What is the value of preoperative prophylactic heparin in reducing venous thromboembolism in major non-cardiac thoracic surgery?

Niyi Odewade; Nosayaba Enofe; Monica Soni; Stanley Wolfe; Chi-Fu Yang; Asishana Osho

doi:10.1016/j.amjsurg.2022.05.034

What is the value of preoperative prophylactic heparin in reducing venous thromboembolism in major non-cardiac thoracic surgery?

Am J Surg. 2022 Oct;224(4):1086-1089. doi: 10.1016/j.amjsurg.2022.05.034. Epub 2022 May 27.

Authors

Niyi Odewade¹, Nosayaba Enofe², Monica Soni³, Stanley Wolfe⁴, Chi-Fu Yang⁵, Asishana Osho⁶

Affiliations

¹ Harvard Medical School, Boston, MA, USA.
² Drexel University School of Medicine, Philadelphia, PA, USA; Crozer Chester Medical Center, General Surgery, One Medical Blvd, Upland, PA, 19013, USA.
³ Georgetown University School of Medicine, Washington, DC, USA.
⁴ Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Cardiac Surgery, Cox 6, 55 Fruit Street, Boston, MA, 02114, USA.
⁵ Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Thoracic Surgery, Austen 7, 55 Fruit Street, Boston, MA, 02114, USA.
⁶ Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Cardiac Surgery, Cox 6, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: Asishana.osho@mgh.harvard.edu.

PMID: 35660085
DOI: 10.1016/j.amjsurg.2022.05.034

Abstract

Background: Studies have investigated the utility of preoperative heparin to mitigate venous thromboembolism risk after surgery. However, whether heparin reduces the risk of VTE following major thoracic surgery is undetermined. A national heparin shortage beginning in September 2019 provided the opportunity for a natural experiment to explore this question.

Methods: A retrospective analysis was conducted including all major thoracic surgery cases at a single center from March 2019 to April 2020. The primary outcome was VTE. Two sample t-tests, Chi-Square analyses, and multivariable regressions were performed.

Results: The study consisted of 890 patients, 391 before the heparin shortage and 499 afterwards. 398 total patients received heparin, 340 before the heparin shortage and 58 afterwards. On univariate analyses, there was no association between VTE and preoperative heparin (p > 0.90). This remained consistent on multivariable analyses (p > 0.1).

Conclusion: In this single center analysis, there was no association between preoperative heparin and the occurrence of postoperative VTE. Analyses in larger cohorts will provide additional evidence to guide policies on the use of preoperative prophylactic heparin.

Keywords: Adverse events; Decision making; Management; Quality of care; Thoracic.

MeSH terms

Anticoagulants / therapeutic use
Heparin / therapeutic use
Humans
Retrospective Studies
Thoracic Surgery*
Venous Thromboembolism* / etiology
Venous Thromboembolism* / prevention & control

Substances

Anticoagulants
Heparin