TY - JOUR
T1 - International Delphi survey of the ESTS/AATS/ISTH task force on venous thromboembolism prophylaxis in thoracic surgery
T2 - The role of extended post-discharge prophylaxis
AU - Agzarian, John
AU - Litle, Virginia
AU - Linkins, Lori Ann
AU - Brunelli, Alessandro
AU - Schneider, Laura
AU - Kestenholz, Peter
AU - Li, Hui
AU - Rocco, Gaetano
AU - Girard, Philippe
AU - Nakajima, Jun
AU - Samama, Charles Marc
AU - Scarci, Marco
AU - Anraku, Masaki
AU - Falcoz, Pierre Emmanuel
AU - Bertolaccini, Luca
AU - Lin, Jules
AU - Murthy, Sudish
AU - Hofstetter, Wayne
AU - Okumura, Meinoshin
AU - Solli, Piergiorgio
AU - Minervini, Fabrizio
AU - Kirk, Alan
AU - Douketis, James
AU - Shargall, Yaron
N1 - Publisher Copyright:
© 2019 The Author(s).
PY - 2020/5/1
Y1 - 2020/5/1
N2 - OBJECTIVES: Venous thromboembolic events can be successfully prevented with chemical and/or mechanical prophylaxis measures, but evidence-based guidelines in thoracic surgery are limited, particularly regarding extended post-discharge prophylaxis. This study attempts to gather an international consensus on best practices to inform the development of such guidelines. METHODS: A series of 3 surveys was distributed to the ESTS/AATS/ISTH (European Society of Thoracic Surgeons, American Association of Thoracic Surgeons, International Society for Thrombosis and Haemostasis) venous thromboembolic events prophylaxis working group starting January 2017. This iterative Delphi consensus process sought to gather a consensus on (i) risk factors; (ii) preferred agents; (iii) duration; and (iv) perceived barriers to an extended thromboprophylaxis approach. Participant responses were expressed on a 10-point scale, and the results were summarized and circulated to all respondents in subsequent rounds. A coefficient of variance of ≤0.3 was identified pre hoc to identify agreement. RESULTS: A total of 21 Working Group members completed the surveys, composed of 19% non-surgeon thrombosis experts, and 48% from North America. Respondents largely saw agreement regarding risk factors that indicate a need for extended thromboprophylaxis. The group agreed that low-molecular-weight heparin is a suitable agent for use post-discharge, but there was a wide variety in response regarding agents, duration and barriers to extended prophylaxis, where no consensus was observed across the three rounds. CONCLUSIONS: There is strong agreement around indications for extended venous thromboembolic events thromboprophylaxis after thoracic surgery, but there is little consensus regarding the agents and duration to be employed. Further research is required to better inform guideline development.
AB - OBJECTIVES: Venous thromboembolic events can be successfully prevented with chemical and/or mechanical prophylaxis measures, but evidence-based guidelines in thoracic surgery are limited, particularly regarding extended post-discharge prophylaxis. This study attempts to gather an international consensus on best practices to inform the development of such guidelines. METHODS: A series of 3 surveys was distributed to the ESTS/AATS/ISTH (European Society of Thoracic Surgeons, American Association of Thoracic Surgeons, International Society for Thrombosis and Haemostasis) venous thromboembolic events prophylaxis working group starting January 2017. This iterative Delphi consensus process sought to gather a consensus on (i) risk factors; (ii) preferred agents; (iii) duration; and (iv) perceived barriers to an extended thromboprophylaxis approach. Participant responses were expressed on a 10-point scale, and the results were summarized and circulated to all respondents in subsequent rounds. A coefficient of variance of ≤0.3 was identified pre hoc to identify agreement. RESULTS: A total of 21 Working Group members completed the surveys, composed of 19% non-surgeon thrombosis experts, and 48% from North America. Respondents largely saw agreement regarding risk factors that indicate a need for extended thromboprophylaxis. The group agreed that low-molecular-weight heparin is a suitable agent for use post-discharge, but there was a wide variety in response regarding agents, duration and barriers to extended prophylaxis, where no consensus was observed across the three rounds. CONCLUSIONS: There is strong agreement around indications for extended venous thromboembolic events thromboprophylaxis after thoracic surgery, but there is little consensus regarding the agents and duration to be employed. Further research is required to better inform guideline development.
KW - Deep vein thrombosis
KW - Delphi
KW - Prophylaxis
KW - Pulmonary embolism
KW - Survey
KW - Thoracic surgery
KW - Thromboprophylaxis
KW - Venous thromboembolism
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U2 - 10.1093/ejcts/ezz319
DO - 10.1093/ejcts/ezz319
M3 - Article
C2 - 31769796
AN - SCOPUS:85084024756
SN - 1010-7940
VL - 57
SP - 854
EP - 859
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 5
ER -