Timing and characteristics of venous thromboembolism after noncancer surgery

J Vasc Surg Venous Lymphat Disord . 2021 Jul;9(4):859-867.e2. doi: 10.1016/j.jvsv.2020.11.017. Epub 2020 Nov 26.

Fecha de la publicación: 26/11/2020

Autor: Manuela Expósito-Ruiz (1), Juan Ignacio Arcelus (2), Joseph A Caprini (3), Cristina López-Espada (4), Alessandra Bura-Riviere (5), Cristina Amado (6), Mónica Loring (7), Daniela Mastroiacovo (8), Manuel Monreal (9), RIETE Investigators

Palabras clave: Deep vein thrombosis, Duration of risk, Pulmonary embolism, Surgery, Thromboprophylaxis

PMID

PMID: 33248295
DOI: 10.1016/j.jvsv.2020.11.017

Affiliations

¹Unit of Biostatistics, Department of Statistics, School of Medicine, University of Granada, Granada, Spain.

²Department of General Surgery, Hospital Universitario Virgen de las Nieves, University of Granada, Granada, Spain. Electronic address: jarcelus@ugr.es.

³NorthShore University, HealthSystem-Emeritus, Evanston, Ill; Pritzker School of Medicine, University of Chicago, Chicago, Ill.

⁴Department of Angiology and Vascular Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain.

⁵Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France.

⁶Department of Internal Medicine, Hospital Sierrallana, Santander, Spain.

⁷Department of Internal Medicine, Hospital Comarcal de Axarquía, Málaga, Spain.

⁸Department of Angiology, Ospedale SS, Filippo e Nicola, Avezzano, Italy.

⁹Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona; Department of Medicine, Universidad Católica de Murcia, Murcia, Spain.

RIETE Investigators:

Manuel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge-Bancel, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Peter Verhamme, Joseph A Caprini, Hanh My Bui, M D Adarraga, M Agud, J Aibar, M A Aibar, C Amado, J I Arcelus, C Baeza, A Ballaz, R Barba, C Barbagelata, M Barrón, B Barrón-Andrés, A Blanco-Molina, E Botella, A M Camon, S Campos, I Cañas, I Casado, J Castro, J Criado, C de Ancos, J de Miguel, J Del Toro, P Demelo-Rodríguez, C Díaz-Pedroche, J A Díaz-Peromingo, J Díez-Sierra, I M Domínguez, J C Escribano, C Falgá, A I Farfán, K Fernández de Roitegui, C Fernández-Aracil, C Fernández-Capitán, J L Fernández-Reyes, M A Fidalgo, K Flores, C Font, L Font, I Francisco, I Furest, C Gabara, F Galeano-Valle, M A García, F García-Bragado, R García-Hernáez, A García-Raso, O Gavín-Sebastián, A Gil-Díaz, C Gómez-Cuervo, J González-Martínez, E Grau, M Giménez-Suau, L Guirado, J Gutiérrez, L Hernández-Blasco, E Hernando, M Herreros, L Jara-Palomares, M J Jaras, D Jiménez, R Jiménez, M D Joya, I Jou, A Lalueza, R Lecumberri, J Lima, P Llamas, J L Lobo, L López-Jiménez, P López-Miguel, J J López-Núñez, R López-Reyes, J B López-Sáez, A Lorenzo, M Loring, O Madridano, A Maestre, P J Marchena, M Martín Del Pozo, F Martín-Martos, C Mella, M Mellado, M I Mercado, J Moisés, M Monreal, M V Morales, A Muñoz-Blanco, D Muñoz-Guglielmetti, N Muñoz-Rivas, J A Nieto, A Núñez-Ares, M J Núñez-Fernández, B Obispo, M C Olivares, J L Orcastegui, M D Ortega-Recio, J Osorio, S Otalora, R Otero, D Paredes, P Parra, V Parra, J M Pedrajas, G Pellejero, D Pesántez, J A Porras, J Portillo, A Riera-Mestre, A Rivas, F Rivera, A Rodríguez-Cobo, C Rodríguez-Matute, J Rogado, V Rosa, C M Rubio, P Ruiz-Artacho, N Ruiz-Giménez, J Ruiz-Ruiz, P Ruiz-Sada, J C Sahuquillo, G Salgueiro, A Sampériz, J F Sánchez-Muñoz-Torrero, T Sancho, P Sigüenza, S Soler, J M Suriñach, M I Torres, C Tolosa, J Trujillo-Santos, F Uresandi, R Valle, J R Vela, G Vidal, P Villares, C Zamora, P Gutiérrez, F J Vázquez, T Vanassche, C Vandenbriele, P Verhamme, J Hirmerova, R Malý, I Benzidia, L Bertoletti, A Bura-Riviere, B Crichi, P Debourdeau, O Espitia, D Farge-Bancel, H Helfer, I Mahé, F Moustafa, G Poenou, S Schellong, A Braester, B Brenner, I Tzoran, F Bilora, B Brandolin, E Bucherini, M Ciammaichella, D Colaizzo, P Di Micco, E Grandone, D Marchi, D Mastroiacovo, R Maida, F Pace, R Pesavento, P Prandoni, R Quintavalla, N Rinzivillo, A Rocci, C Siniscalchi, A Tufano, A Visonà, B Zalunardo, V Gibietis, D Kigitovica, A Skride, M Ferreira, S Fonseca, F Martins, J Meireles, M Bosevski, G Krstevski, H Bounameaux, L Mazzolai, J A Caprini, A J Tafur, I Weinberg, H Wilkins, H M Bui

Abstract

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperatively. The use of pharmacologic prophylaxis is effective in reducing the incidence of VTE. However, the prophylaxis is often discontinued at hospital discharge, especially for those with benign disease. The implications of this practice are not known. We assessed the data from a large, ongoing registry regarding the time course of VTE and outcomes after noncancer surgery.

Methods: We analyzed the RIETE (Computerized Registry on Venous Thromboembolism) registry, which includes data from consecutive patients with symptomatic confirmed VTE. In the present study, we focused on general surgical patients who had developed symptomatic postoperative VTE in the first 8 weeks after noncancer surgery. The main objective was to assess the interval between surgery and the occurrence of VTE. Additional variables included the clinical presentation associated with the event, the use of thrombosis prophylaxis, and unfavorable outcomes.

Results: The data from 3296 patients were analyzed. The median time from surgery to the detection of VTE was 16 days (interquartile range, 8-30 days). Of the VTE events, 77% were detected after the first postoperative week and 27% after 4 weeks. Overall, 43.9% of the patients with VTE had received pharmacologic prophylaxis after surgery for a median of 8 days (interquartile range, 5-14 days), and three quarters of the VTE events were detected after pharmacologic prophylaxis had been discontinued. Overall, 54% of the patients with VTE had presented with pulmonary embolism. For 15% of the patients, the clinical outcome was unfavorable, including 4% who had died within 90 days.

Conclusions: The risk of VTE after noncancer general surgery remains high for ≤2 months. More than one half of the patients had presented with symptomatic PE as the VTE event, and 15% had had unfavorable outcomes. Only 44% of these patients had received pharmacologic prophylaxis for around 1 week.

Trial registration: ClinicalTrials.gov NCT02832245.