Prevalence and Predictors of Venous Thromboembolism Following Coronary Bypass Surgery

Abstract

Background: Venous thromboembolism (VTE) is a rare complication after coronary artery bypass surgery (CABG), leading to increased morbidity and mortality. There are no current societal guidelines directing prophylaxis. Utilizing a regional database, we sought to determine the prevalence of VTE and characterize regional center practices.

Methods: We identified all patients undergoing on-pump, isolated CABG (2010–2020). Patients on oral therapeutic anticoagulation or requiring mechanical circulatory support were excluded. Participating centers were surveyed to determine center level practices. Multivariable regression and hierarchical logistic regression were utilized for risk-adjusted outcomes and influence of center practices on VTE rates, respectively.

Results: Of 20,719 CABG patients, the overall prevalence of postoperative VTE was 1.3% (266/20,719). Patients developing VTE were more often female (30.1% vs. 23.4%, p = 0.01), had higher STS predicted risk of mortality (1.2% [0.7%, 2.2%] vs. 0.9% [0.5%, 1.7%], p < 0.001) and higher unadjusted operative mortality (4.1% vs. 1.0%, p < 0.001). Risk-adjusted analysis demonstrated pulmonary embolism as an independent predictor of mortality (OR = 3.4 [1.06, 11.0], p = 0.04). Increasing time from admission to surgery (OR = 1.05 [1.01, 1.09], p = 0.001), preoperative heparin use (OR = 1.47 [1.13, 1.90], p = 0.004), and intraoperative prothrombin complex concentrate (PCC) (OR = 4.85 [1.47, 15.96], p = 0.009) were predictors of VTE. Regional practices were mainly homogenous with no specific center-level protocol associated with decreases in VTE.

Conclusion: VTE following CABG is an infrequent postoperative complication with pulmonary embolism as an independent predictor of mortality. Increasing time from admission to surgery and intraoperative PCC may increase the risk of VTE.