J Am Coll Surg. 2021 Aug 23:S1072-7515(21)01927-X. doi: 10.1016/j.jamcollsurg.2021.07.687. Online ahead of print.
ABSTRACT
BACKGROUND: Peri-operative thromboprophylaxis guidelines offer conflicting recommendations on when to start thromboprophylaxis. As a result, there is significant variation in clinical practice which may lead to worse patient outcomes. The objective of this study was to evaluate the association between the start time of peri-operative thromboprophylaxis with venous thromboembolism (VTE) and bleeding outcomes.
STUDY DESIGN: EMBASE, MEDLINE and CENTRAL databases were searched on October 23, 2020. Randomized controlled trials that evaluated VTE and/or bleeding between groups receiving the initial dose of pharmacological thromboprophylaxis at different times pre-operatively, intra-operatively or post-operatively were included. Only trials that randomized patients to the same medication between groups were eligible. Studies on any type of surgery were included. The PRISMA guidelines were followed. The Cochrane Collaboration Risk of Bias tool was used. The review was registered with PROSPERO (CRD42019142079). The outcomes of interest were VTE and bleeding. Pre-specified subgroup analyses of studies including orthopedic and non-orthopedic surgery were performed.
RESULTS: A total of 22 trials (n=17,124 patients) met eligibility criteria. Pooled results showed a non-statistically significant decrease in the rate of VTE with pre-operative initiation of thromboprophylaxis when compared to post-operative initiation (RR 0.77, 95% CI 0.55-1.08, I2=0%, n=1,933). There was also a non-statistically significant increase in the rate of bleeding with pre-operative initiation compared to post-operative (RR 1.17, 95% CI 0.94-1.46, I2=35%, n=2,752). The risk of bias was moderate. Heterogeneity between studies was low (I2 0-35%).
CONCLUSIONS: This meta-analysis found a non-statistically significant decrease in the rate of VTE and increase in the rate of bleeding when thromboprophylaxis was initiated pre-operatively compared to post-operatively.
PMID:34438079 | DOI:10.1016/j.jamcollsurg.2021.07.687
