The National Practice Patterns of Venous Thromboembolism Prophylaxis Post-Cardiothoracic Surgery.
BACKGROUND
The rates of venous thromboembolism (VTE) post-cardiothoracic surgery are not well understood. The american college of chest physicians (CHEST) guidelines report weak recommendations for starting VTE prophylaxis post-cardiothoracic surgery. It is suspected that due to the increase in bleed risk, postsurgery initiation of pharmacologic VTE prophylaxis is limited.


OBJECTIVE
The study sought to investigate the use of VTE prevention in US hospitals performing cardiac surgery and the use of mechanical/chemical prophylaxis postoperatively.


METHODS
This is a multicenter survey distributed to cardiac hospitals in the United States. The survey was distributed through 3 separate listservs. Data were analyzed utilizing descriptive statistics.


RESULTS
The majority of the hospitals were academic and/or community and completed coronary artery bypass graft (CABG), valve replacement (mitral/aortic/tricuspid), and aortic repair. It was common for hospitals to start mechanical and pharmacologic prophylaxis post-cardiothoracic surgery on postoperative day (POD) 1 to 2. The anticoagulation most commonly used consisted of unfractionated heparin.


CONCLUSIONS
The majority of the institutions are initiating therapy POD 1 to 2 with both mechanical and chemical prophylaxis. The full impact of early initiation of VTE prophylaxis is unknown, and more studies are needed to assess the true risks/benefits of these practices.
1 Pharmacy Department, Tulane Medical Center, New Orleans, LA, USA.
Sheena E
SE
Mathew
2 Pharmacy Department, UK Healthcare, Lexington, KY, USA.
Craig J
CJ
Beavers
3 Clinical Services Group, Hospital Corporation of America, Nashville, TN, USA.
Elizabeth
E
McNeely
D000925:Anticoagulants / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D006801:Humans; D056990:Post-Exposure Prophylaxis / Q000379:methods* / Q000639:trends; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control*
D000925:Anticoagulants
chemical prophylaxis; mechanical prophylaxis; post-cardiac surgery; survey; venous thromboembolism prophylaxis