Faculty of Medicine University of Ottawa, Ottawa, Ontario, Canada.
Department of Surgery, University of Ottawa The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Thromb Res. 2024 Mar;235:175-180. doi: 10.1016/j.thromres.2024.01.026. Epub 2024 Feb 4.
Major abdominopelvic surgery is an important risk factor for postoperative venous thromboembolism (VTE). VTE is the leading cause of 30-day postoperative mortality in patients with cancer undergoing major abdominopelvic surgery. Randomized controlled trials have shown that extended duration thromboprophylaxis using a low molecular weight heparin or a direct oral anticoagulant significantly decreases the risk of overall VTE (symptomatic events and asymptomatic deep vein thrombosis). Hence, several clinical practice guidelines suggest the use of extended duration thromboprophylaxis for all high-risk patients undergoing major abdominopelvic surgery. Despite these recommendations by clinical practice guidelines, adoption of extended duration thromboprophylaxis in clinical practice remains low and clinical equipoise seems to persist. In this narrative review, we aim is to highlight and summarize the reasons that may explain discrepancy between clinical guideline recommendations and current practice regarding extended duration thromboprophylaxis in this patient population. We also aim to review different personalized approaches based on patients' individualized risk of VTE that may foster shared decision making and improve patient outcomes by reducing decisional conflict, increasing patient knowledge, and increasing risk perception accuracy.
主要的腹盆腔手术是术后静脉血栓栓塞症（VTE）的一个重要危险因素。VTE 是接受主要腹盆腔手术的癌症患者术后 30 天内死亡的主要原因。随机对照试验表明，使用低分子量肝素或直接口服抗凝剂延长血栓预防时间可显著降低总体 VTE（有症状事件和无症状深静脉血栓形成）的风险。因此，一些临床实践指南建议对所有接受主要腹盆腔手术的高危患者使用延长时间的血栓预防。尽管临床实践指南有这些建议，但在临床实践中，延长时间的血栓预防的采用仍然很低，似乎仍然存在临床平衡。在这篇叙述性综述中，我们的目的是强调并总结可能解释临床指南建议与当前这一患者群体中延长时间的血栓预防实践之间差异的原因。我们还旨在回顾基于患者 VTE 个体化风险的不同个性化方法，这些方法可能通过减少决策冲突、增加患者知识和提高风险感知准确性来促进共同决策并改善患者结局。
