Venous Thromboembolism: A Review of Risk and Prevention in Colorectal Surgery Patients |
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Authors: | David Bergqvist MD PhD FRCS |
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Institution: | (1) Department of Surgical Sciences, Section of Surgery, University of Uppsala, 751 85 Uppsala, Sweden |
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Abstract: | Hospitalization for surgery has a high risk of developing venous thromboembolism, a condition that encompasses both deep-vein
thrombosis and its potentially fatal complication, pulmonary embolism. Colorectal surgery implies a specific high risk for
postoperative thromboembolic complications relative to other general surgery. This may be a result of pelvic dissection, the
perioperative positioning of these patients, or the presence of additional risk factors common to this patient group, such
as cancer, advanced age, or inflammatory bowel disease. The potential impact of venous thromboembolism and the need for effective
thromboprophylaxis often are underestimated in these patients. Recommendations for thromboprophylaxis in colorectal surgery
patients are based on the American College of Chest Physicians guidelines for thrombosis prevention in general surgery patients,
with treatment stratified according to the type of surgery and additional venous thromboembolism risk factors present. Prophylaxis
with low-molecular-weight heparin or unfractionated heparin is recommended for colorectal surgery patients classified as moderate
to high risk. The small number of studies focusing specifically on colorectal patients, or on cancer or abdominal surgery
patients with a colorectal subgroup, has shown that both low-molecular-weight heparin and unfractionated heparin can effectively
reduce the incidence of venous thromboembolism. Low-molecular-weight heparin has the practical advantage of once-daily administration
and shows a lower risk of heparin-induced thrombocytopenia. This review will assess the risk of venous thromboembolism in
colorectal surgery patients and discuss current evidence-based guidelines and recommendations for prevention of venous thromboembolism.
Funded by Sanofi-Aventis, NJ.
Reprints are not available. |
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Keywords: | Colorectal surgery Deep-vein thrombosis Low-molecular-weight heparin Prophylaxis Pulmonary embolism Venous thrombosis |
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