Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network

Anne Godier¹, Dominique Lasne², Gilles Pernod³, Normand Blais⁴, Fanny Bonhomme⁵, Fanny Bounes⁶, Alex Bourguignon⁷, Ariel Cohen⁸, Emmanuel de Maistre⁹, Pierre Fontana¹⁰, Jean-Philippe Galanaud¹¹, Delphine Garrigue Huet¹², Alexandre Godon¹³, Isabelle Gouin-Thibault¹⁴, Samia Jebara¹⁵, Silvy Laporte¹⁶, Thomas Lecompte¹⁷, Dan Longrois¹⁸, Jerrold H Levy¹⁹, Grégoire Le Gal²⁰, Yves Gruel²¹, Alexandre Mansour²², Anne-Céline Martin²³, Mikael Mazighi²⁴, Pierre-Emmanuel Morange²⁵, Serge Motte²⁶, François Mullier²⁷, Philippe Nguyen²⁸, Nadia Rosencher²⁹, Stéphanie Roullet³⁰, Pierre-Marie Roy³¹, Jean-François Schved³², Marie-Antoinette Sevestre³³, Pierre Sié³⁴, Sophie Susen³⁵, Charles Tacquard³⁶, André Vincentelli³⁷, Paul Zufferey³⁸, Patrick Mismetti³⁹, Pierre Albaladejo⁴⁰

Affiliations

¹ Université Paris Cité, Service d'anesthésie-réanimation, AP-HP, Hôpital Georges Pompidou, UMRS_1140, F-75006 Paris, France. Electronic address: Anne.godier@aphp.fr.
² Laboratoire d'hématologie générale, AP-HP, Hôpital Necker-Enfants Malades, INSERM UMRS_1176, Paris, France.
³ Service de Médecine Vasculaire, Université Grenoble-Alpes, Grenoble, France, F-CRIN INNOVTE network, Saint-Etienne, France.
⁴ Service d'hématologie et d'oncologie médicale. Centre Hospitalier de l'Université de Montréal. Canada.
⁵ Service d'Anesthésiologie, Département de Médecine Aigue, Hôpitaux Universitaires de Genève.
⁶ Pole Anesthésie-Réanimation CHU Toulouse, INSERM U1297 équipe 11 LIPSIPLAT, Toulouse, France.
⁷ Service d'hémato-oncologie, Centre Hospitalier Universitaire de Montréal, Montréal, Canada.
⁸ Service de cardiologie, hôpital Saint-Antoine, hôpital Tenon, Assistance publique-Hôpitaux de Paris, Sorbonne université, Paris, France.
⁹ Service d'Hématologie Biologique, Hôpital Le Bocage, CHRU de Dijon, 21000 Dijon, France.
¹⁰ Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland.
¹¹ Department of Medicine, Sunnybrook Heath Sciences Centre, University of Toronto, Toronto, ON, Canada.
¹² Department of anesthesiology and surgical care, CHU Lille, F-59000 Lille,France.
¹³ Univ. Grenoble Alpes, Anesthesiology and Critical Care, CHU Grenoble Alpes, Grenoble, France.
¹⁴ Department of Laboratory Hematology, Pontchaillou University Hospital, IRSET-INSERM-1085, Univ Rennes, Rennes, France.
¹⁵ St Joseph University, Department of anesthesia and critical care, Hotel Dieu de France hospital, Beirut,Lebanon.
¹⁶ Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Service de Pharmacologie Clinique, INSERM, SAINBIOSE U1059, F-42023 Saint-Étienne, France.
¹⁷ Université de Lorraine, Médecine, CHRU de Nancy, médecine vasculaire, France.
¹⁸ Department of Anesthesia and Intensive Care, Hôpital Bichat-Claude Bernard, Université de Paris, Paris, France.
¹⁹ Duke University School of Medicine, Departments of Anesthesiology, Critical Care and Surgery, Durham, NC, United States.
²⁰ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
²¹ Université Francois Rabelais, Inserm UMR1327 ISCHEMIA, Faculté de Médecine, Tours, France.
²² Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France. Univ Rennes, CHU Rennes, Inserm, IRSET, UMR_S 1085, F35000 Rennes, France.
²³ Unité Médico-chirurgicale d'Insuffisance Cardiaque Sévère, Chirurgie Cardiaque, AP-HP, Hôpital Européen Georges-Pompidou, and Université Paris Cité, INSERM UMRS_1140, F-75006 Paris, France.
²⁴ Neurology Department, Hôpital Lariboisière, and Interventional Neuroradiology Department, Hôpital Fondation A. de Rothschild, FHU Neurovasc, INSERM 1144, Université Paris-Cité, Paris, France.
²⁵ Aix Marseille Univ, INSERM 1263, INRAE 1260, C2VN, Marseille, France ; Hematology Laboratory, La Timone University Hospital of Marseille, Marseille, France.
²⁶ Université Libre de Bruxelles, Hôpital Universitaire de Bruxelles, Bruxelles, Belgium.
²⁷ Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis & Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Namur, and Institute of Experimental and Clinical Research, UCLouvain, Belgium.
²⁸ Université de Reims Champagne Ardenne, Reims, France.
²⁹ Paris, France.
³⁰ Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Paul Brousse, Département d'Anesthésie Réanimation, Villejuif, France and Université Paris-Saclay, INSERM, Hémostase inflammation thrombose HITH U1176, Le Kremlin-Bicêtre, France.
³¹ F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine d'urgence et service de médecine vasculaire, CHU d'Angers, 49000 Angers, France; Institut Mitovasc, UMR 1083, UFR santé, université d'Angers, 49000 Angers, France.
³² Université Montpellier.
³³ Service de Médecine Vasculaire CHU Amiens 80054 UPJV Equipe Chimère, France.
³⁴ Toulouse University Hospital, 31300 Toulouse, France.
³⁵ University Lille, Inserm, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France.
³⁶ Department of anesthesia and intensive care, Strasbourg University Hospital, Strasbourg ; UMR_S1255 EFS-INSERM; Strasbourg, France.
³⁷ Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France.
³⁸ CHU Saint-Étienne, Service d'Anesthésie Réanimation, INSERM, SAINBIOSE U1059, F-42023 Saint-Étienne, France.
³⁹ Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Service de Médecine Vasculaire et Thérapeutique, INSERM, SAINBIOSE U1059, F-42023 Saint-Étienne, France.
⁴⁰ Department of Anaesthesia and critical Care, Grenoble Alpes University Hospital, Grenoble, France.

PMID: 39447869
DOI: 10.1016/j.accpm.2024.101446

Free article

Practice Guideline

Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network

Anne Godier et al. Anaesth Crit Care Pain Med. 2024.

Free article

. 2024 Oct 22:101446.

doi: 10.1016/j.accpm.2024.101446. Online ahead of print.

Authors

Affiliations

¹ Université Paris Cité, Service d'anesthésie-réanimation, AP-HP, Hôpital Georges Pompidou, UMRS_1140, F-75006 Paris, France. Electronic address: Anne.godier@aphp.fr.
² Laboratoire d'hématologie générale, AP-HP, Hôpital Necker-Enfants Malades, INSERM UMRS_1176, Paris, France.
³ Service de Médecine Vasculaire, Université Grenoble-Alpes, Grenoble, France, F-CRIN INNOVTE network, Saint-Etienne, France.
⁴ Service d'hématologie et d'oncologie médicale. Centre Hospitalier de l'Université de Montréal. Canada.
⁵ Service d'Anesthésiologie, Département de Médecine Aigue, Hôpitaux Universitaires de Genève.
⁶ Pole Anesthésie-Réanimation CHU Toulouse, INSERM U1297 équipe 11 LIPSIPLAT, Toulouse, France.
⁷ Service d'hémato-oncologie, Centre Hospitalier Universitaire de Montréal, Montréal, Canada.
⁸ Service de cardiologie, hôpital Saint-Antoine, hôpital Tenon, Assistance publique-Hôpitaux de Paris, Sorbonne université, Paris, France.
⁹ Service d'Hématologie Biologique, Hôpital Le Bocage, CHRU de Dijon, 21000 Dijon, France.
¹⁰ Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland.
¹¹ Department of Medicine, Sunnybrook Heath Sciences Centre, University of Toronto, Toronto, ON, Canada.
¹² Department of anesthesiology and surgical care, CHU Lille, F-59000 Lille,France.
¹³ Univ. Grenoble Alpes, Anesthesiology and Critical Care, CHU Grenoble Alpes, Grenoble, France.
¹⁴ Department of Laboratory Hematology, Pontchaillou University Hospital, IRSET-INSERM-1085, Univ Rennes, Rennes, France.
¹⁵ St Joseph University, Department of anesthesia and critical care, Hotel Dieu de France hospital, Beirut,Lebanon.
¹⁶ Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Service de Pharmacologie Clinique, INSERM, SAINBIOSE U1059, F-42023 Saint-Étienne, France.
¹⁷ Université de Lorraine, Médecine, CHRU de Nancy, médecine vasculaire, France.
¹⁸ Department of Anesthesia and Intensive Care, Hôpital Bichat-Claude Bernard, Université de Paris, Paris, France.
¹⁹ Duke University School of Medicine, Departments of Anesthesiology, Critical Care and Surgery, Durham, NC, United States.
²⁰ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
²¹ Université Francois Rabelais, Inserm UMR1327 ISCHEMIA, Faculté de Médecine, Tours, France.
²² Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France. Univ Rennes, CHU Rennes, Inserm, IRSET, UMR_S 1085, F35000 Rennes, France.
²³ Unité Médico-chirurgicale d'Insuffisance Cardiaque Sévère, Chirurgie Cardiaque, AP-HP, Hôpital Européen Georges-Pompidou, and Université Paris Cité, INSERM UMRS_1140, F-75006 Paris, France.
²⁴ Neurology Department, Hôpital Lariboisière, and Interventional Neuroradiology Department, Hôpital Fondation A. de Rothschild, FHU Neurovasc, INSERM 1144, Université Paris-Cité, Paris, France.
²⁵ Aix Marseille Univ, INSERM 1263, INRAE 1260, C2VN, Marseille, France ; Hematology Laboratory, La Timone University Hospital of Marseille, Marseille, France.
²⁶ Université Libre de Bruxelles, Hôpital Universitaire de Bruxelles, Bruxelles, Belgium.
²⁷ Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis & Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Namur, and Institute of Experimental and Clinical Research, UCLouvain, Belgium.
²⁸ Université de Reims Champagne Ardenne, Reims, France.
²⁹ Paris, France.
³⁰ Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Paul Brousse, Département d'Anesthésie Réanimation, Villejuif, France and Université Paris-Saclay, INSERM, Hémostase inflammation thrombose HITH U1176, Le Kremlin-Bicêtre, France.
³¹ F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine d'urgence et service de médecine vasculaire, CHU d'Angers, 49000 Angers, France; Institut Mitovasc, UMR 1083, UFR santé, université d'Angers, 49000 Angers, France.
³² Université Montpellier.
³³ Service de Médecine Vasculaire CHU Amiens 80054 UPJV Equipe Chimère, France.
³⁴ Toulouse University Hospital, 31300 Toulouse, France.
³⁵ University Lille, Inserm, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France.
³⁶ Department of anesthesia and intensive care, Strasbourg University Hospital, Strasbourg ; UMR_S1255 EFS-INSERM; Strasbourg, France.
³⁷ Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France.
³⁸ CHU Saint-Étienne, Service d'Anesthésie Réanimation, INSERM, SAINBIOSE U1059, F-42023 Saint-Étienne, France.
³⁹ Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Service de Médecine Vasculaire et Thérapeutique, INSERM, SAINBIOSE U1059, F-42023 Saint-Étienne, France.
⁴⁰ Department of Anaesthesia and critical Care, Grenoble Alpes University Hospital, Grenoble, France.

PMID: 39447869
DOI: 10.1016/j.accpm.2024.101446

Abstract

Background: Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE.

Objective: A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011.

Methods: The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed.

Results: 78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts.

Conclusions: These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs.

Keywords: Guidelines; anticoagulant; bleeding; surgery; thromboembolism.

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