medicine; Female; Humans; Intensive; Internal medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Pain Medicine; Patients; Pediatrics; Perioperative Care; Pneumology/Respiratory System; Postoperative Complications - prevention & control; Recovery (Medical); Recovery of Function; Review Article/Brief Review; Thrombocytopenia; Thromboembolism; Thrombosis; Venous Thromboembolism - prevention & control; Canada; Rivaroxaban; Dabigatran; Acetylsalicylic Acid; Apixaban; Fondaparinux
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-014-0262-2

Purpose To review the evidence surrounding appropriate prophylaxis for venous thromboembolism (VTE) in patients undergoing surgery. Principal findings Appropriate prophylactic strategies for surgical patients have been defined in major society guidelines. We review the evidence behind these guidelines in a case-based format, including patients with a high risk of bleeding, history of heparin-induced thrombocytopenia, obesity, and cancer. Selecting the most suitable means for VTE prophylaxis includes evaluating patient, anesthetic, and surgical factors. Nevertheless, pharmacologic VTE prophylaxis will be appropriate for the vast majority of inpatients undergoing surgery. Conclusions Venous thromboembolism is a serious but preventable complication of hospitalization, especially among surgical patients. Historically, it has accounted for a high burden of postoperative morbidity and mortality. In the Enhanced Recovery After Surgery era, our aim should be no less ambitious than the eradication of postoperative VTE.