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Published (Version of Record)CC BY-NC V4.0, Open Access
Journal article
Incidence of venous thromboembolism and benefits and risks of thromboprophylaxis after cardiac surgery: A systematic review and meta‐analysis
Journal of the American Heart Association, Vol.4(10), Article e002652
2015
Abstract
Background-Optimal thromboprophylaxis after cardiac surgery is uncertain. This systematic review aimed to define the incidence and risk factors for deep vein thrombosis (DVT), fatal and nonfatal pulmonary embolism (PE), and assess whether venous thromboembolism (VTE) prophylaxis was effective in reducing VTE without complications after cardiac surgery.
Methods and Results-Two reviewers independently searched and assessed the quality and outcomes of randomized, controlled trials (RCTs) and observational studies on VTE after cardiac surgery in the MEDLINE, EMBASE, and Cochrane controlled trial register (1966 to December 2014). Sixty-eight studies provided data on VTE outcomes or complications related to thromboprophylaxis after cardiac surgery. The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta-analyses. VTE prophylaxis was associated with a reduced risk of PE (relative risk [RR], 0.45; 95% confidence interval [CI], 0.28-0.72; P=0.0008) or symptomatic VTE (RR, 0.44; 95% CI, 0.28-0.71; P=0.0006) compared to the control without significant heterogeneity. Median incidence (interquartile range) of symptomatic DVT, PE, and fatal PE were 3.2% (0.6-8.1), 0.6% (0.3-2.9), and 0.3% (0.08-1.7), respectively. Previous history of VTE, obesity, left or right ventricular failure, and prolonged bed rest, mechanical ventilation, or use of a central venous catheter were common risk factors for VTE. Bleeding or cardiac tamponade requiring reoperation owing to pharmacological VTE prophylaxis alone, without systemic anticoagulation, was not observed.
Conclusions-Unless proven otherwise by adequately powered RCTs, initiating pharmacological VTE prophylaxis as soon as possible after cardiac surgery for patients who have no active bleeding is highly recommended.
Details
- Title
- Incidence of venous thromboembolism and benefits and risks of thromboprophylaxis after cardiac surgery: A systematic review and meta‐analysis
- Authors/Creators
- K.M. Ho (Author/Creator) - The University of Western AustraliaE. Bham (Author/Creator) - Fiona Stanley HospitalW. Pavey (Author/Creator) - Fiona Stanley Hospital
- Publication Details
- Journal of the American Heart Association, Vol.4(10), Article e002652
- Publisher
- Wiley Blackwell
- Identifiers
- 991005544383207891
- Murdoch Affiliation
- School of Veterinary and Life Sciences
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.75 Blood Clotting
- 1.75.271 Venous Thromboembolism
- Web Of Science research areas
- Cardiac & Cardiovascular Systems
- ESI research areas
- Clinical Medicine