Anti-Clotting Drugs May Be Unnecessary in Many Surgery Patients
According to a recent study, 75% of patients might not benefit from anti-clotting drugs after surgery.
The study was conducted to determine if individual risk assessment would reduce overtreatment and assist in identifying high risk patients in need of chemoprophylaxis post-surgery.
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The meta-analysis included 14,776 cases from 11 studies with data on postoperative venous thromboembolism (VTE) events, and 8 with data on clinically relevant bleeding with or without chemoprophylaxis use. Most patients in the studies received mechanical prophylaxis.
Researchers stratified the primary outcomes of VTE and clinically relevant bleeding after surgical procedures using the Caprini score, and a random-effects model was used to perform a meta-analysis.
“A 14-fold variation in VTE risk (from 0.7% to 10.7%) was identified among surgical patients who did not receive chemoprophylaxis, and patients at increased levels of Caprini risk were significantly more likely to have VTE,” the researchers stated.
Chemoprophylaxis in patients who had Caprini scores of 7 to 8 or more significantly reduced the risk for VTE after surgery. Conversely, anti-clotting drugs did not reduce the risk of VTE in patients with a Caprini score less than or equal to 6. Patients with middle to low Caprini risk scores comprised 75% of cases in the meta-analysis.
In addition, researchers did not identify associations between postoperative bleeding risk and Caprini scores.
“The benefit of peri-operative VTE chemoprophylaxis was only found among surgical patients with Caprini scores >=7. Precision medicine using individualized VTE risk stratification helps ensure that chemoprophylaxis is used only in appropriate surgical patients and may minimize bleeding complications,” the researchers concluded.
—Melissa Weiss
Reference:
Pannucci CJ. Swistun L, MacDonald JK, Henke PK, and Brooke BS. Individualized venous thromboembolism risk stratification using the 2005 Caprini score to identify the benefits and harms of chemoprophylaxis in surgical patients: a meta-analysis [published online January 19, 2017]. Annals of Surgery. doi:10.1097/SLA.0000000000002126.