Abstract
Purpose
To describe risk assessment models that have been developed to stratify patients into different risk levels of postoperative venous thromboembolism (VTE) and then to review the different methods of prophylaxis and to outline the evidence supporting their effectiveness and safety.
Source
Our review of the literature is focused on consensus documents, recent large randomized trials and meta-analyses.
Principal findings
The risk of VTE is determined by the type of surgery and underlying patient factors. Risk assessment models are useful in stratifying patients into different VTE risk levels. However, multiple risk factors are often present in the same patient and in practice the evaluation of their relative contribution to the overall risk remains difficult. A variety of prophylactic strategies including physical and pharmacological methods have been shown to be effective in different patient groups. Patients with a moderate or high risk of VTE should receive prophylaxis consisting of an antithrombotic agent, unless contraindicated, used alone or in combination with a mechanical method. Recommendations concerning which prophylaxis to use and how intensive it should be are based mainly on data from trials using surrogate endpoints, and do not translate easily into practical decisions aiming to reduce the incidence of symptomatic events.
Conclusion
Although risk assessment models and recommendations provided by consensus documents are of practical assistance, a decision concerning any patient is best made by combining recommendations of the literature with clinical judgment, including individual patient risk factors for thrombosis and bleeding.
Objectif
Dêcrire les modèles ďêvaluation du risque dêveloppês pour classer les patients selon diffêrents niveaux de risque de thromboembolie veineuse postopêratoire (TEV) et ensuite, revoir les mêthodes de prophylaxie et êbaucher la preuve de leur efficacitê et de leur sêcuritê.
Source
Notre revue de la littêrature est centrêe sur des documents de consensus, de rêcentes grandes êtudes randomisêes et mêta-analyses.
Constatations principales
Le risque de TEV dêpend du type de chirurgie et de facteurs sous-jacents reliês au patient. Les modèles ďêvaluation du risque sont utiles pour classer les patients selon diffêrents niveaux de risque de TEV. Cependant, de multiples facteurs de risque sont souvent prêsents chez le même patient et, en pratique, ľêvaluation de leur contribution relative au risque global demeure difficile. Diverses stratêgies prophylactiques, dont des mêthodes physiques et pharmacologiques, se sont rêvêlêes efficaces auprès de diffêrents groupes de patients. Les patients à risque modêrê ou êlevê de TEV devraient recevoir une thêrapie prêventive avec des antithrombotiques, à moins de contre-indication, utilisês seuls ou en combinaison avec une mêthode mêcanique. Les recommandations sur le choix de la prophylaxie à utiliser et sur son importance sont fondêes principalement sur les donnêes ďessais qui utilisent des paramètres indirects et ne se traduisent pas facilement en dêcisions pratiques visant à rêduire ľincidence ďêvênements symptomatiques.
Conclusion
Même si les modèles ďêvaluation du risque et les recommandations fournies par les documents de consensus sont pratiques, toute dêcision concernant un patient est plus juste si on combine recommandations de la littêrature et jugement clinique, comprenant les facteurs de risque individuels de thrombose et ďhêmorragie.
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Motte, S., Samama, C.M., Guay, J. et al. Prevention of postoperative venous thromboembolism. Risk assessment and methods of prophylaxis. Can J Anesth 53 (Suppl 2), S68–S79 (2006). https://doi.org/10.1007/BF03022254
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DOI: https://doi.org/10.1007/BF03022254