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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2002 March;21(1):78-85


lingua: Inglese

The use of low molecular weight heparins for the prevention of postoperative venous thromboembolism in general surgery. A survey of practice in the United States

Caprini J. A., Arcelus J. *, Sehgal L. R., Cohen E. B., Reyna J. J. *

From the Departments of Surgery, Evanston Northwestern Healthcare, Evanston, IL, Northwestern University Medical School, Chicago, IL, USA and
* Hospital de la Axarquía, Vélez-Málaga, Spain

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Background. Even ­though low molec­u­lar ­weight hep­a­rins (LMWHs) have ­become the stan­dard for ­venous throm­boem­bo­lism (VTE) pro­phy­lax­is in most European coun­tries and Canada, it was not until recent­ly that LMWHs were ­approved for use in the United States. The main objec­tive of this study was to ­assess the cur­rent pref­er­enc­es and atti­tudes of United States sur­geons ­toward the pre­ven­tion of VTE with par­tic­u­lar ref­er­ence to LMWH.
Methods. A sur­vey with ques­tions rel­a­tive to VTE aware­ness, risk fac­tors, and pre­ven­tion prac­tic­es was ­mailed to 10,000 Fel­lows of the American College of Surgeons.
Results. A total of 1,145 (11.45%) ­usable ques­tion­naires were ­returned. The vast major­ity (96%) of respon­dents use pro­phy­lax­is ­against VTE. Although LMWHs were rated first regard­ing effi­ca­cy and sec­ond regard­ing sim­plic­ity of use, con­ven­tion­al unfrac­tion­at­ed hep­ar­in at fixed doses ­remains the pre­ferred phar­mac­o­log­i­cal agent for VTE pre­ven­tion (74%), fol­lowed by 2 LMWHs: enox­ap­ar­in (34%) and dal­tep­ar­in (16%). Overall, 52% of sur­geons pre­ferred phys­i­cal meth­ods over phar­mac­o­log­i­cal meth­ods when used sep­ar­ate­ly and 26% of sur­geons uti­lize com­bined phys­i­cal-phar­mac­o­log­i­cal modal­ities.
Conclusions. North American gen­er­al sur­geons have sub­stan­tial­ly mod­i­fied their ­approach to VTE pre­ven­tion in the last 4 years. Physical meth­ods and unfrac­tion­at­ed hep­ar­in ­remain the pre­ferred pro­phy­lac­tic modal­ities, but LMWHs have ­gained rapid accep­tance since their approv­al for use for VTE pre­ven­tion in North America. Even ­though the ­results of this sur­vey must be inter­pret­ed with cau­tion ­because of the lim­it­ed ­response rate and pos­sible sam­pling bias, they still ­reflect the cur­rent pref­er­enc­es and atti­tudes of North American sur­geons ­toward pro­phy­lax­is.

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