Risk for Recurrent Venous Thromboembolism Following Surgery

AUTHORS: Nemeth B et al.

JAMA Netw Open 2019 May 10

In patients undergoing surgery, does having a previous non–surgery-related venous thromboembolism (VTE, i.e., deep venous thrombosis or pulmonary embolism) augment risk for postoperative VTE? To address this question, researchers identified 3741 patients with one or more prior episodes of treated VTE who were followed for as long as 10 years in a Dutch registry; during follow-up, 580 patients underwent 808 surgical procedures (most of which were categorized as major — i.e., lasting longer than 30 minutes). The authors believe, but could not confirm, that all patients received recommended postoperative VTE prophylaxis.

The cumulative incidence of recurrent VTE after surgery was 2.1% at 1 month, 3.3% at 3 months, and 4.6% at 6 months, compared with an incidence of 0.8% at 3 months in patients not exposed to surgery. Patients who underwent gastrointestinal, major orthopedic, or cancer-related surgery experienced the highest cumulative incidence of VTE (5%–9%) by 6 months. Men had roughly three times higher risk than did women, and people with the Factor V Leiden mutation had three times higher risk than patients without the mutation.