Individualized Venous Thromboembolism Risk Stratification and Chemoprophylaxis in Surgical Patients

Graphic- Individualized Venous Thromboembolism Risk Stratification and Chemoprophylaxis in Surgical Patients
Rates of venous thromboembolism in surgical patients who received no chemoprophylaxis, stratified by Caprini score.


Venous thromboembolism (VTE) can occur following a surgical procedure, and is usually prevented using anticoagulant chemoprophylaxis. The risk/benefit ratio of chemoprophylaxis, however, varies among individual patients; surgical patients at low risk for VTE may not benefit from chemoprophylaxis, but still be subjected to the bleeding risk. The research team of Christopher Pannucci, MD, and Benjamin Brooke, MD, set out to determine whether chemoprophylaxis for VTE among surgical patients could be better achieved through individualized risk stratification using established Caprini scores. They performed a meta-analysis of nearly 15,000 surgery patients, stratified by Caprini scores for VTE risk levels. When chemoprophylaxis was provided peri-operatively, high-risk patients (Caprini scores >7) exhibited significant VTE risk-reduction without significant increase in bleeding. In comparison, 75% of low-risk patients (Caprini scores <6) had an unfavorable risk/benefit ratio and, therefore, chemoprophylaxis was unwarranted. This study highlights the benefits of a precision-medicine (i.e., risk-stratification) approach to VTE prevention and has important practice implications.

References:

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Inadequate venous thromboembolism risk stratification predicts venous thromboembolic events in surgical intensive care unit patients. Pannucci CJ, Obi A, Alvarez R, Abdullah N, Nackashi A, Hu HM, Bahl V, Henke PK. J Am Coll Surg. 2014 May;218(5):898.

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Christopher J. Pannucci, MD