What is the role of anticoagulation for minimally invasive surgery?


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Comments

I have not been routinely sending patients who undergo minimally invasive surgery home on prophylactic anticoagulation. I have yet to see data that suggests benefit in this population. If someone has h/o VTE or other significant risk factors, I will consider on a case by base basis.  What do others do?

Joshua Cohen replied on

This discussion prompted me to go to the Caprini score calculator, which I normally do not do for MIS patients (as I typically send them home without AC either).  however, may of our patients would score in a range to recommend a week of chemoprophylaxis for VTE postop.  Food for thought! 

 

Sharmilee Korets replied on

I do! Our practice follows the ASCO clinical practice guidelines and recommend ppx for major cancer surgery for at least a week- extend to 4 weeks if laparotomy or other high risk features (restricted mobility, obesity, etc). [https://ascopubs.org/doi/10.1200/JCO.19.01461] I do factor in fall risk, financial toxicity and bleeding risk to individualize prn and recognize limitations in data. Work in an urban underserved community, so high risk patient population. Interested to hear what others think!

Stephanie Sullivan replied on