Is Extended-Duration (Post-Hospital Discharge) Venous Thromboembolism Chemoprophylaxis Safe and Efficacious in High-Risk Surgery Patients? A Systematic Review

Abstract

Background

The risk of venous thromboembolism (VTE) persists beyond hospitalization in surgical patients, yet post-hospital discharge chemoprophylaxis regimens are not common. The purpose of this study is to systematically review the literature regarding extended-duration (post-hospital discharge) venous thromboembolism chemoprophylaxis and to determine whether it is warranted in high-risk surgical patients, as determined by its safety and efficacy.

Method

We searched four online databases for articles evaluating extended-duration (post-hospital discharge) VTE chemoprophylaxis regimens in surgical patients between the years January 2000 and February 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. GRADE methodology and the Cochrane Risk of Bias Assessment Tool for Randomized Controlled Trials were used to grade the quality of evidence and assess risk of bias.

Results

Nineteen studies with 10,544 patients were analyzed. The duration for extended-duration VTE chemoprophylaxis ranged from 7 to 42 days. In our study cohort, high-risk patients not prescribed extended-duration VTE chemoprophylaxis had a mean VTE incidence rate of 12.23%, while patients receiving 28–30 days of chemoprophylaxis had a mean VTE incidence rate of 4.37% (p = 0.006). The risk of bleeding events did not correlate with the duration of chemoprophylaxis.

Conclusion

Extended-duration VTE chemoprophylaxis in high-risk surgical patients decreased the incidence of thrombotic complications without increasing the risk of bleeding events. Further research is needed to establish guidelines for the optimal duration of VTE chemoprophylaxis in high-risk surgical patients.

Level of evidence

III.

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Fig. 1

Change history

  • 01 July 2020

    In the original article, the authors’ affiliations and affiliation addresses are inaccurate. They are correct as reflected here.

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Shaikh, Reddy, and Elkbuli were involved in the study conception and design. Shaikh, Reddy, and Elkbuli collected, interpreted, and analyzed the data. Shaikh and Reddy drafted the manuscript. Elkbuli, Shaikh, McKenney, and Reddy critically revised the manuscript. Shaikh, Elkbuli, Reddy, and McKenney were involved in the approval of the final version.

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Correspondence to Adel Elkbuli.

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Shaikh, S., Reddy, M., McKenney, M. et al. Is Extended-Duration (Post-Hospital Discharge) Venous Thromboembolism Chemoprophylaxis Safe and Efficacious in High-Risk Surgery Patients? A Systematic Review. World J Surg (2020). https://doi.org/10.1007/s00268-020-05638-4

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