A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind?
Venous thromboembolism (VTE) remains an important consideration within surgery, with recent evidence looking to refine clinical guidance. This review provides a contemporary update of existing clinical evidence for antithrombotic regimens for surgical patients, providing future directions for prophy...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/19/4294 |
| _version_ | 1797516184099225600 |
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| author | Amulya Khatri Matthew Machin Aditya Vijay Safa Salim Joseph Shalhoub Alun Huw Davies |
| author_facet | Amulya Khatri Matthew Machin Aditya Vijay Safa Salim Joseph Shalhoub Alun Huw Davies |
| author_sort | Amulya Khatri |
| collection | DOAJ |
| description | Venous thromboembolism (VTE) remains an important consideration within surgery, with recent evidence looking to refine clinical guidance. This review provides a contemporary update of existing clinical evidence for antithrombotic regimens for surgical patients, providing future directions for prophylaxis regimens and research. For moderate to high VTE risk patients, existing evidence supports the use of heparins for prophylaxis. Direct oral anticoagulants (DOACs) have been validated within orthopaedic surgery, although there remain few completed randomised controlled trials in other surgical specialties. Recent trials have also cast doubt on the efficacy of mechanical prophylaxis, especially when adjuvant to pharmacological prophylaxis. Despite the ongoing uncertainty in higher VTE risk patients, there remains a lack of evidence for mechanical prophylaxis in low VTE risk patients, with a recent systematic search failing to identify high-quality evidence. Future research on rigorously developed and validated risk assessment models will allow the better stratification of patients for clinical and academic use. Mechanical prophylaxis’ role in modern practice remains uncertain, requiring high-quality trials to investigate select populations in which it may hold benefit and to explore whether intermittent pneumatic compression is more effective. The validation of DOACs and aspirin in wider specialties may permit pharmacological thromboprophylactic regimens that are easier to administer. |
| first_indexed | 2024-03-10T06:57:41Z |
| format | Article |
| id | doaj.art-266b6cebea7d47c5bd899f49de523578 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T06:57:41Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-266b6cebea7d47c5bd899f49de5235782023-11-22T16:17:15ZengMDPI AGJournal of Clinical Medicine2077-03832021-09-011019429410.3390/jcm10194294A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind?Amulya Khatri0Matthew Machin1Aditya Vijay2Safa Salim3Joseph Shalhoub4Alun Huw Davies5Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London W6 8RF, UKAcademic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London W6 8RF, UKAcademic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London W6 8RF, UKAcademic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London W6 8RF, UKAcademic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London W6 8RF, UKAcademic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London W6 8RF, UKVenous thromboembolism (VTE) remains an important consideration within surgery, with recent evidence looking to refine clinical guidance. This review provides a contemporary update of existing clinical evidence for antithrombotic regimens for surgical patients, providing future directions for prophylaxis regimens and research. For moderate to high VTE risk patients, existing evidence supports the use of heparins for prophylaxis. Direct oral anticoagulants (DOACs) have been validated within orthopaedic surgery, although there remain few completed randomised controlled trials in other surgical specialties. Recent trials have also cast doubt on the efficacy of mechanical prophylaxis, especially when adjuvant to pharmacological prophylaxis. Despite the ongoing uncertainty in higher VTE risk patients, there remains a lack of evidence for mechanical prophylaxis in low VTE risk patients, with a recent systematic search failing to identify high-quality evidence. Future research on rigorously developed and validated risk assessment models will allow the better stratification of patients for clinical and academic use. Mechanical prophylaxis’ role in modern practice remains uncertain, requiring high-quality trials to investigate select populations in which it may hold benefit and to explore whether intermittent pneumatic compression is more effective. The validation of DOACs and aspirin in wider specialties may permit pharmacological thromboprophylactic regimens that are easier to administer.https://www.mdpi.com/2077-0383/10/19/4294antithromboticsanti-coagulantsanti-plateletscardiovascular diseaseischaemic heart diseaseatrial fibrillation |
| spellingShingle | Amulya Khatri Matthew Machin Aditya Vijay Safa Salim Joseph Shalhoub Alun Huw Davies A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind? Journal of Clinical Medicine antithrombotics anti-coagulants anti-platelets cardiovascular disease ischaemic heart disease atrial fibrillation |
| title | A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind? |
| title_full | A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind? |
| title_fullStr | A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind? |
| title_full_unstemmed | A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind? |
| title_short | A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind? |
| title_sort | review of current and future antithrombotic strategies in surgical patients leaving the graduated compression stockings behind |
| topic | antithrombotics anti-coagulants anti-platelets cardiovascular disease ischaemic heart disease atrial fibrillation |
| url | https://www.mdpi.com/2077-0383/10/19/4294 |
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