EARLY PROPHYLACTIC ANTICOAGULATION IN THE POST-OPERATIVE PERIOD: A LITERATURE REVIEW

• Published in: Hematology, Transfusion and Cell Therapy
• Main Authors: MCKD Nascimento, NSD Nascimento, CB Sousa
• Format: Article
• Language: English
• Published: Elsevier 2024-10-01
• Online Access: http://www.sciencedirect.com/science/article/pii/S2531137924023368

Objectives: Thromboembolic complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE) are frequent and potentially serious and lethal after a surgical procedure. Early anticoagulation is a widely discussed preventive strategy aimed at minimizing the risk of these complications, but it is not fully used in practice due to concerns about the risk of bleeding. The aim of this study was to evaluate the efficacy and safety of early anticoagulation in the postoperative period in general. Material and methods: A systematic literature review was carried out using the Scielo and Google Scholar databases, using the keywords “prophylactic anticoagulation” and “postoperative”. Randomized clinical studies, controlled trials and literature reviews published in the last 10 years comparing early anticoagulation with late anticoagulation or no anticoagulation were included. The analysis focused on parameters such as the incidence of DVT and PE, bleeding events and adverse effects associated with early anticoagulation. Results: The study used 25 articles on the subject. The post-operative period favors the appearance of thrombotic events due to the activation of the three elements that make up Virchow's triad: venous stasis, endothelial damage and hypercoagulability. Venous stasis occurs due to reduced blood flow as a result of immobilization and reduced muscle activation, especially in the lower limbs. Endothelial damage occurs due to tissue manipulation during the procedure. In addition, the inflammatory state and altered homeostasis create a hypercoagulable environment, activating platelet aggregation and the coagulation cascade. In this way, the patient is subject to various thrombotic complications. Discussion: It has been observed that early anticoagulation, started within 12 to 24 hours of surgery, is effective in significantly reducing the incidence of thromboembolic events and morbidity and mortality in the postoperative period. The safety of early anticoagulation has also been evaluated, and it has been shown that there is no significant increase in the risk of serious hemorrhagic events in restarting anticoagulation in the immediate postoperative period. However, some studies point to a slight increase in the risk of minor bleeding and associated complications, reinforcing the need for strict patient monitoring in this period. Conclusion: Early anticoagulation is an effective approach to preventing complications and thromboembolic phenomena, with a favorable safety profile. It is necessary for institutions to implement early anticoagulation protocols to improve post-operative outcomes, assessing individual patients and surgical procedures for appropriate risk-benefit ratios.