Should all patients receive the same prophylaxis? Racial variation in the risk of venous thromboembolism after major abdominal operations

Ya-Wen Chen; Zhi Ven Fong; Motaz Qadan; Hiroko Kunitake; John T Mullen; David C Chang

doi:10.1016/j.amjsurg.2021.05.020

Should all patients receive the same prophylaxis? Racial variation in the risk of venous thromboembolism after major abdominal operations

Am J Surg. 2021 Nov;222(5):884-889. doi: 10.1016/j.amjsurg.2021.05.020. Epub 2021 Jun 10.

Authors

Ya-Wen Chen¹, Zhi Ven Fong², Motaz Qadan³, Hiroko Kunitake⁴, John T Mullen⁵, David C Chang⁶

Affiliations

¹ Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, 55 Fruit Street, Boston, MA, USA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, 165 Cambridge St, Suite 403, USA. Electronic address: ychen120@mgh.harvard.edu.
² Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, 55 Fruit Street, Boston, MA, USA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, 165 Cambridge St, Suite 403, USA. Electronic address: zfong@mgh.harvard.edu.
³ Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, 55 Fruit Street, Boston, MA, USA. Electronic address: mqadan@mgh.harvard.edu.
⁴ Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, 55 Fruit Street, Boston, MA, USA. Electronic address: hkunitake@partners.org.
⁵ Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, 55 Fruit Street, Boston, MA, USA. Electronic address: jmullen@mgh.harvard.edu.
⁶ Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, 55 Fruit Street, Boston, MA, USA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, 165 Cambridge St, Suite 403, USA. Electronic address: dchang8@mgh.harvard.edu.

PMID: 34144805
DOI: 10.1016/j.amjsurg.2021.05.020

Abstract

Background: Whether prevention strategy for postoperative venous thromboembolism (VTE) should be tailored across racial groups remains unknown.

Methods: Patients who underwent major abdominal operation in the Nationwide Inpatient Sample (NIS) were examined. Our primary outcome was postoperative VTE, and the secondary outcome was postoperative bleeding. Multivariable logistic regression analyses were performed and validated with the National Surgical Quality Improvement Program (NSQIP) database.

Results: 781,888 patients from NIS were analyzed. Overall VTE rate was 2.0%. Compared to White patients, Hispanic (OR 0.85, 95% CI 0.78-0.93, p < 0.01) and Asian patients (OR 0.49, 95% CI 0.40-0.61, p < 0.01) had significantly lower risks for VTE. In contrast, Asian patients had a significantly higher risk of bleeding (OR 1.39, 95% CI 1.24-1.56, p < 0.01). Similar trends were observed in NSQIP.

Conclusions: The risk-benefit ratio of postoperative VTE prophylaxis for Asian patients is roughly three times higher than that for White patients, suggesting a tailored approach is necessary.

Keywords: Heterogeneity of treatment effect; Race and personalized medicine; Tailored thromboembolism prophylaxis.

MeSH terms

Adolescent
Adult
Anticoagulants / therapeutic use*
Asian People / statistics & numerical data
Black People / statistics & numerical data
Digestive System Surgical Procedures / adverse effects*
Female
Humans
Male
Middle Aged
Postoperative Hemorrhage / ethnology
Postoperative Hemorrhage / etiology
Racial Groups / statistics & numerical data*
Risk Factors
Venous Thromboembolism / ethnology
Venous Thromboembolism / etiology
Venous Thromboembolism / prevention & control*
White People / statistics & numerical data
Young Adult

Substances

Anticoagulants