PMID- 28203409
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 9
IP  - 1
DP  - 2017 Jan
TI  - Practice patterns in venous thromboembolism (VTE) prophylaxis in thoracic 
      surgery: a comprehensive Canadian Delphi survey.
PG  - 80-87
LID - 10.21037/jtd.2017.01.38 [doi]
AB  - BACKGROUND: The incidence of venous thromboembolic events (VTE) after resection 
      of thoracic malignancies can reach 15%, but prophylaxis guidelines are yet to be 
      established. We aimed to survey Canadian practitioners regarding perioperative 
      risk factors for VTE, impact of those factors on extended prophylaxis selection, 
      type of preferred prophylaxis, and timing of initiation and duration of 
      thromboprophylaxis. METHODS: A modified Delphi survey was undertaken over three 
      rounds with thoracic surgeons, thoracic anesthesiologists and thrombosis experts 
      across Canada. Participants were asked to rate each parameter on a ten-point 
      scale. Agreement was determined a priori as an item reaching a coefficient of 
      variation of </=30% (0.3), with the item then discontinued from later rounds. 
      RESULTS: In total, 72, 57 and 50 respondents participated in three consecutive 
      rounds, respectively. Consensus was reached on previous VTE, age, cancer 
      diagnosis, thrombophilia, poor mobilization, extended resections, and 
      pre-operative chemotherapy as risk factors. Consensus on risk factors impacting 
      extended prophylaxis decisions was achieved on cancer diagnosis, obesity, 
      previous VTE and poor mobilization. With respect to perioperative prophylaxis, 
      once daily low-molecular-weight heparin (LMWH) was the only parameter that 
      demonstrated agreement as a common practice pattern. No agreement was achieved 
      regarding the role of mechanical prophylaxis, unfractionated heparin (UFH) or 
      timing of initiation of peri-operative treatment. VTE prophylaxis until discharge 
      reached agreement but there was substantial variability regarding the role of 
      extended prophylaxis. CONCLUSIONS: There is agreement between Canadian clinicians 
      treating patients with thoracic malignancies regarding most risk factors for VTE, 
      but there is no agreement on timing of initiation of prophylaxis, the agents used 
      or factors mandating usage of extended prophylaxis.
FAU - Agzarian, John
AU  - Agzarian J
AD  - Department of Surgery, Faculty of Health Sciences, McMaster University, St. 
      Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.
FAU - Linkins, Lori-Ann
AU  - Linkins LA
AD  - Department of Medicine, Faculty of Health Sciences, McMaster University, 
      Hamilton, ON L8S 4K1, Canada.
FAU - Schneider, Laura
AU  - Schneider L
AD  - Department of Surgery, Faculty of Health Sciences, McMaster University, St. 
      Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.
FAU - Hanna, Wael C
AU  - Hanna WC
AD  - Department of Surgery, Faculty of Health Sciences, McMaster University, St. 
      Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.
FAU - Finley, Christian J
AU  - Finley CJ
AD  - Department of Surgery, Faculty of Health Sciences, McMaster University, St. 
      Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.
FAU - Schieman, Colin
AU  - Schieman C
AD  - Department of Surgery, Faculty of Health Sciences, McMaster University, St. 
      Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.
FAU - De Perrot, Marc
AU  - De Perrot M
AD  - Department of Surgery, Faculty of Medicine, University of Toronto, University 
      Health Network, Toronto, ON M5G 2C4, Canada.
FAU - Crowther, Mark
AU  - Crowther M
AD  - Department of Medicine, Faculty of Health Sciences, McMaster University, 
      Hamilton, ON L8S 4K1, Canada.
FAU - Douketis, James
AU  - Douketis J
AD  - Department of Medicine, Faculty of Health Sciences, McMaster University, 
      Hamilton, ON L8S 4K1, Canada.
FAU - Shargall, Yaron
AU  - Shargall Y
AD  - Department of Surgery, Faculty of Health Sciences, McMaster University, St. 
      Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.
LA  - eng
PT  - Journal Article
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
PMC - PMC5303083
OTO - NOTNLM
OT  - Blood
OT  - coagulation/anticoagulation
OT  - esophageal surgery operations
OT  - lung cancer surgery
OT  - pulmonary embolism (PE)
OT  - surgery complications
COIS- Conflicts of Interest: Moderated poster presentation at the 25th International 
      Society on Thrombosis and Haemostasis Congress/61st Annual Scientific and 
      Standardization Committee Meeting; Toronto, Ontario, Canada; June 20-25 2015.
EDAT- 2017/02/17 06:00
MHDA- 2017/02/17 06:01
PMCR- 2017/01/01
CRDT- 2017/02/17 06:00
PHST- 2017/02/17 06:00 [entrez]
PHST- 2017/02/17 06:00 [pubmed]
PHST- 2017/02/17 06:01 [medline]
PHST- 2017/01/01 00:00 [pmc-release]
AID - jtd-09-01-80 [pii]
AID - 10.21037/jtd.2017.01.38 [doi]
PST - ppublish
SO  - J Thorac Dis. 2017 Jan;9(1):80-87. doi: 10.21037/jtd.2017.01.38.