Impact of drugs on venous thromboembolism risk in surgical patients

Abstract

Purpose

This review focuses on the most common drugs administered to surgical patients during the perioperative period that affect the risk of venous thromboembolism (VTE).

Results

Among analgesics, the risk of VTE is increased in patients treated with diclofenac, ibuprofen, and rofecoxib, but not naproxen, while metamizole can confer a protective effect. The relationship between sedatives and VTE has not been sufficiently studied. Tricyclic antidepressants, low-potency serotonin reuptake inhibitors, and antipsychotics have been associated with increased risk of VTE. The use of diuretics in the perioperative period is poorly researched; however, hyponatremia is considered a risk factor. Other factors that may influence the risk of VTE include bridging anticoagulation, allogeneic transfusion, and hemostatic management before surgery. Pharmacotherapy for HIV or cancer may also increase VTE risk.

Conclusion

Increased monitoring for VTE is therefore advisable in surgical patients and those receiving antipsychotics, antidepressants, diuretics, or analgesics.

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Acknowledgements

This work is supported by the Ministry of Health of the Czech Republic, grant nr. 15-33437A (R. Staffa). This publication is the result of the project implementation: "CENTER OF EXCELLENCE FOR RESEARCH IN PERSONALIZED THERAPY (CEVYPET)", ITMS: 26220120053 supported by the Operational Programme Research and Innovation funded by the ERDF.

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Kovačič, A.P.M., Caprnda, M., Mrhar, A. et al. Impact of drugs on venous thromboembolism risk in surgical patients. Eur J Clin Pharmacol 75, 751–767 (2019). https://doi.org/10.1007/s00228-019-02636-x

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Keywords

  • Venous thromboembolism
  • Analgesics
  • Diuretics
  • Antidepressants
  • Antipsychotics
  • Oral contraceptives
  • Surgery
  • Bridging anticoagulation
  • Transfusion
  • Thromboprophylaxis