[Postoperative pulmonary thromboembolism and its prevention from the perspective of the establishment of Japanese guidelines].
The incidence of venous thromboembolism (VTE) is rapidly increasing in Japan. Ideally, the guidelines for its prevention should be based on solid evidence, but there are few clinical data on the prevalence and prophylaxis of VTE in Japan. Comprehensive, standard guidelines for the prevention of VTE were recently established by applying the risk-prophylaxis relationship of the sixth American College of Chest Physicians (ACCP) consensus recommendations. Since patients undergoing cancer surgery make up a relatively homogenous, "highest-risk" group, we could precisely evaluate the difference in VTE risk between Japan and the West. The risk of clinical PE in Japanese cancer surgery was found to be one or two risk levels lower than that in the West. Therefore the Japanese risk stratification was set to be one level lower than that in the sixth ACCP guidelines. For prophylaxis, the recommendations of the Japanese guidelines are basically identical to those of the sixth ACCP guidelines. Since the present guidelines are not sufficiently based on Japanese evidence, they should be reviewed in a prospective, nationwide epidemiologic study. In this review article, the theoretical background of and future perspectives on the Japanese guidelines are discussed.
Sakon
Masato
M
Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan.
D006801:Humans; D007564:Japan; D009369:Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000517:prevention & control*