Should all patients receive the same prophylaxis? Racial variation in the risk of venous thromboembolism after major abdominal operations - 29/11/21

Doi : 10.1016/j.amjsurg.2021.05.020

Ya-Wen Chen ^a,^b , Zhi Ven Fong ^a,^b , Motaz Qadan ^a , Hiroko Kunitake ^a , John T. Mullen ^a , David C. Chang ^a,^b,^⁎
^a Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, 55 Fruit Street, Boston, MA, USA
^b Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, 165 Cambridge St, Suite 403, USA

^∗Corresponding author. Department of Surgery, Massachusetts General Hospital, Boston, 165 Cambridge St, Suite 403, MA, 02114.Department of SurgeryMassachusetts General Hospital165 Cambridge StSuite 403BostonMA02114

Abstract

Background

Whether prevention strategy for postoperative venous thromboembolism (VTE) should be tailored across racial groups remains unknown.

Methods

Patients who underwent major abdominal operation in the Nationwide Inpatient Sample (NIS) were examined. Our primary outcome was postoperative VTE, and the secondary outcome was postoperative bleeding. Multivariable logistic regression analyses were performed and validated with the National Surgical Quality Improvement Program (NSQIP) database.

Results

781,888 patients from NIS were analyzed. Overall VTE rate was 2.0%. Compared to White patients, Hispanic (OR 0.85, 95% CI 0.78–0.93, p < 0.01) and Asian patients (OR 0.49, 95% CI 0.40–0.61, p < 0.01) had significantly lower risks for VTE. In contrast, Asian patients had a significantly higher risk of bleeding (OR 1.39, 95% CI 1.24–1.56, p < 0.01). Similar trends were observed in NSQIP.

Conclusions

The risk-benefit ratio of postoperative VTE prophylaxis for Asian patients is roughly three times higher than that for White patients, suggesting a tailored approach is necessary.

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Highlights

•	Hispanic and Asian patients have a lower risk of postoperative venous thromboembolism.
•	Asian patients have a higher risk of postoperative bleeding.
•	The risk-benefit ratio of prophylaxis for Asian patients is roughly three times higher than that for White patients.
•	Tailored approach to postoperative venous thromboembolism prophylaxis is necessary.

El texto completo de este artículo está disponible en PDF.

Keywords : Tailored thromboembolism prophylaxis, Heterogeneity of treatment effect, Race and personalized medicine