Extended pharmacological thromboprophylaxis and clinically relevant venous thromboembolism after major abdominal and pelvic surgery: international, prospective, propensity score-weighted cohort study

作者：EuroSurg Collaborative and STARSurg Collaborative, A Sgrò, Ruth Blanco‐Colino, Niall Brindl, D Chaudhry, K Gressmann, Rohan R Gujjuri, Amie Hilder, E Matey, I S Pereira, Akif Turna, Chris Varghese, W Xu, Kenneth A McLean, R Blanco-Colino, N Brindl, Steven R. Brown, William Cambridge, D Chaudhry, K Gressmann, Rohan R Gujjuri, Amie Hilder, Amir K. Jaffer, Ieva Jakaityte, Sivesh K. Kamarajah, Michal Kawka, Omar Kouli, E Matey, Kenneth A McLean, Aleksandra Mergo, Emily Mills, Victoria Murray, Szy Ooi, I S Pereira, Aya Riad, A Sgrò, Shakib Shafi, Isobel M Trout, Akif Turna, Chris Varghese, W Xu, Bruce Biccard, Annemarie B Docherty, J Martin, Kariem El‐Boghdadly, Mandeep Phull, Ronélle Mouton, Aneel Bhangu, James Glasbey, Ewen M. Harrison, Kenneth A McLean, Neil Smart, S Moug, Thomas Pinkney, Tomos Richards, I Dajti, Michael de Cillia, Gabriëlle H. van Ramshorst, S Delibegovic, Hafiz Muhammad Faizan Mughal, J Mihanovic, Nikolaos Gouvas, Petr Kocián, V Levesen, J Kaupilla, N Brindl, Daniela Merz, M. Joos, Argyrios Ioannidis, G Nnaji, Francesco Pata, G Pellino, A Gori, M Podda, C Riboni, Elisabetta Moggia, Enver Fekaj, Simone Oliver Senica, A Dauksa, Josephine Psaila, F de Ruitjer, Piotr Major, Ignacio de los Santos, Mafalda Sampaio-Alves, Joana Simões, Eduard-Alexandru Bonci, Andrei Paşca, A Novikova, Branislav Kovačević, Vladimir Milosavljević, Boris Tadić, J Kosir, Ruth Blanco‐Colino, S Pérez Ajates, M E Ossola Revilla, Andrea Papadia, C Riboni, Maria Luisa Gasparri, M K Aktas, B E Baki, Mustafa Deniz Tepe, Arda Ulaş Mutlu, Ashwani K. Singal, J Osei-Bonsu, Hubert Lacey, S W Chan, M. Allison, Kwaku Duah-Asante, David C. Chen, Nauman Ahmed, A Ejiz, C Takyi, M Mujeeb, Nishant Ravikumar, M Khan, Jennifer Hayes, J Mckenna, Jin Wang, N Essa, H Xianghan, Li-Wei Ko, Yousif Aldabbagh, Josip Plascevic, Nicholas Zia, R Ismail, Yasser Mostafa Kamel, Ilias Ektor Epanomeritakis, Ru‐San Tan, Nien‐Mu Chiu, Atif Naeem, Mehak Kakwani, Rakesh Mehra, Kynan Feeney, C L Yan Naing, Ahmad Uzair Qureshi, A. Richens, H Li, Rashid Ahmed, L. Wilson, Sophia M Abraha, I Dajti, Saulius Mikalauskas, Joseph Kahn, Daniela Kniepeiss, Maša Kušar, André Belarmino, J Frenk, I Mikalauskiene, A. De Angelis, James Elvis Waha, S Al-Sharafy, Musrat Sandano, Peter Schemmer, Christian Reiterer, Karen D. Horvath, Alexander Taschner, Stefan Riss, Felix Harpain, Christopher Dawoud, Nicole Hantáková, Nikolas Adamowitsch, S Schallmeiner, Taylor Christian, Vivian Xu, Melanie Kuhrn, Kerstin Melanie Widmann, Bronislav Čapek, Berfin Kama, Selin Turan Turgut, Laurenz Hauptmann, Michael de Cillia, Martin Grünbart, Hannes Hoi, Ashley Binder, Thomas Gürtler, P. Riedl, David Mayer, K Van Belle, Océane Wautelet, Eugènie Dekkers, Elke Van Daele, T. Apers, Gabriëlle H. van Ramshorst, Frederik Berrevoet, Natalie Rennie, Pieter Dries, Paraschiva Cherecheș-Panța, Alban Denys, Willem Pype, T Bauwens, Nuria Renard, Sarah Violon, Jasper Stijns, TA Winkel, Ellen Van Eetvelde, Mirhan Salibasic, S Delibegovic, Sadat Pušina, Edin Hodžić, M Kruščica, S Žilić, E Bicakcic, Ajdin Rovcanin, Edin Kulović, Emsad Halilović, Amir Hodžić, E Kalbić, S Delibegovic, Aida Mujić, M Mešan, Ervin Matović, S Delibegovic, Amar Kesetovic, Dragomir Dardanov, Elena Arabadzhieva, B. Markov, К Спасова, C Biji, Neyara dos Santos Oliveira, V Miroslavov, G. Korukov, Kapilraj Ravendran, N Shah, Y Mitkov, K Arivanandan, Rupali B Gaikwad, S Gotru, Rashmi Saraff, N. S. Sain, Desislav Stanchev, Lyubomir Gaydarski, Usama Ahmed Ali, Lorraine Joseph Kandathil, A Krishnaveni, Иван Иванов, I Ganev, Т Krapeshki, Mansoor R Miza, Msk Mumu, Ilia Bashliev, Aamir Sajjad, Lata R Chandel, D Yordanov, Evguenia Hristova, Kolyo Spassov, Tsanko Tsankov, Tsvetomir Ivanov, E Filipov, D Georgiev, V Neykov, E Daleva, Iliana Ilieva, Daniela Krasimirova, Christo Christov, Maia Arsova, O Soladoye, A Biswakarma, Rhea Raj, A Negi, Aparajit Ballav Dey, J K Adidela, U G Alionye, A. U. NDUKWE, Rosen Dimov, V. A. 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Thaha, Michael Bath, S A Saadqain, Y Benallal, Zhezhen Jin, Ashley Jackson, Ashvin Kuri, Muhammad Usman Malik, H Jos, Ee Teng Goh, M E Paraskevopoulou, A Kythreotis, Yousra Ahmed, Sevasti Panagiota Glynou, HS Rehan, Akila Pai, Apostolos Georgiannakis, N Dworschak, Soo Ick Cho, Benjamin J.W. Chow, Yusra Habib Khan, T Enthoven, A Malik, Irum Latif, Alpa Lakhani, Nafis A. Rahman, Katherine A. Morgan, S Gkolia, N Khalessi, Plz May, A Lwin, P Kanesaratnam, M Tudgee, Rachel English, Kenneth S. Hu, N Pathanchaly, Dcs Chien, M. Holloway, Kun Gao, G Lekka, Ravi Srinivasan, Syed Nabeel Zafar, M R Peris, K Keiarash, Hariprasath Kanesan, Belinda Chong, Marta Kobus, Dobson Dominic, D A, Douglas A. Dennis, S Frankland, Viral N. Shah, B Youssef, U Sadia, Ammar Hassouneh, Anthony Jaipersad, Tianhui Chen, M Fulford, Andrew Dawson, Kush Kapur, Trisha Jha, P Zope, Marc D. Wilkinson, V. Bhatnagar, Jason S. Knight, Thumuluru Kavitha Madhuri, T Katsiari, N Pasternak-Albert, E Moussa, L Emms, Marc Lamah, Zahida Batool, Arvind Sabesan, Sajia Islam, Mirza Rafi Baig, Maneesh Dave, Yang Liu, LM Stuart, Sarah Harvey, Veerle Dam, P Ezuma, J Lee, S Suntharalingam, Simrandeep Singh, Paul Preston, Frances Rickard, Tejpal Gupta, Stephen F. Madden, Cathy Jones, Risha Gidwani, X Wang, Michael V. McConnell, Stephanie Hanna, A Mcgettigan, K Brown, Ana Cios, C Ward-Bradley, O Hurrell, V Paice, Nyasha Mutsonziwa, S Pogoson, Rory Coulter, June Corry, Louise McClean, F. P. Keenan, S O’dolan, Alexander T. Plonkowski, R Brady, Rucira Ooi, David Iles, Laurent Guillemot, Chen Sheng Low, S El-Barraj, Jay S. Epstein, Milton L. Pressler, Ioannis Ioannou, N. Soliman, A Ktayen, A.M. MacConnachie, Jaime Lorenzo, J. E. Tooke, K Noman, Laura Wilkins, John Warner‐Levy, Richard Evans, Andrew Torrance, Claudine Fear, Hilton Humphries, Ganesh Velayudham, Zak Jefferson-Pillai, Jennifer J. Brady, Ranu Oza, Dhruv P. Singh, A Hamid, P Hartop, Parham Shojaie, João F. Mano, Tanisha Rajah, Ymc Cabdi, Ashwani K. Singal, Mohammad H. Afzali, Jin‐Moo Lee, Debabrata Bandyopadhyay, J Bennett, P Mendenhall, Allan R. Millett, Sue‐Anne Davidson, R Kallam, M Pishia, Helen Butler, S Isidore, D Boutsias, Kathleen Bryce, T De Rancourt, Jonathan Barry, H Henry, Alexander I. Aspinall, L Smith, Charles R. Conway, H Shanmugathas, Chien‐Cheng Huang, Michael Doherty, Kawsar Ahmed, Thomas K. Chung, Thea Emily Benson, Alouani Habiba, Jagdeep Singh Bhangu, B Bingor, L Fice, H Premanandhan, J Mckenna, I Jimenez-Reid, M Hoque, E Griffiths, John Loughran, M Laskowski, A. Mehmood, R O'Kane, Michael Mullan, RE McClenaghan, Grace Kettyle, F Hosty-Blaney, Xhf Chan, Sumsum P. Sunny, Mandeep Kaur, Stephen O. Vose, Vineeth George, D Killoran, R Doherty, Z Zagorac, A. M. Pullyblank, R Ismail, Natalie Anderton, Lisa Dwyer‐Joyce, Rebecca Morgan, Na Zhang, B French, Helen Cox, J Tetro, Anne Clarke, Katie Shaw, R Iau, E. King, Saavan Patel, M Ovakimian, A Zahid, Guy Anthony Rowley, Rikki M. Tanner, Kaveh Davoudi, Brian M. Shear, Meiying Xu, Krit Karan, A. O’Reilly, Sofia B. Ahmed, T. Kирилова, Angbashim Jude Ezekiel, M. Shapland, Maithilee Mitra, T Krum, George Higginbotham, Rahul Winayak · 发表于：British journal of surgery · 年份：2025 · DOI：10.1093/bjs/znaf005 · 被引用次数：3 · 研究领域：Venous Thromboembolism Diagnosis and Management、Antiplatelet Therapy and Cardiovascular Diseases、Cardiac, Anesthesia and Surgical Outcomes

BACKGROUND: There is low-certainty evidence on the impact of extended pharmacological prophylaxis on venous thromboembolism-associated morbidity and mortality. The aim of this study was to determine the efficacy and safety of extended prophylaxis after major abdominopelvic surgery for the prevention of clinically relevant venous thromboembolism after hospital discharge. METHODS: CArdiovaSCulAr outcomes after major abDominal surgEry (CASCADE) was a prospective, international, cohort study into which consecutive adult patients undergoing major abdominopelvic surgery were enrolled (January-May 2022). Extended prophylaxis was considered at least 28 days of anticoagulant prescription after surgery. The primary efficacy outcome was clinically relevant venous thromboembolism and the primary safety outcome was clinically relevant bleeding within 30 days after surgery (European Medicines Agency definitions). The independent association of these outcomes with extended prophylaxis was explored using mixed-effects logistic regression and propensity score weighting. RESULTS: A total of 11 571 patients (median age of 58.0 years; 6399 (55.3%) women) from 29 countries were included. The extended prophylaxis prescription rate was 31.7% (3670 patients). The post-discharge venous thromboembolism and bleeding rates were 0.1% (12 patients) and 0.7% (85 patients) respectively. After weighting, extended prophylaxis was not significantly associated with increased bleeding risk (OR 1.07 (95% c.i. 0.6...