Background: Venous thromboembolism (VTE), a composite of deep vein thrombosis and pulmonary embolism, is a preventable cause of morbidity and mortality in surgical patients. Method: National and international treatment guidelines and major clinical trials on mechanical or pharmacological VTE prophylaxis in surgical patients were reviewed. Results: The risk of perioperative VTE is dependent on patient- and surgery-related risk factors. Based on a thorough and individualized risk assessment, each surgical patient should be assigned a low, intermediate, or high risk of VTE. Whereas basic (e.g. early mobilization and avoidance of dehydration) and mechanical (i.e. graduated compression stockings) measures are appropriate for most low-risk patients, visceral surgical patients at intermediate or high risk of VTE should receive pharmacological thromboprophylaxis for at least 7-10 days. The risk of VTE should be balanced against the risk of bleeding. Low-molecular-weight heparin (LMWH) offers several advantages over low-dose unfractionated heparin and should be administered for prolonged periods in patients undergoing particularly high-risk (i.e. cancer) surgery. Conclusion: Perioperative VTE prophylaxis should be carried out in an individualized and risk-adapted manner. In visceral surgical patients with a moderate-to-high risk of VTE and a low risk of bleeding, pharmacological thromboprophylaxis with LMWH is a standard of care.

Keywords:
Surgery, Thrombosis, Low-molecular-weight heparin, Cancer, Thromboprophylaxis
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2013
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