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.
Anne Godier, Dominique Lasne, Gilles Pernod, Normand Blais, Fanny Bonhomme, Fanny Bounes, Alex Bourguignon, Ariel Cohen, Emmanuel de Maistre, Pierre Fontana, Jean-Philippe Galanaud, Delphine Garrigue Huet, Alexandre Godon, Isabelle Gouin-Thibault, Samia Jebara, Silvy Laporte, Thomas Lecompte, Dan Longrois, Jerrold H Levy, Grégoire Le Gal, Yves Gruel, Alexandre Mansour, Anne-Céline Martin, Mikael Mazighi, Pierre-Emmanuel Morange, Serge Motte, François Mullier, Philippe Nguyen, Nadia Rosencher, Stéphanie Roullet, Pierre-Marie Roy, Jean-François Schved, Marie-Antoinette Sevestre, Pierre Sié, Sophie Susen, Charles Tacquard, André Vincentelli, Paul Zufferey, Patrick Mismetti, Pierre Albaladejo
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Abstract
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: 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: 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: 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: 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.
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Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.
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