Download PDF
Clin Colon Rectal Surg
DOI: 10.1055/s-0045-1807287
Review Article

Role of Postdischarge Venous Thromboembolism Prophylaxis after Colorectal Surgery

Pavel Lenkov
1   Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland, Ohio
,
Elissa Dabaghi
1   Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland, Ohio
,
Stefan Holubar
1   Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland, Ohio
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Despite significant advances in colorectal surgery (CRS), postoperative venous thromboembolism (VTE) remains a critical issue that contributes to substantial morbidity and mortality. The incidence of VTE, including deep vein thrombosis, pulmonary embolism, and portomesenteric vein thrombosis, in the colorectal surgical population varies from 2 to 15%, with elevated risks in patients with colorectal cancer and inflammatory bowel disease. This review article examines the effects of VTE on postoperative outcomes and explores the efficacy of extended chemoprophylaxis (ePPx) for mitigating these risks. We will review the rates of morbidity and mortality associated with VTE, as well as the role of postdischarge ePPx in VTE prevention, while exploring how other specialties utilize ePPx strategies to decrease their postdischarge VTE rates, some of which may be translatable to CRS patients. Our analysis highlights the role of various prophylactic measures, including low-molecular-weight heparin (LMWH), aspirin, and direct oral anticoagulants (DOACs), comparing their effectiveness and cost implications as well as the use of thromboelastography to help guide ePPx management. Overall, findings suggest that VTE ePPx with LMWH significantly reduces the incidence of postoperative VTE and related complications, although patient compliance remains a challenge. While aspirin is a cost-effective alternative, its efficacy in patients with CRS requires further investigation. Emerging data on DOACs indicate their potential as viable options for ePPx, although their safety profile requires careful consideration. Tailored ePPx strategies, particularly with LMWH, appear to be crucial for reducing VTE in CRS patients. Further research is needed to refine the prophylactic approaches and establish standardized guidelines that incorporate new insights into VTE prevention and management in CRS.

Keywords

venous thromboembolism - VTE prophylaxis - inflammatory bowel disease - colorectal surgery


Publication History

Article published online:
17 April 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Am J Surg 2010; 199 (1, suppl): S3-S10
    CrossrefPubMedSearch in Google Scholar
  • 2 Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med 2010; 38 (4, suppl): S495-S501
    CrossrefPubMedSearch in Google Scholar
  • 3 Emoto S, Nozawa H, Kawai K. et al. Venous thromboembolism in colorectal surgery: Incidence, risk factors, and prophylaxis. Asian J Surg 2019; 42 (09) 863-873
    PubMedSearch in Google Scholar
  • 4 Kusunoki C, Uemura M, Takeda M. et al. Assessing risk factors for elevated creatine kinase levels as an indicator of compartment syndrome following laparoscopic or robot-assisted colorectal cancer surgery in the lithotomy-trendelenburg position. Surg Endosc 2024; 38 (10) 6139-6145
    PubMedSearch in Google Scholar
  • 5 Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5 (03) 632-634
    CrossrefPubMedSearch in Google Scholar
  • 6 Kosir MA, Kozol RA, Perales A. et al. Is DVT prophylaxis overemphasized? A randomized prospective study. J Surg Res 1996; 60 (02) 289-292
    PubMedSearch in Google Scholar
  • 7 Towbin A. Pulmonary embolism: incidence and significance. J Am Med Assoc 1954; 156 (03) 209-215
    PubMedSearch in Google Scholar
  • 8 Wallaert JB, De Martino RR, Marsicovetere PS. et al. Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP. Dis Colon Rectum 2012; 55 (11) 1138-1144
    CrossrefPubMedSearch in Google Scholar
  • 9 Gross ME, Vogler SA, Mone MC, Sheng X, Sklow B. The importance of extended postoperative venous thromboembolism prophylaxis in IBD: a National Surgical Quality Improvement Program analysis. Dis Colon Rectum 2014; 57 (04) 482-489
    PubMedSearch in Google Scholar
  • 10 Gamal Eldin M, De Haan RK, Sklow B. et al. Portomesenteric venous thrombosis after colorectal surgery for inflammatory bowel disease: a call to action?. Dis Colon Rectum 2021; 64 (05) e109-e364
    PubMedSearch in Google Scholar
  • 11 McKenna NP, Bews KA, Behm KT, Habermann EB, Cima RR. Postoperative venous thromboembolism in colon and rectal cancer: Do tumor location and operation matter?. J Am Coll Surg 2023; 236 (04) 658-665
    CrossrefPubMedSearch in Google Scholar
  • 12 Jiménez D, Aujesky D, Moores L. et al. RIETE Investigators. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010; 170 (15) 1383-1389
    CrossrefPubMedSearch in Google Scholar
  • 13 Kearon C, Kahn SR. Long-term treatment of venous thromboembolism. Blood 2020; 135 (05) 317-325
    CrossrefPubMedSearch in Google Scholar
  • 14 Monreal M, Muñoz-Torrero JF, Naraine VS. et al. RIETE Investigators. Pulmonary embolism in patients with chronic obstructive pulmonary disease or congestive heart failure. Am J Med 2006; 119 (10) 851-858
    PubMedSearch in Google Scholar
  • 15 Mullin CJ, Klinger JR. Chronic thromboembolic pulmonary hypertension. Heart Fail Clin 2018; 14 (03) 339-351
    PubMedSearch in Google Scholar
  • 16 McKenna NP, Bews KA, Behm KT, Mathis KL, Cima RR, Habermann EB. Timing and location of venous thromboembolisms after surgery for inflammatory bowel disease. J Surg Res 2024; 296: 563-570
    PubMedSearch in Google Scholar
  • 17 Gu J, Stocchi L, Gorgun E, Remzi FH. Risk factors associated with portomesenteric venous thrombosis in patients undergoing restorative proctocolectomy for medically refractory ulcerative colitis. Colorectal Dis 2016; 18 (04) 393-399
    PubMedSearch in Google Scholar
  • 18 Lee CHA, Jia X, Lipman JM. et al. Defining the economic burden of perioperative venous thromboembolism in inflammatory bowel disease in the United States. Dis Colon Rectum 2021; 64 (07) 871-880
    PubMedSearch in Google Scholar
  • 19 Brady MT, Patts GJ, Rosen A. et al. Postoperative venous thromboembolism in patients undergoing abdominal surgery for IBD: A common but rarely addressed problem. Dis Colon Rectum 2017; 60 (01) 61-67
    PubMedSearch in Google Scholar
  • 20 Lightner AL, Sklow B, Click B. et al. Venous thromboembolism in patients admitted for IBD: An enterprise-wide experience of 86,000 hospital encounters. Dis Colon Rectum 2023; 66 (03) 410-418
    CrossrefPubMedSearch in Google Scholar
  • 21 Ali F, Al-Kindi SG, Blank JJ, Peterson CY, Ludwig KA, Ridolfi TJ. Elevated venous thromboembolism risk following colectomy for IBD is equal to those for colorectal cancer for ninety days after surgery. Dis Colon Rectum 2018; 61 (03) 375-381
    PubMedSearch in Google Scholar
  • 22 Hayes JW, Ryan EJ, Boland PA, Creavin B, Kelly ME, Beddy D. The prevalence of venous thromboembolism in rectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34 (05) 849-860
    CrossrefPubMedSearch in Google Scholar
  • 23 McKenna NP, Behm KT, Ubl DS. et al. Analysis of postoperative venous thromboembolism in patients with chronic ulcerative colitis: Is it the disease or the operation?. Dis Colon Rectum 2017; 60 (07) 714-722
    PubMedSearch in Google Scholar
  • 24 Stahl TJ, Gregorcyk SG, Hyman NH, Buie WD. Standards Practice Task Force of The American Society of Colon and Rectal Surgeons. Practice parameters for the prevention of venous thrombosis. Dis Colon Rectum 2006; 49 (10) 1477-1483
    PubMedSearch in Google Scholar
  • 25 Fleming F, Gaertner W, Ternent CA. et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guideline for the prevention of venous thromboembolic disease in colorectal surgery. Dis Colon Rectum 2018; 61 (01) 14-20
    CrossrefPubMedSearch in Google Scholar
  • 26 Devani K, Patil N, Simons-Linares CR. et al. Trends in hospitalization and mortality of venous thromboembolism in hospitalized patients with colon cancer and their outcomes: US perspective. Clin Colorectal Cancer 2017; 16 (03) e199-e204
    PubMedSearch in Google Scholar
  • 27 Lightner AL, Vaidya P, Holubar S. et al. Perioperative safety of tofacitinib in surgical ulcerative colitis patients. Colorectal Dis 2021; 23 (08) 2085-2090
    PubMedSearch in Google Scholar
  • 28 Russell TA, Banerjee S, Lipman JM. et al. Tofacitinib is associated with increased risk of postoperative venous thromboembolism in patients with ulcerative colitis. Dis Colon Rectum 2024; 67 (05) 693-699
    PubMedSearch in Google Scholar
  • 29 Greaves SW, Holubar SD. Preoperative hospitalization is independently associated with increased risk for venous thromboembolism in patients undergoing colorectal surgery: A National Surgical Quality Improvement Program Database Study. Dis Colon Rectum 2015; 58 (08) 782-791
    PubMedSearch in Google Scholar
  • 30 Rogers Jr SO, Kilaru RK, Hosokawa P, Henderson WG, Zinner MJ, Khuri SF. Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007; 204 (06) 1211-1221
    PubMedSearch in Google Scholar
  • 31 Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell Jr DA, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg 2010; 251 (02) 344-350
    CrossrefPubMedSearch in Google Scholar
  • 32 Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F. Clinical assessment of venous thromboembolic risk in surgical patients. Semin Thromb Hemost 1991; 17 (Suppl. 03) 304-312
    PubMedSearch in Google Scholar
  • 33 Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008; 111 (10) 4902-4907
    CrossrefPubMedSearch in Google Scholar
  • 34 Kulshrestha V, Kumar S. DVT prophylaxis after TKA: routine anticoagulation vs risk screening approach - a randomized study. J Arthroplasty 2013; 28 (10) 1868-1873
    CrossrefPubMedSearch in Google Scholar
  • 35 Cheong JY, Connelly TM, Russell T. et al. Venous thromboembolism risk stratification for patients undergoing surgery for IBD using a novel six factor scoring system using NSQIP-IBD registry. ANZ J Surg 2023; 93 (06) 1620-1625
    PubMedSearch in Google Scholar
  • 36 Benlice C, Holubar SD, Gorgun E. et al. Extended venous thromboembolism prophylaxis after elective surgery for IBD patients: Nomogram-based risk assessment and prediction from nationwide cohort. Dis Colon Rectum 2018; 61 (10) 1170-1179
    CrossrefPubMedSearch in Google Scholar
  • 37 Holubar S, Eisenstein S, Bordeianou L. et al. current venous thromboembolism chemoprophylaxis practices after surgery for IBD: Saves-IBD trial initial report. Inflamm Bowel Dis 2022; 28: S40-S40
    PubMedSearch in Google Scholar
  • 38 Lobastov K, Dementieva G, Soshitova N. et al. Utilization of the Caprini score in conjunction with thrombodynamic testing reduces the number of unpredicted postoperative venous thromboembolism events in patients with colorectal cancer. J Vasc Surg Venous Lymphat Disord 2020; 8 (01) 31-41
    CrossrefPubMedSearch in Google Scholar
  • 39 Vaidya P, Lee CHA, Lightner A. et al. Preoperative hypercoagulable thromboelastography profiles are associated with post-operative venous thromboembolism in inflammatory bowel disease patients. Gastroenterology 2020; 158 (06) S-1546
    PubMedSearch in Google Scholar
  • 40 Zhang D, Li F, Li X, Du G. Effect of intermittent pneumatic compression on preventing deep vein thrombosis among stroke patients: A systematic review and meta-analysis. Worldviews Evid Based Nurs 2018; 15 (03) 189-196
    PubMedSearch in Google Scholar
  • 41 Herring B, Lowen D, Ho P, Hodgson R. A systematic review of venous thromboembolism mechanical prophylaxis devices during surgery. Langenbecks Arch Surg 2023; 408 (01) 410
    PubMedSearch in Google Scholar
  • 42 Collins R, Scrimgeour A, Yusuf S, Peto R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med 1988; 318 (18) 1162-1173
    PubMedSearch in Google Scholar
  • 43 Mismetti P, Laporte S, Darmon JY, Buchmüller A, Decousus H. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg 2001; 88 (07) 913-930
    CrossrefPubMedSearch in Google Scholar
  • 44 Wille-Jørgensen P, Rasmussen MS, Andersen BR, Borly L. Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev 2003; (04) CD001217
    PubMedSearch in Google Scholar
  • 45 McLeod RS, Geerts WH, Sniderman KW. et al. Canadian Colorectal Surgery DVT Prophylaxis Trial investigators. Subcutaneous heparin versus low-molecular-weight heparin as thromboprophylaxis in patients undergoing colorectal surgery: results of the canadian colorectal DVT prophylaxis trial: a randomized, double-blind trial. Ann Surg 2001; 233 (03) 438-444
    CrossrefPubMedSearch in Google Scholar
  • 46 Vedovati MC, Becattini C, Rondelli F. et al. A randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer. Ann Surg 2014; 259 (04) 665-669
    CrossrefPubMedSearch in Google Scholar
  • 47 Vedovati MC, Becattini C, Rondelli F, Agnelli G. Reply to Letter: “A randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer”. Ann Surg 2015; 262 (06) e123-e124
    PubMedSearch in Google Scholar
  • 48 Vedovati MC, Becattini C, Rondelli F, Agnelli G. Reply to Letter: “A randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer”. Ann Surg 2016; 263 (04) e63
    PubMedSearch in Google Scholar
  • 49 Gould MK, Garcia DA, Wren SM. et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 suppl): e227S-e277S
    CrossrefPubMedSearch in Google Scholar
  • 50 Ivatury SJ, Holubar SD. Just do it: Changing our culture to embrace optimal perioperative venous thromboembolism chemoprophylaxis for abdominal and pelvic cancer patients. Ann Surg Oncol 2016; 23 (05) 1420-1421
    PubMedSearch in Google Scholar
  • 51 Mongelli M, Lorusso D, Zanagnolo V, Pignata S, Colombo N, Cormio G. Venous thromboembolism prophylaxis in gynecologic oncology: A MITO-MaNGO Survey. Diagnostics (Basel) 2024; 14 (11) 1159
    PubMedSearch in Google Scholar
  • 52 ENOXACAN Study Group. Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: a double-blind randomized multicentre trial with venographic assessment. Br J Surg 1997; 84 (08) 1099-1103
    CrossrefPubMedSearch in Google Scholar
  • 53 Bergqvist D, Agnelli G, Cohen AT. et al. ENOXACAN II Investigators. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002; 346 (13) 975-980
    CrossrefPubMedSearch in Google Scholar
  • 54 Bergqvist D. Venous thromboembolism in cancer patients: expanding horizons. Semin Thromb Hemost 2002; 28 (Suppl. 03) 19-23
    PubMedSearch in Google Scholar
  • 55 Shinke G, Takeda Y, Ohmura Y. et al. Randomized, controlled, multi-center phase II study of postoperative enoxaparin treatment for venous thromboembolism prophylaxis in patients undergoing surgery for hepatobiliary-pancreatic malignancies. Ann Gastroenterol Surg 2024; 8 (05) 868-876
    PubMedSearch in Google Scholar
  • 56 Haut ER. Please stop using venous thromboembolism (VTE) outcomes for Pay-for-Performance and Public reporting. Jt Comm J Qual Patient Saf 2019; 45 (03) 145-147
    PubMedSearch in Google Scholar
  • 57 Leeds IL, Haut ER. Are we really supposed to start giving venous thromboembolism prophylaxis for a month after outpatient surgery?. JAMA Surg 2019; 154 (12) 1133
    PubMedSearch in Google Scholar
  • 58 Leeds IL, DiBrito SR, Canner JK, Haut ER, Safar B. Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for crohn's disease. Dis Colon Rectum 2019; 62 (11) 1371-1380
    PubMedSearch in Google Scholar
  • 59 Holubar S, Dulai P, Piazik B, Finlayson S, Udeh B. Extended enoxaparin venous thromboembolism prophylaxis after surgery for inflammatory bowel disease: A cost-based decision-analysis. J Crohns Colitis 2018; 12: S499-S500
    PubMedSearch in Google Scholar
  • 60 Rasmussen MS, Jorgensen LN, Wille-Jørgensen P. et al. FAME Investigators. Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost 2006; 4 (11) 2384-2390
    CrossrefPubMedSearch in Google Scholar
  • 61 Kakkar VV, Balibrea JL, Martínez-González J, Prandoni P. CANBESURE Study Group. Extended prophylaxis with bemiparin for the prevention of venous thromboembolism after abdominal or pelvic surgery for cancer: the CANBESURE randomized study. J Thromb Haemost 2010; 8 (06) 1223-1229
    CrossrefPubMedSearch in Google Scholar
  • 62 Cappetto CM, Dooley ER. Impact of reduced enoxaparin prophylactic dosing on bleeding and thrombotic risk for low body weight post-operative colorectal surgery patients. Hosp Pharm 2024; 59 (01) 70-76
    PubMedSearch in Google Scholar
  • 63 Cordova-Cassia C, Wong D, Cotter MB, Cataldo TE, Poylin VY. Patient's compliance is a contributor to failure of extended antithrombotic prophylaxis in colorectal surgery: prospective cohort study. Surg Endosc 2022; 36 (01) 267-273
    PubMedSearch in Google Scholar
  • 64 Sidhu V, Naylor JM, Adie S. et al. Post-discharge patient-reported non-adherence to aspirin compared to enoxaparin for venous thromboembolism prophylaxis after hip or knee arthroplasty. ANZ J Surg 2023; 93 (04) 989-994
    PubMedSearch in Google Scholar
  • 65 Anderson DR, Dunbar M, Murnaghan J. et al. Aspirin or rivaroxaban for vte prophylaxis after hip or knee arthroplasty. N Engl J Med 2018; 378 (08) 699-707
    CrossrefPubMedSearch in Google Scholar
  • 66 Anderson DR, Dunbar MJ, Bohm ER. et al. Aspirin versus low-molecular-weight heparin for extended venous thromboembolism prophylaxis after total hip arthroplasty: a randomized trial. Ann Intern Med 2013; 158 (11) 800-806
    CrossrefPubMedSearch in Google Scholar
  • 67 Jameson SS, Charman SC, Gregg PJ, Reed MR, van der Meulen JH. The effect of aspirin and low-molecular-weight heparin on venous thromboembolism after hip replacement: a non-randomised comparison from information in the National Joint Registry. J Bone Joint Surg Br 2011; 93 (11) 1465-1470
    PubMedSearch in Google Scholar
  • 68 Salman LA, Altahtamouni SB, Khatkar H, Al-Ani A, Hameed S, Alvand A. The efficacy of aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis after knee and hip arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2024; (e-pub ahead of print)
    CrossrefPubMedSearch in Google Scholar
  • 69 Farey JE, An VVG, Sidhu V, Karunaratne S, Harris IA. Aspirin versus enoxaparin for the initial prevention of venous thromboembolism following elective arthroplasty of the hip or knee: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2021; 107 (01) 102606
    CrossrefPubMedSearch in Google Scholar
  • 70 Jenny JY, Pabinger I, Samama CM. ESA VTE Guidelines Task Force. European guidelines on perioperative venous thromboembolism prophylaxis: Aspirin. Eur J Anaesthesiol 2018; 35 (02) 123-129
    PubMedSearch in Google Scholar
  • 71 Johnson SA, Jones AE, Young E. et al. A risk-stratified approach to venous thromboembolism prophylaxis with aspirin or warfarin following total hip and knee arthroplasty: A cohort study. Thromb Res 2021; 206: 120-127
    PubMedSearch in Google Scholar
  • 72 Sidhu VS, Kelly TL, Pratt N. et al. CRISTAL Study Group. Effect of aspirin vs enoxaparin on symptomatic venous thromboembolism in patients undergoing hip or knee arthroplasty: The CRISTAL Randomized Trial. JAMA 2022; 328 (08) 719-727
    CrossrefPubMedSearch in Google Scholar
  • 73 Whipple MO. Review of Article: CRISTAL Study Group. Effect of aspirin vs. enoxaparin on symptomatic venous thromboembolism in patients undergoing hip or knee arthroplasty: The CRISTAL randomized trial. JAMA. 2022;328(8):719-727. J Vasc Nurs 2022; 40 (03) 155-156
    PubMedSearch in Google Scholar
  • 74 Pellegrini Jr VD, Eikelboom JW, Evarts CM. et al. Steering Committee of the PEPPER Trial and the PEPPER Trial Investigators, funded by PCORI. Randomised comparative effectiveness trial of Pulmonary Embolism Prevention after hiP and kneE Replacement (PEPPER): the PEPPER trial protocol. BMJ Open 2022; 12 (03) e060000
    PubMedSearch in Google Scholar
  • 75 Fu SH, Wang CY. is it time to comprehensively utilize low-dose aspirin for preventing venous thromboembolism after total knee arthroplasty?: Commentary on an article by Monish S. Lavu, MHM, et al.: “Low-dose aspirin is the safest prophylaxis for prevention of venous thromboembolism after total knee arthroplasty across all patient risk profiles”. J Bone Joint Surg Am 2024; 106 (14) e29
    CrossrefPubMedSearch in Google Scholar
  • 76 Lavu MS, Porto JR, Hecht II CJ. et al. Low-dose aspirin is the safest prophylaxis for prevention of venous thromboembolism after total knee arthroplasty across all patient risk profiles. J Bone Joint Surg Am 2024; 106 (14) 1256-1267
    CrossrefPubMedSearch in Google Scholar
  • 77 Za P, Papalia GF, Franceschetti E, Rizzello G, Adravanti P, Papalia R. Aspirin is a safe and effective thromboembolic prophylaxis after total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31 (10) 4407-4421
    CrossrefPubMedSearch in Google Scholar
  • 78 Leeds IL, Sklow B, Gorgun E. et al. Cost-effectiveness of aspirin for extended venous thromboembolism prophylaxis after major surgery for inflammatory bowel disease. J Gastrointest Surg 2022; 26 (06) 1275-1285
    PubMedSearch in Google Scholar
  • 79 Fujikawa T, Takahashi R. Impact of antithrombotic therapy on the outcome of patients undergoing laparoscopic colorectal cancer surgery: A systematic literature review. Cureus 2022; 14 (03) e23390
    PubMedSearch in Google Scholar
  • 80 Wu S, Wang H, Li C. et al. Efficacy and safety of direct oral anticoagulants for preventing venous thromboembolism in hospitalized cancer patients: a national multicenter retrospective cohort study. Front Pharmacol 2024; 15: 1373635
    PubMedSearch in Google Scholar
  • 81 Guntupalli SR, Brennecke A, Behbakht K. et al. Safety and efficacy of apixaban vs enoxaparin for preventing postoperative venous thromboembolism in women undergoing surgery for gynecologic malignant neoplasm: A randomized clinical trial. JAMA Netw Open 2020; 3 (06) e207410
    CrossrefPubMedSearch in Google Scholar
  • 82 Stewart KT, Jafari H, Pattillo J. et al. Avoiding the needle: A quality improvement program introducing apixaban for extended thromboprophylaxis after major gynecologic cancer surgery. Gynecol Oncol 2024; 188: 131-139
    PubMedSearch in Google Scholar
  • 83 Longo de Oliveira ALM, de Oliveira Pereira RF, Agati LB. et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after major gynecological cancer surgery: The VALERIA Trial : Venous thromboembolism prophylAxis after gynecoLogical pElvic cancer surgery with RIvaroxaban versus enoxAparin (VALERIA trial). Clin Appl Thromb Hemost 2022; 28: 10 760296221132556
    CrossrefPubMedSearch in Google Scholar
  • 84 Becattini C, Pace U, Pirozzi F. et al. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. Blood 2022; 140 (08) 900-908
    CrossrefPubMedSearch in Google Scholar
  • 85 Patel T, Nadeem T, Shahbaz U. et al. Comparative efficacy of direct oral anticoagulants and low-molecular-weight heparin in cancer-associated thromboembolism: A systematic review and meta-analysis. Cureus 2023; 15 (06) e41071
    PubMedSearch in Google Scholar
  • 86 Zhou H, Ye LL, Zhou JT, Ma FX, Ma JJ, Zhang JH. Direct oral anticoagulants (DOACs) versus low-molecular-weight heparin (LMWH) for extended thromboprophylaxis following major abdominal/pelvic cancer-related surgery: a systematic review and meta-analysis. Surg Endosc 2024; 38 (03) 1131-1138
    PubMedSearch in Google Scholar
  • 87 Gibson CM, Halaby R, Korjian S. et al. APEX Investigators. The safety and efficacy of full- versus reduced-dose betrixaban in the Acute Medically Ill VTE (Venous Thromboembolism) Prevention With Extended-Duration Betrixaban (APEX) trial. Am Heart J 2017; 185: 93-100
    PubMedSearch in Google Scholar
  • 88 Ogilvie Jr JW, Khan MT, Hayakawa E, Parker J, Luchtefeld MA. Low-dose rivaroxaban as extended prophylaxis reduces postdischarge venous thromboembolism in patients with malignancy and IBD. Dis Colon Rectum 2024; 67 (03) 457-465
    CrossrefPubMedSearch in Google Scholar
  • 89 Faye AS, Hung KW, Cheng K. et al. Minor hematochezia decreases use of venous thromboembolism prophylaxis in patients with inflammatory bowel disease. Inflamm Bowel Dis 2020; 26 (09) 1394-1400
    CrossrefPubMedSearch in Google Scholar
  • 90 Ra G, Thanabalan R, Ratneswaran S, Nguyen GC. Predictors and safety of venous thromboembolism prophylaxis among hospitalized inflammatory bowel disease patients. J Crohns Colitis 2013; 7 (10) e479-e485
    PubMedSearch in Google Scholar
  • 91 Zhou LB, Wang CC, Zhang LT, Wu T, Zhang GQ. Effectiveness of different antithrombotic agents in combination with tranexamic acid for venous thromboembolism prophylaxis and blood management after total knee replacement: a prospective randomized study. BMC Musculoskelet Disord 2023; 24 (01) 5
    PubMedSearch in Google Scholar
  • 92 Prien C, Ribakow D, Steele SR. et al. What about patient cost? Defining copay and out-of-pocket costs of extended venous thromboembolism chemoprophylaxis after colorectal surgery. J Gastrointest Surg 2023; 27 (01) 152-154
    PubMedSearch in Google Scholar
  • 93 Teoh D, Berchuck A, Alvarez Secord A. et al. Cost comparison of strategies for the management of venous thromboembolic event risk following laparotomy for ovarian cancer. Gynecol Oncol 2011; 122 (03) 467-472
    PubMedSearch in Google Scholar
  • 94 Iannuzzi JC, Rickles AS, Kelly KN. et al. Defining high risk: cost-effectiveness of extended-duration thromboprophylaxis following major oncologic abdominal surgery. J Gastrointest Surg 2014; 18 (01) 60-68
    PubMedSearch in Google Scholar
  • 95 Trepanier M, Alhassan N, Sabapathy CA. et al. Cost-effectiveness of extended thromboprophylaxis in patients undergoing colorectal surgery from a Canadian Health Care System perspective. Dis Colon Rectum 2019; 62 (11) 1381-1389
    PubMedSearch in Google Scholar
  • 96 Bradley CT, Brasel KJ, Miller JJ, Pappas SG. Cost-effectiveness of prolonged thromboprophylaxis after cancer surgery. Ann Surg Oncol 2010; 17 (01) 31-39
    PubMedSearch in Google Scholar
  • 97 Horlocker TT, Vandermeuelen E, Kopp SL. et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med 2018; 43 (03) 263-309
    CrossrefPubMedSearch in Google Scholar
  • 98 Smith M, Wakam G, Wakefield T, Obi A. New trends in anticoagulation therapy. Surg Clin North Am 2018; 98 (02) 219-238
    PubMedSearch in Google Scholar
  • 99 Tritschler T, Kraaijpoel N, Le Gal G, Wells PS. Venous thromboembolism: Advances in diagnosis and treatment. JAMA 2018; 320 (15) 1583-1594
    PubMedSearch in Google Scholar
  • 100 Stevens SM, Woller SC, Baumann Kreuziger L. et al. Executive Summary: Antithrombotic therapy for VTE disease: Second update of the CHEST Guideline and Expert Panel report. Chest 2021; 160 (06) 2247-2259
    CrossrefPubMedSearch in Google Scholar
  • 101 Mubashir M, Carnell C, Haddadin I, Holubar SD. Refractory ulcerative colitis requiring preoperative suction thrombectomy of submassive bilateral pulmonary emboli before total abdominal colectomy. Dig Dis Sci 2023; 68 (05) 1656-1657
    PubMedSearch in Google Scholar
  • 102 Mismetti P, Laporte S, Pellerin O. et al. PREPIC2 Study Group. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA 2015; 313 (16) 1627-1635
    CrossrefPubMedSearch in Google Scholar
  • 103 Key NS, Khorana AA, Kuderer NM. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 2020; 38 (05) 496-520
    CrossrefPubMedSearch in Google Scholar
  • 104 Streiff MB, Holmstrom B, Angelini D. et al. Cancer-Associated Venous Thromboembolic Disease, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19 (10) 1181-1201
    PubMedSearch in Google Scholar