John Agzarian1, Virginia Litle2, Lori-Ann Linkins3, Alessandro Brunelli4, Laura Schneider1, Peter Kestenholz5, Hui Li6, Gaetano Rocco7, Philippe Girard8, Jun Nakajima9, Charles Marc Samama10, Marco Scarci11, Masaki Anraku9, Pierre-Emmanuel Falcoz12, Luca Bertolaccini13, Jules Lin14, Sudish Murthy15, Wayne Hofstetter16, Meinoshin Okumura17, Piergiorgio Solli18, Fabrizio Minervini5, Alan Kirk19, James Douketis3, Yaron Shargall1. 1. Department of Surgery, McMaster University, Hamilton, ON, Canada. 2. Department of Surgery, Boston University School of Medicine, Boston, MA, USA. 3. Department of Medicine, McMaster University, Hamilton, ON, Canada. 4. Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK. 5. Department of Thoracic Surgery, Kantonsspital Luzern, Lucerne, Switzerland. 6. Department of Thoracic Surgery, Capital Medical University, Beijing, China. 7. Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 8. Thoracic Department, Institut Mutualiste Montsouris, Paris, France. 9. Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 10. Department of Anaesthesia and Intensive Care Medicine, Cochin and Hôtel-Dieu University Hospitals, Paris, France. 11. Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy. 12. Department of Thoracic Surgery, University Hospital Strasbourg, Strasbourg, France. 13. Division of Thoracic Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy. 14. Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA. 15. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA. 16. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 17. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 18. Department of Thoracic Surgery, Maggiore Hospital and Bellaria Hospital, Bologna, Italy. 19. Department of Cardiothoracic Surgery, Golden Jubilee, National Hospital, Glasgow, UK.
Abstract
OBJECTIVES: Venous thromboembolic events can be successfully prevented with chemical and/or mechanical prophylaxis measures, but evidence-based guidelines in thoracic surgery are limited, particularly regarding extended post-discharge prophylaxis. This study attempts to gather an international consensus on best practices to inform the development of such guidelines. METHODS: A series of 3 surveys was distributed to the ESTS/AATS/ISTH (European Society of Thoracic Surgeons, American Association of Thoracic Surgeons, International Society for Thrombosis and Haemostasis) venous thromboembolic events prophylaxis working group starting January 2017. This iterative Delphi consensus process sought to gather a consensus on (i) risk factors; (ii) preferred agents; (iii) duration; and (iv) perceived barriers to an extended thromboprophylaxis approach. Participant responses were expressed on a 10-point scale, and the results were summarized and circulated to all respondents in subsequent rounds. A coefficient of variance of ≤0.3 was identified pre hoc to identify agreement. RESULTS: A total of 21 Working Group members completed the surveys, composed of 19% non-surgeon thrombosis experts, and 48% from North America. Respondents largely saw agreement regarding risk factors that indicate a need for extended thromboprophylaxis. The group agreed that low-molecular-weight heparin is a suitable agent for use post-discharge, but there was a wide variety in response regarding agents, duration and barriers to extended prophylaxis, where no consensus was observed across the three rounds. CONCLUSIONS: There is strong agreement around indications for extended venous thromboembolic events thromboprophylaxis after thoracic surgery, but there is little consensus regarding the agents and duration to be employed. Further research is required to better inform guideline development.
OBJECTIVES: Venous thromboembolic events can be successfully prevented with chemical and/or mechanical prophylaxis measures, but evidence-based guidelines in thoracic surgery are limited, particularly regarding extended post-discharge prophylaxis. This study attempts to gather an international consensus on best practices to inform the development of such guidelines. METHODS: A series of 3 surveys was distributed to the ESTS/AATS/ISTH (European Society of Thoracic Surgeons, American Association of Thoracic Surgeons, International Society for Thrombosis and Haemostasis) venous thromboembolic events prophylaxis working group starting January 2017. This iterative Delphi consensus process sought to gather a consensus on (i) risk factors; (ii) preferred agents; (iii) duration; and (iv) perceived barriers to an extended thromboprophylaxis approach. Participant responses were expressed on a 10-point scale, and the results were summarized and circulated to all respondents in subsequent rounds. A coefficient of variance of ≤0.3 was identified pre hoc to identify agreement. RESULTS: A total of 21 Working Group members completed the surveys, composed of 19% non-surgeon thrombosis experts, and 48% from North America. Respondents largely saw agreement regarding risk factors that indicate a need for extended thromboprophylaxis. The group agreed that low-molecular-weight heparin is a suitable agent for use post-discharge, but there was a wide variety in response regarding agents, duration and barriers to extended prophylaxis, where no consensus was observed across the three rounds. CONCLUSIONS: There is strong agreement around indications for extended venous thromboembolic events thromboprophylaxis after thoracic surgery, but there is little consensus regarding the agents and duration to be employed. Further research is required to better inform guideline development.