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Risk of PE significantly raised well beyond six weeks post-surgery

Postoperative pulmonary embolism risk still elevated 7-12 weeks later, regardless of the type of procedure

Louise Prime

Thursday, 10 October 2019

The risk of pulmonary embolism (PE) remains significantly elevated beyond six weeks after a surgical procedure, according to a new study* published in JAMA Surgery, that showed that the excess risk of PE can be raised by as much as four times even 7-12 weeks post-surgery. The researchers behind the study called for further investigation into how postoperative prophylactic anticoagulation can balance the relative risks of thrombosis and bleeding after surgery.

The research team from the University of Lille, France, assessed the duration and magnitude of the late postoperative risk of PE by type of surgery, by conducting a case-crossover analysis of 60,703 cancer-free men and women aged 45-64 years from the French national inpatient database. They included six types of surgery in their analysis: vascular surgery, gynaecological surgery, gastrointestinal surgery, hip or knee replacement, fractures, and other orthopaedic operations.

They found that the risk of postoperative PE was significantly elevated for at least 12 weeks after all types of surgery and was highest during the immediate postoperative period (one to six weeks). The excess risk of postoperative PE ranged from odds ratio (OR) 5.24 for vascular surgery to OR 8.34 for surgery for fractures.

However, the risk remained elevated from seven to 12 weeks, with the OR ranging from 2.26 for gastrointestinal operations to 4.23 for surgery for fractures. The risk was not clinically significant beyond 18 weeks post-surgery for all types of procedures.

They commented: “The risk of postoperative pulmonary embolism is elevated beyond six weeks post-surgery regardless of the type of procedure. The persistence of this excess risk suggests that further randomised clinical trials are required to evaluate whether the duration of postoperative prophylactic anticoagulation should be extended and to define the optimal duration of treatment with regard to both the thrombotic and bleeding risks.”

*Caron A, Depas N, Chazard E, et al. Risk of pulmonary embolism more than 6 weeks after surgery among cancer-free middle-aged patients. JAMA Surg. Published: October 09, 2019. DOI:10.1001/jamasurg.2019.3742.

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