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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

Copyright © 2003 EDIZIONI MINERVA MEDICA

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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