Key result
Extended thromboprophylaxis lacks evidence for preventing postoperative VTE after colorectal surgery in IBD patients.
Why the study?
Patients with inflammatory bowel disease are at increased risk of postoperative venous thromboembolism after colorectal surgery but are not regularly prescribed extended thromboprophylaxis, and evidence-based guidelines are lacking.
Does extended pharmacological thromboprophylaxis prevent postoperative VTE in patients with IBD undergoing colorectal surgery?
Systematic Review
Does extended pharmacological thromboprophylaxis prevent postoperative VTE in patients with IBD undergoing colorectal surgery?
Patients with IBD undergoing colorectal surgery are at heightened risk for postoperative VTE, but there is a lack of evidence regarding extended pharmacological thromboprophylaxis, warranting future studies.
VTE vigilance remains essential in IBD colorectal surgery; leaves open whether extended prophylaxis improves outcomes.
AIM: Patients with inflammatory bowel disease (IBD) are at increased risk of postoperative venous thromboembolism (VTE) following major abdominal surgery. The pathogenesis is multifactorial and not fully understood. A combination of pathophysiology, patient and surgical risk factors increase the risk of postoperative VTE in these patients. Despite being at increased risk, IBD patients are not regularly prescribed extended pharmacological thromboprophylaxis following colorectal surgery. Currently, there is a paucity of evidence-based guidelines. Thus, the aim of this review is to evaluate the role of extended pharmacological thromboprophylaxis in IBD patients undergoing colorectal surgery. METHOD: A search of Ovid Medline, EMBASE and PubMed databases was performed. A qualitative analysis was performed using 10 clinical questions developed by colorectal surgeons and a thrombosis haematologist. The Newcastle-Ottawa Scale was utilized to assess the quality of evidence. RESULTS: A total of 1229 studies were identified, 38 of which met the final inclusion criteria (37 retrospective, one case-control). Rates of postoperative VTE ranged between 0.6% and 8.9%. Patient-specific risk factors for postoperative VTE included ulcerative colitis, increased age and obesity. Surgery-specific risk factors for postoperative VTE included open surgery, emergent surgery and ileostomy creation. Patients with IBD were more frequently at increased risk in the included studies for postoperative VTE than patients with colorectal cancer. The risk of bias assessment demonstrated low risk of bias in patient selection and comparability, with variable risk of bias in reported outcomes. CONCLUSION: There is a lack of evidence regarding the use of extended pharmacological thromboprophylaxis in patients with IBD following colorectal surgery. As these patients are at heightened risk of postoperative VTE, future study and consideration of the use of extended pharmacological thromboprophylaxis is warranted.
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McKechnie et al. (2019) conducted a systematic review in Inflammatory bowel disease. Extended pharmacological thromboprophylaxis was evaluated on Postoperative venous thromboembolism (VTE). In a systematic review of 38 studies, postoperative VTE rates in IBD patients undergoing colorectal surgery ranged from 0.6% to 8.9%, with a lack of evidence for extended thromboprophylaxis.
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