Screening rates and geographical disparities shape venous thromboembolism risk after cardiac surgery: a systematic review and meta-analysis

INTRODUCTION: Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious complication following cardiac surgery. Despite existing investigations, the true incidence rates and risk factors remain incompletely defined. METHODS: We systematically searched PubMed, Cochrane, Embase, and Web of Science databases, incorporating 21 eligible studies (n = 794,662). A random-effects model was applied to perform a meta-analysis assessing the incidence of VTE and associated risk factors after cardiac surgery. RESULTS: The pooled incidence of VTE after cardiac surgery was 10.2% (95% CI: 7.6%–13.1%), with incidences of DVT and PE reported at 10.6% (95% CI: 7.6%–14.0%) and 1.6% (95% CI: 0.8%–2.6%), respectively based on random‑effects models. Subgroup analyses revealed lower VTE rates in studies conducted in the Americas than in those from Eurasia (6.5% vs. 19.3%). Studies using antithrombotic prophylaxis, including combined therapy (19.6%) or pharmacological prophylaxis alone (23.2%), also showed lower VTE rates than studies without prophylaxis, although these differences were not statistically significant. Studies employing universal screening (100% screening rate) detected significantly higher VTE rates compared with those without (23.1% vs. 3.9%). CONCLUSIONS: In conclusion, VTE incidence after cardiac surgery remains high, but reported rates are heavily influenced by screening intensity. The clinical significance of screen‑detected events is uncertain. Future research should distinguish asymptomatic from symptomatic VTE and evaluate the cost‑effectiveness of targeted versus universal screening.