Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND:

Optimal thromboprophylaxis after cardiac surgery is uncertain. This systematic review aimed to define the incidence and risk factors for deep vein thrombosis (DVT), fatal and nonfatal pulmonary embolism (PE), and assess whether venous thromboembolism (VTE) prophylaxis was effective in reducing VTE without complications after cardiac surgery.

METHODS AND RESULTS:

Two reviewers independently searched and assessed the quality and outcomes of randomized, controlled trials (RCTs) and observational studies on VTE after cardiac surgery in the MEDLINE, EMBASE, and Cochrane controlled trial register (1966 to December 2014). Sixty-eight studies provided data on VTE outcomes or complications related to thromboprophylaxis after cardiac surgery. The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta-analyses. VTE prophylaxis was associated with a reduced risk of PE (relative risk [RR], 0.45; 95% confidence interval [CI], 0.28-0.72; P=0.0008) or symptomatic VTE (RR, 0.44; 95% CI, 0.28-0.71; P=0.0006) compared to the control without significant heterogeneity. Median incidence (interquartile range) of symptomatic DVT, PE, and fatal PE were 3.2% (0.6-8.1), 0.6% (0.3-2.9), and 0.3% (0.08-1.7), respectively. Previous history of VTE, obesity, left or right ventricular failure, and prolonged bed rest, mechanical ventilation, or use of a central venous catheter were common risk factors for VTE. Bleeding or cardiac tamponade requiring reoperation owing to pharmacological VTE prophylaxis alone, without systemic anticoagulation, was not observed.

CONCLUSIONS:

Unless proven otherwise by adequately powered RCTs, initiating pharmacological VTE prophylaxis as soon as possible after cardiac surgery for patients who have no active bleeding is highly recommended.

• Authors: Kwok M Ho, Ebrahim Bham, Warren Pavey
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 4 Issue 10 Pg. e002652 (Oct 26 2015) ISSN: 2047-9980 [Electronic] England
• PMID: 26504150 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Chemical References

• Anticoagulants
• Fibrinolytic Agents

Topics

• Anticoagulants (administration & dosage, adverse effects)
• Cardiac Surgical Procedures (adverse effects)
• Chi-Square Distribution
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Hemorrhage (chemically induced)
• Humans
• Incidence
• Odds Ratio
• Pulmonary Embolism (diagnosis, epidemiology, prevention & control)
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Venous Thromboembolism (diagnosis, epidemiology, prevention & control)
• Venous Thrombosis (diagnosis, epidemiology, prevention & control)