Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/29613
Title: Early Versus Postoperative Chemical Thromboprophylaxis Is Associated with Increased Bleeding Risk Following Abdominal Visceral Resections: a Multicenter Cohort Study.
Austin Authors: Liu, David Shi Hao ;Newbold, Ryan;Stevens, Sean ;Wong, Enoch;Fong, Jonathan;Mori, Krinal ;Wong, Darren J;Gill, Anna Sonia;Lee, Sharon;Jamel, Wael;Crowe, Amy;Howard, Tess;Jain, Anshini;Beh, Pith Soh ;Slevin, Maeve;Fleming, Nicola ;Bennet, Simon;Chung, Chi
Affiliation: Department of Surgery, The University of Melbourne, Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia..
Gastroenterology and Hepatology
Surgery (University of Melbourne)
Department of Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Victoria, 3128, Australia..
Division of Surgery, Anaesthesia and Procedural Medicine
Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia..
Issue Date: 22-Mar-2022
Date: 2022
Publication information: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract 2022; 26(7): 1495-1502
Abstract: Abdominal visceral resections incur relatively higher rates of postoperative bleeding and venous thromboembolism (VTE). While guidelines recommend the use of perioperative chemical thromboprophylaxis, the most appropriate time for its initiation is unknown. Here, we investigated whether early (before skin closure) versus postoperative commencement of chemoprophylaxis affected VTE and bleeding rates following abdominal visceral resection. Retrospective review of all elective abdominal visceral resections undertaken between January 1, 2018, and June 30, 2019, across four tertiary-referral hospitals. Major bleeding was defined as the need for blood transfusion, reintervention, or > 20 g/L fall in hemoglobin from baseline. Clinical VTE was defined as imaging-proven symptomatic disease < 30 days post-surgery. A total of 945 cases were analyzed. Chemoprophylaxis was given early in 265 (28.0%) patients and postoperatively in 680 (72.0%) patients. Mean chemoprophylaxis exposure doses were similar between the two groups. Clinical VTE developed in 14 (1.5%) patients and was unrelated to chemoprophylaxis timing. Postoperative bleeding occurred in 71 (7.5%) patients, with 57 (80.3%) major bleeds, requiring blood transfusion in 48 (67.6%) cases and reintervention in 31 (43.7%) cases. Bleeding extended length-of-stay (median (IQR), 12 (7-27) versus 7 (5-11) days, p < 0.001). Importantly, compared to postoperative chemoprophylaxis, early administration significantly increased the risk of bleeding (10.6% versus 6.3%, RR 1.45, 95% CI 1.05-1.93, p = 0.038) and independently predicted its occurrence. The risk of bleeding following elective abdominal visceral resections is substantial and is higher than the risk of clinical VTE. Compared with early chemoprophylaxis, postoperative initiation reduces bleeding risk without an increased risk of clinical VTE.
URI: https://ahro.austin.org.au/austinjspui/handle/1/29613
DOI: 10.1007/s11605-022-05301-4
ORCID: 0000-0001-8936-4123
0000-0003-3522-1412
0000-0001-8513-2130
0000-0003-0117-0071
0000-0002-5366-3049
0000-0002-0037-5238
Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
PubMed URL: 35318594
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/35318594/
Type: Journal Article
Subjects: Chemoprophylaxis
Laparotomy
Thromboembolism
Timing
Appears in Collections:Journal articles

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