• Tino Singh, Lauri I Lavikainen, Alex L E Halme, Riikka Aaltonen, Arnav Agarwal, Marco H Blanker, Kostiantyn Bolsunovskyi, Rufus Cartwright, Herney García-Perdomo, Rachel Gutschon, Yung Lee, Negar Pourjamal, Robin W M Vernooij, Philippe D Violette, Jari Haukka, Gordon H Guyatt, and TikkinenKari A OKAO0000-0002-1389-8214Faculty of Medicine, University of Helsinki, Helsinki, Finland.Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.Department of Surgery, South Karelian Central Hospital, .
• Faculty of Medicine, University of Helsinki, Helsinki, Finland.
• Br J Surg. 2023 Apr 12; 110 (5): 553561553-561.

BackgroundThe timing at which venous thromboembolism (VTE) occurs after major surgery has major implications for the optimal duration of thromboprophylaxis. The aim of this study was to perform a systematic review and meta-analysis of the timing of postoperative VTE up to 4 weeks after surgery.MethodsA systematic search of MEDLINE, Scopus, and CINAHL databases was performed between 1 January 2009 and 1 April 2022. Prospective studies that recruited patients who underwent a surgical procedure and reported at least 20 symptomatic, postoperative VTE events by time were included. Two reviewers independently selected studies according to the eligibility criteria, extracted data, and evaluated risk of bias. Data were analysed with a Poisson regression model, and the GRADE approach was used to rate the certainty of evidence.ResultsSome 6258 studies were evaluated, of which 22 (11 general, 5 urological, 4 mixed, and 2 orthopaedic postoperative surgical populations; total 1 864 875 patients and 24 927 VTE events) were eligible. Pooled evidence of moderate certainty showed that 47.1 per cent of the VTE events occurred during the first, 26.9 per cent during the second, 15.8 per cent during the third, and 10.1 per cent during the fourth week after surgery. The timing of VTE was consistent between individual studies.ConclusionAlthough nearly half of symptomatic VTE events in first 4 weeks occur during the first postoperative week, a substantial number of events occur several weeks after surgery. These data will inform clinicians and guideline developers about the duration of postoperative thromboprophylaxis.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

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