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:
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.
Evidence-based recipes for venous thromboembolism prophylaxis: a practical safety guide. Pannucci CJ. Plast Reconstr Surg. 2017 Feb;139(2):520e.
Individualized venous thromboembolism risk stratification using the 2005 Caprini score to identify the benefits and harms of chemoprophylaxis in surgical patients: a meta-analysis. Pannucci CJ, Swistun L, MacDonald JK, Henke PK, Brooke BS. Ann Surg. 2017 Jun;265(6):1094.
Press Releases and Media:
University of Utah Health: “Standard of Care Anti-Clotting Drugs May Be Unnecessary for Most Surgery Patients”
