Perioperative medicine & outcomes
Optimal Timing of Perioperative Chemical Thromboprophylaxis in Elective Major Abdominal Surgery: A Systematic Review and Meta-analysis
Authors' conclusion
Our findings advocate for initiating chemoprophylaxis postoperatively in elective abdominal surgery to minimize bleeding risk without compromising VTE protection.
Study context
- Population
- Patients undergoing elective major abdominal surgery (bariatric, antireflux, hepato-pancreatic-biliary, colorectal, ventral hernia, major intra-abdominal)
- Participants
- 24,922 patients · 14 studies
- Comparison
- Chemoprophylaxis initiated before skin closure vs postoperatively
- Earlyn = 10,403
- Postoperativen = 14,519reference
- Outcome
- VTE and bleeding rates
Methodological detailsPRISMA guidelines
- PRISMA guidelines
Pooled result
As reported in the abstract
Symptomatic VTE
Symptomatic VTE rates comparable between study groups
RR, 0.81; 95% CI, 0.45-1.43
P =0.460
Further pooled results
- Overall VTE rates comparable between study groups
- RR, 0.74; 95% CI, 0.45-1.24; P =0.250
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| All bleeding | 1.56 (1.13–2.15) | P = 0.007 | |
| Major bleeding | 1.63 (1.16–2.28) | P = 0.005 | |
| Blood transfusion | 1.48 (1.24–1.76) | P < 0.001 | |
| Reintervention | 1.94 (1.19–3.18) | P = 0.008 | |
| 0.20.5125Relative risk (log scale) |
Original publication
Optimal Timing of Perioperative Chemical Thromboprophylaxis in Elective Major Abdominal Surgery: A Systematic Review and Meta-analysis. Ann Surg. Published 24 November 2022. doi:10.
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