Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network.

Guidelines anticoagulant bleeding surgery thromboembolism

Journal

Anaesthesia, critical care & pain medicine
ISSN: 2352-5568
Titre abrégé: Anaesth Crit Care Pain Med
Pays: France
ID NLM: 101652401

Informations de publication

Date de publication:
22 Oct 2024
Historique:
received: 30 05 2024
revised: 17 06 2024
accepted: 18 06 2024
medline: 25 10 2024
pubmed: 25 10 2024
entrez: 24 10 2024
Statut: aheadofprint

Résumé

Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE. A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011. The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed. 78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts. These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs.

Sections du résumé

BACKGROUND BACKGROUND
Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE.
OBJECTIVE OBJECTIVE
A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011.
METHODS METHODS
The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed.
RESULTS RESULTS
78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts.
CONCLUSIONS CONCLUSIONS
These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs.

Identifiants

DOI: 10.1016/j.accpm.2024.101446 PMID: 39447869
pubmed: 39447869
pii: S2352-5568(24)00104-8
doi: 10.1016/j.accpm.2024.101446
pii:
doi:

Types de publication

Journal Article Practice Guideline

Langues

eng

Sous-ensembles de citation

IM

Pagination

101446

Informations de copyright

Copyright © 2024. Published by Elsevier Masson SAS.

Auteurs

Anne Godier (A)

Université Paris Cité, Service d'anesthésie-réanimation, AP-HP, Hôpital Georges Pompidou, UMRS_1140, F-75006 Paris, France. Electronic address: Anne.godier@aphp.fr.

Dominique Lasne (D)

Laboratoire d'hématologie générale, AP-HP, Hôpital Necker-Enfants Malades, INSERM UMRS_1176, Paris, France.

Gilles Pernod (G)

Service de Médecine Vasculaire, Université Grenoble-Alpes, Grenoble, France, F-CRIN INNOVTE network, Saint-Etienne, France.

Normand Blais (N)

Service d'hématologie et d'oncologie médicale. Centre Hospitalier de l'Université de Montréal. Canada.

Fanny Bonhomme (F)

Service d'Anesthésiologie, Département de Médecine Aigue, Hôpitaux Universitaires de Genève.

Fanny Bounes (F)

Pole Anesthésie-Réanimation CHU Toulouse, INSERM U1297 équipe 11 LIPSIPLAT, Toulouse, France.

Alex Bourguignon (A)

Service d'hémato-oncologie, Centre Hospitalier Universitaire de Montréal, Montréal, Canada.

Ariel Cohen (A)

Service de cardiologie, hôpital Saint-Antoine, hôpital Tenon, Assistance publique-Hôpitaux de Paris, Sorbonne université, Paris, France.

Emmanuel de Maistre (E)

Service d'Hématologie Biologique, Hôpital Le Bocage, CHRU de Dijon, 21000 Dijon, France.

Pierre Fontana (P)

Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland.

Jean-Philippe Galanaud (JP)

Department of Medicine, Sunnybrook Heath Sciences Centre, University of Toronto, Toronto, ON, Canada.

Delphine Garrigue Huet (DG)

Department of anesthesiology and surgical care, CHU Lille, F-59000 Lille,France.

Alexandre Godon (A)

Univ. Grenoble Alpes, Anesthesiology and Critical Care, CHU Grenoble Alpes, Grenoble, France.

Isabelle Gouin-Thibault (I)

Department of Laboratory Hematology, Pontchaillou University Hospital, IRSET-INSERM-1085, Univ Rennes, Rennes, France.

Samia Jebara (S)

St Joseph University, Department of anesthesia and critical care, Hotel Dieu de France hospital, Beirut,Lebanon.

Silvy Laporte (S)

Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Service de Pharmacologie Clinique, INSERM, SAINBIOSE U1059, F-42023 Saint-Étienne, France.

Thomas Lecompte (T)

Université de Lorraine, Médecine, CHRU de Nancy, médecine vasculaire, France.

Dan Longrois (D)

Department of Anesthesia and Intensive Care, Hôpital Bichat-Claude Bernard, Université de Paris, Paris, France.

Jerrold H Levy (J)

Duke University School of Medicine, Departments of Anesthesiology, Critical Care and Surgery, Durham, NC, United States.

Grégoire Le Gal (G)

Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

Yves Gruel (Y)

Université Francois Rabelais, Inserm UMR1327 ISCHEMIA, Faculté de Médecine, Tours, France.

Alexandre Mansour (A)

Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France. Univ Rennes, CHU Rennes, Inserm, IRSET, UMR_S 1085, F35000 Rennes, France.

Anne-Céline Martin (AC)

Unité Médico-chirurgicale d'Insuffisance Cardiaque Sévère, Chirurgie Cardiaque, AP-HP, Hôpital Européen Georges-Pompidou, and Université Paris Cité, INSERM UMRS_1140, F-75006 Paris, France.

Mikael Mazighi (M)

Neurology Department, Hôpital Lariboisière, and Interventional Neuroradiology Department, Hôpital Fondation A. de Rothschild, FHU Neurovasc, INSERM 1144, Université Paris-Cité, Paris, France.

Pierre-Emmanuel Morange (PE)

Aix Marseille Univ, INSERM 1263, INRAE 1260, C2VN, Marseille, France ; Hematology Laboratory, La Timone University Hospital of Marseille, Marseille, France.

Serge Motte (S)

Université Libre de Bruxelles, Hôpital Universitaire de Bruxelles, Bruxelles, Belgium.

François Mullier (F)

Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis & Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Namur, and Institute of Experimental and Clinical Research, UCLouvain, Belgium.

Philippe Nguyen (P)

Université de Reims Champagne Ardenne, Reims, France.

Nadia Rosencher (N)

Paris, France.

Stéphanie Roullet (S)

Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Paul Brousse, Département d'Anesthésie Réanimation, Villejuif, France and Université Paris-Saclay, INSERM, Hémostase inflammation thrombose HITH U1176, Le Kremlin-Bicêtre, France.

Pierre-Marie Roy (PM)

F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine d'urgence et service de médecine vasculaire, CHU d'Angers, 49000 Angers, France; Institut Mitovasc, UMR 1083, UFR santé, université d'Angers, 49000 Angers, France.

Jean-François Schved (JF)

Université Montpellier.

Marie-Antoinette Sevestre (MA)

Service de Médecine Vasculaire CHU Amiens 80054 UPJV Equipe Chimère, France.

Pierre Sié (P)

Toulouse University Hospital, 31300 Toulouse, France.

Sophie Susen (S)

University Lille, Inserm, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France.

Charles Tacquard (C)

Department of anesthesia and intensive care, Strasbourg University Hospital, Strasbourg ; UMR_S1255 EFS-INSERM; Strasbourg, France.

André Vincentelli (A)

Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France.

Paul Zufferey (P)

CHU Saint-Étienne, Service d'Anesthésie Réanimation, INSERM, SAINBIOSE U1059, F-42023 Saint-Étienne, France.

Patrick Mismetti (P)

Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Service de Médecine Vasculaire et Thérapeutique, INSERM, SAINBIOSE U1059, F-42023 Saint-Étienne, France.

Pierre Albaladejo (P)

Department of Anaesthesia and critical Care, Grenoble Alpes University Hospital, Grenoble, France.

Classifications MeSH