Extended Pharmacological Thromboprophylaxis After Abdominal Surgery

Abdominal surgery is a well-recognized risk factor for venous thromboembolism (VTE). The aim of the study was to determine the e–cacy and safety of extended pharmacological prophylaxis (EPP) after abdominal surgery to prevent clinically signi†cant VTE after hospital discharge. Material and methods. The obtained materials were studied as part of the pan-European prospective CASCADE study. The analysis was performed in accordance with the STROBE recommendations. Data collection was carried out from January 23 to May 1, 2022. The primary e–cacy outcome was the incidence of VTE after discharge. Visualization (ultrasound Doppler phleboscanning) was performed only in cases of clinical symptoms. The secondary outcome was the incidence of clinically relevant bleeding after discharge. Results. A total of 234 patients were included in the study, including 125 women (53.4%). The median age of patients was 61.0 years. The postoperative incidence of clinically relevant VTE was 1.3% (2 in-hospital patients, and 1 person after discharge). After adjusting for variables using mixed-e—ects logistic regression, the median postoperative VTE incidence was 0.2%. Both in-hospital VTE and bleeding were identi†ed after right hemicolectomy. Clinically signi†cant bleeding after discharge was noted in 2 patients (0.9%) (1 clinically insigni†cant bleeding and 1 clinically signi†cant bleeding). After risk adjustment and accounting for treatment selection bias using propensity score weighting, there was no signi†cant association between EPP and the incidence of post-discharge bleeding. Conclusions. Current clinical guidelines have doubtful validity because they do not re˜ect modern trends in surgery. In modern surgical practice, the incidence of postoperative VTE is low. EPP is safe, but its clinical e–cacy remains questionable. Careful selection of patients for EPP is required.