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


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.
Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia (K.M.H.) School of Population Health, University of Western Australia, Perth, WA, Australia (K.M.H.) School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia (K.M.H., W.P.).
Kwok M
KM
Ho
Department of Anesthesia, Fiona Stanley Hospital, Perth, WA, Australia (E.B., W.P.).
Ebrahim
E
Bham
School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia (K.M.H., W.P.) Department of Anesthesia, Fiona Stanley Hospital, Perth, WA, Australia (E.B., W.P.).
Warren
W
Pavey
D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*
D000925:Anticoagulants; D005343:Fibrinolytic Agents
deep vein thrombosis; heart surgery; prevention; pulmonary embolism