Preoperative Sepsis Is Associated with Risk for Arterial and Venous Thromboses

Authors: Donzé JD et al., BMJ 2014 Sep 8; 349:g5334

Risk increases with severity of sepsis.

Coronary artery disease is a risk factor for postoperative arterial thrombosis; male sex, older age, cancer history, and prior venous thrombosis are risk factors for postoperative venous thrombosis. However, whether systemic inflammation (which induces a hypercoagulable state) promotes risk for postoperative arterial or venous thrombosis is unclear. In this study, investigators used data on 2.3 million adults who underwent surgery at 374 U.S. hospitals from 2005 to 2012 to evaluate associations between preoperative sepsis and risk for postoperative venous and arterial thromboses. Preoperative sepsis was defined as systemic inflammatory response syndrome (SIRS), sepsis, and severe sepsis/shock within 48 hours preceding surgery.

Identified outcomes were arterial thrombosis (myocardial infarction or stroke) and venous thrombosis (deep venous thrombosis or pulmonary embolism) during the 30 days following surgery. After adjustment for multiple potential confounders, preoperative sepsis was associated with excess risk for arterial and venous thromboses (adjusted odds ratio, 3.1). Risk for thrombosis increased with sepsis severity: Adjusted ORs were 2.5 for SIRS, 3.3 for sepsis, and 5.7 for severe sepsis/shock. Similar results were obtained when the study analyses were limited to venous or arterial thromboses alone.

Comment
In this study, preoperative SIRS, sepsis, and severe sepsis/shock were associated independently with excess risk for arterial and venous thromboses. The authors recommend avoiding elective surgical procedures in affected patients until SIRS and sepsis have resolved. For patients with preoperative SIRS and sepsis who must undergo surgery, thromboprophylaxis should be provided.