Perioperative Thromboprophylaxis and Anticoagulation in Patients Undergoing Non-Cardiac Vascular Surgery

Taha      Khan; Ravinder      S. Vohra; Shervanthi      Homer-Vanniasinkam

Abstract

Patients undergoing non-cardiac vascular surgery (NCVS) are at high risk of developing perioperative venous and arterial thrombotic complications. Effective thromboprophylaxis is an essential part of the perioperative management of patients undergoing surgical procedures. To ensure appropriate delivery of antithrombotic agents and standardise clinical practice, numerous national and international guidelines have been developed in recent years. Very few of these recommendations are designed specifically for patients undergoing NCVS. This review aims to highlight the relevant guidelines and novel recommendations that are available for patients undergoing NCVS while noting their limitations and providing suggestions for specific subsets.

Keywords: Vascular, thromboembolism, thromboprophylaxis, surgery, varicose veins, bypass, vascular surgery (NCVS), arterial thrombotic complications, pathophysi-ology, Virchow's triad, VTE, pulmonary embo-lism (PE), ileo-femoral deep, abdominal aortic aneurysm repair and bypass procedures, bypass surgery, lower limb amputations, procedures, co-morbidities, aspirin, clopidogrel, unfractionated heparin, venous thromboprophylaxis, American College of Chest Physicians, NICE, sedation, puerperium, Prolonged patient immobilisation, Previous VTE or varicose veins, Prolonged limb immobilisation, Hormone therapy e.g. Oestrogen, tamoxifen, Chest infection, Thrombophilia, Post-operative MI, Lower limb paralysis, Cardiac arrest, Nephrotic syndrome, Urinary tract infection, Myocardial infarction (MI) or heart failure, Acute renal impairment, Malignancy (especially pelvic, Blood transfusion for bleeding (, >, 4 units), High body mass index, LMWH, Tinzaparin, UFH, parinux, thromboprophylactic agents, neuraxial anaesthesia, analgesia, deep peripheral nerve blocks