Efficacy and Safety of Pharmacological Thromboprophylactic Agents for the Prevention of Venous Thromboembolism after Major Abdominal Surgery

Abstract

Statement of the problem: The type and duration of pharmacological thromboprophylaxis post major abdominal surgery remains controversial. Methods of investigation: A systematic review and pooled analysis of literature was performed to assess the risk benefit ratio of the different pharmacological thromboprophylaxis agents compared to placebo or no thromboprophylaxis post major abdominal surgery. A survey of the clinical practice among both general surgeons and thrombosis expert was conducted. Results: The systematic review demonstrated that all five pharmacological thromboprophylaxis regimens were associated with similar rates of overall VTE. The 95% CI of the different estimates overlapped indicating no statistically significant difference between any of the pharmacological interventions and placebo. While all the surgeons and thrombosis experts recommended thromboprophylaxis post major abdominal surgery, over 70% of them recommended it during hospitalization only. Conclusion: Pharmacological thromboprophylaxis was not associated with a significant benefit in reducing the rate of overall VTE events post major abdominal surgery. There is an agreement between general surgeons and thrombosis experts in using LMWH for thromboprophylaxis post major abdominal surgery. However, there is still equipoise around the use of pharmacological thromboprophylaxis post discharge.