American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Preventing VTE takes a data-driven team effort

OCTOBER 25, 2017
Clinical Congress Daily Highlights, Wednesday Second Edition

Thromboembolic disease requires special attention from surgeons, as it affects perioperative management. A Wednesday session discussed strategies for managing patients on anticoagulants, as well as new approaches for reducing venous thromboembolism (VTE) complications.

Rachael A. Callcut, MD, MSPH, FACS, University of California San Francisco, discussed the emergence of new direct oral anticoagulants (DOACs), which include a direct thrombin inhibitor and several Factor Xa inhibitors. These treatments have recently been favored due to ease of use compared with warfarin. Dr. Callcut presented strategies and guidelines for operating on patients using these medicines, through assessment of bleeding risk, timing of procedure, and risk of thromboembolism.

These recommendations underscore the importance of following the existing clinical data, which for some strategies may actually be quite sparse. Kyla M. Bennett, MD, University of Wisconsin–Madison, cautioned against certain approaches for perioperative bridging in atrial fibrillation, such as the use of anticoagulants with peripheral stents, which lack clear evidence for efficacy. She proposed alternative strategies supported by clinical data for perioperative management across various scenarios.

Because treatment approaches and outcomes can vary, it’s also important to assess a patient’s baseline risk. Christopher J. Pannucci, MD, MS, University of Utah, Salt Lake City, UT, presented data supporting use of the Caprini Score, a weighted risk-assessment tool that can help stratify patients by VTE risk, allowing surgeons to tailor treatment strategies accordingly. He also suggested that modifying risk factors, such as before an elective surgery, should be considered. He urged audience members to ask themselves, “Before we start talking about things you can do to the patient, like give them anticoagulants, how can we modify these risk factors when they’re identified?”

However, simply studying the data and assessing VTE risk in patients isn’t enough. Systemic changes must occur within hospitals in order to improve outcomes. Elliott R. Haut, MD, PhD, FACS, vice chair of Quality, Safety & Service, Johns Hopkins Medicine, Baltimore, MD, presented a VTE prevention program implemented at Johns Hopkins Hospital through the computerized provider order entry system. In a study conducted at his institution, Dr. Haut and his team observed a significant increase in VTE prophylaxis as well as a significant reduction in preventable harm from VTE after using this program. He urged other clinical leaders in the audience to lead changes in their own hospitals: “Changing practice is a team effort. You can have all the science and research in the world, which are important, but you have to actually take it and change practice in the institution. Use that data to make a difference.”

Additional Information:
The Panel Session, Optimal Perioperative Anticoagulation, was held October 25, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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