4 VIEWS & REVIEWS

Postoperative proph~ for venous thromboembolism worth COINderatiOll

Postoperatively initiated prophylaxis fo r venous thromboembolism is safe and effective, according to Drs Clive Kearon and Jack Hirsh from Hamilton, Ontario. Canada. Adopting such an approach could possibly eliminate anticoagulant-i nduced intra­operative bleeding, and therefore reduce physician reluctance to institute prophylaxis.

Conclusions based on review Their conclusions on the safety and efficacy of

postoperative prophylaxis for venous thrombo­embolism are based on a review of relevant studies in patients undergoing e lective surgery. The review included 8 tria1s comparing postoperatively initiated prophylaxis with an untreated control group, and 5 studies comparing different methods of prophylaxis.

Drs Kearon and Hirsh emphasise, however. that they could not identify any studies that compared the same method of prophylaxis initiated preoperatively and postoperatively. Thi s means that the relative efficacy of each approach has not been established, and they call for studies to address this issue.

Many thrombi """"'" spontaneow;ly It has conventionally been accepted that propbyl­

axis for venous thromboembolism must be initiated prior to surgery because leg scanning studies have indicated that a great proportion of cases of deep vein thrombosis are initiated during or shortly after the surgical procedure. However, many of these thrombi may resolve spontaneously, and Drs Kearon and Hirsh suggest that postoperatively initiated prophylaxis may aid such resolution and reduce the risk of deep vein thrombosis developing at a later stage. KaronC. Hlr$b J. Swtin, propIIyluis for '1:nous IlIromboemboliim pow>penli'1:ly. An::bive$ orlntemal MedictM us: 3(;6.372. 27 Feb 1995

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