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European guidelines on perioperative venous thromboembolism prophylaxis: Cardiovascular and thoracic surgery

Ahmed, Aamer B.; Koster, Andreas; Lance, Marcus; Faraoni, Davidfor the ESA VTE Guidelines Task Force

European Journal of Anaesthesiology (EJA): February 2018 - Volume 35 - Issue 2 - p 84–89
doi: 10.1097/EJA.0000000000000708
Guidelines

None of the predictive models for venous thromboembolism (VTE) prophylaxis have been designed for and validated in patients undergoing cardiothoracic and vascular surgery. The presence of one or more risk factors [age over 70 years old, transfusion of more than 4 U of red blood cells/fresh frozen plasma/cryoprecipitate, mechanical ventilation lasting more than 24 h, postoperative complication (e.g. acute kidney injury, infection/sepsis, neurological complication)] should place the cardiac population at high risk for VTE. In this context, we suggest the use of pharmacological prophylaxis as soon as satisfactory haemostasis has been achieved, in addition to intermittent pneumatic compression (IPC) (Grade 2C). In patients undergoing abdominal aortic aneurysm repair, particularly when an open surgical approach is used, the risk for VTE is high and the bleeding risk is high. In this context, we suggest the use of pharmacological prophylaxis as soon as satisfactory haemostasis is achieved (Grade 2C). Patients undergoing thoracic surgery in the absence of cancer could be considered at low risk for VTE. Patients undergoing thoracic surgery with a diagnosis of primary or metastatic cancer should be considered at high risk for VTE. In low-risk patients, we suggest the use of mechanical prophylaxis using IPC (Grade 2C). In high-risk patients, we suggest the use of pharmacological prophylaxis in addition to IPC (Grade 2B).

From the Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK (ABA), Institute for Anaesthesiology, Heart and Diabetes Centre, NRW, Bad Oeynhausen, Ruhr-University Bochum, Bochum, Germany (AK), Department of Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Quatar (ML), and Department of Anaesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (DF)

Correspondence to David Faraoni, Department of Anaesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada E-mail: david.faraoni@mail.utoronto.ca

Published online 6 November 2017

© 2018 European Society of Anaesthesiology