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What is the value of preoperative prophylactic heparin in reducing venous thromboembolism in major non-cardiac thoracic surgery?

      Highlights

      • VTE is not associated with preoperative heparin administration.
      • VTE is not associated with functional status, procedure category, or primary operation.
      • VTE has associations with operation approach (i.e., open vs minimally Invasive).

      Abstract

      Background

      Studies have investigated the utility of preoperative heparin to mitigate venous thromboembolism risk after surgery. However, whether heparin reduces the risk of VTE following major thoracic surgery is undetermined. A national heparin shortage beginning in September 2019 provided the opportunity for a natural experiment to explore this question.

      Methods

      A retrospective analysis was conducted including all major thoracic surgery cases at a single center from March 2019 to April 2020. The primary outcome was VTE. Two sample t-tests, Chi-Square analyses, and multivariable regressions were performed.

      Results

      The study consisted of 890 patients, 391 before the heparin shortage and 499 afterwards. 398 total patients received heparin, 340 before the heparin shortage and 58 afterwards. On univariate analyses, there was no association between VTE and preoperative heparin (p > 0.90). This remained consistent on multivariable analyses (p > 0.1).

      Conclusion

      In this single center analysis, there was no association between preoperative heparin and the occurrence of postoperative VTE. Analyses in larger cohorts will provide additional evidence to guide policies on the use of preoperative prophylactic heparin.

      Keywords

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      References

        • Vaqar Sarosh
        • Graber Matthew
        Thromboembolic Event.” StatPearls.
        StatPearls Publishing, 27 July 2021
      1. Data and Statistics on HA-VTE. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 Feb. 2020
        • Beckman Michele G.
        • et al.
        Venous thromboembolism.
        Am J Prev Med. 1 Apr. 2010; 38: S495-S501https://doi.org/10.1016/j.amepre.2009.12.017
      2. Data and Statistics on Venous Thromboembolism. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 Feb. 2020
        • Champagne Bradley
        • Laryea Jonathan
        Venous thromboembolism prophylaxis.
        Clin Colon Rectal Surg. 2013; 26 (03): 153-159https://doi.org/10.1055/s-0033-1351130
        • Fong Zhi V.
        • et al.
        Does preoperative pharmacologic prophylaxis reduce the rate of venous thromboembolism in pancreatectomy patients?.
        HPB. 12 Nov 2019; 22: 1020-1024https://doi.org/10.1016/j.hpb.2019.10.2437
        • Ross Samuel W.
        • et al.
        Association of the risk of a venous thromboembolic event in emergency vs elective general surgery.
        JAMA Surgery. 1 June 2020; 155: 503-511https://doi.org/10.1001/jamasurg.2020.0433
        • Qadan Motaz
        • et al.
        Venous thromboembolism in elective operations: balancing the choices.
        Surgery. 19 Jun. 2008; 144: 654-661https://doi.org/10.1016/j.surg.2008.06.019
        • Strebel Niklaus
        • et al.
        Preoperative or postoperative start of prophylaxis for venous thromboembolism with low-molecular-weight heparin in elective hip surgery?.
        Arch Intern Med. 8 July 2002; 162: 1451-1456https://doi.org/10.1001/archinte.162.13.1451
        • Abdelsalam Ahmed Mohammed
        • et al.
        Adding a preoperative dose of LMWH may decrease VTE following bariatric surgery.
        World J Surg. 28 Sept. 2020; 45: 126-131https://doi.org/10.1007/s00268-020-05782-x
        • McCarthy Cian P.
        • et al.
        Running thin: implications of a heparin shortage.
        Lancet. 2020; 395: 534-536https://doi.org/10.1016/s0140-6736(19)33135-6
        • Anderson David R.
        • et al.
        American society of hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients.
        Blood Advances. 2019; 3: 3898-3944https://doi.org/10.1182/bloodadvances.2019000975
        • Hirsh Jack
        • et al.
        Guide to anticoagulant therapy: heparin.
        Circulation. 2001; 103: 2994-3018https://doi.org/10.1161/01.cir.103.24.2994
      3. VTE prophylaxis Algorithm for ... - hopkins medicine.
        • Farge D.
        • et al.
        International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer.
        J Thromb Haemostasis. 2013; 11: 56-70https://doi.org/10.1111/jth.12070
        • Abdelsalam Ahmed Mohammed
        • et al.
        Adding a preoperative dose of LMWH may decrease VTE following bariatric surgery.
        World J Surg. 28 Sept. 2020; 45: 126-131https://doi.org/10.1007/s00268-020-05782-x
        • Xu Yaping
        • et al.
        Prevention of venous thromboembolism in patients undergoing major orthopedic surgery in China: a qualitative study of patients' perceptions.
        J Orthop Surg Res. 24 Apr. 2018; 13https://doi.org/10.1186/s13018-018-0813-2
        • Ross Samuel W.
        • et al.
        Association of the risk of a venous thromboembolic event in emergency vs elective general surgery.
        JAMA Surgery. 2020; 155: 503https://doi.org/10.1001/jamasurg.2020.0433
        • Keenan Craig R.
        • White Richard H.
        The effects of race/ethnicity and sex on the risk of venous thromboembolism.
        Curr Opin Pulm Med. 2007; 13: 377-383https://doi.org/10.1097/mcp.0b013e3281eb8ef0
        • White Richard H.
        The epidemiology of venous thromboembolism.
        Circulation. 17 June 2003; 107 (23_suppl_1)https://doi.org/10.1161/01.cir.0000078468.11849.66
        • Amaral Cristina
        • et al.
        The postoperative venous thromboembolism (TREVO) study – risk and case mortality by surgical specialty.
        Revista Portuguesa De Cardiologia (English Edition. Sept. 2017; 36: 609-616https://doi.org/10.1016/j.repce.2016.11.016
        • Heit John A.
        Epidemiology of venous thromboembolism.
        Nat Rev Cardiol. 16 June 2015; 12: 464-474https://doi.org/10.1038/nrcardio.2015.83
        • Thomas D.C.
        • Arnold B.N.
        • Hoag J.R.
        • et al.
        Timing and risk factors associated with venous thromboembolism after lung cancer resection.
        Ann Thorac Surg. 2018; 105: 1469-1475https://doi.org/10.1016/j.athoracsur.2018.01.072