Balancing the risks of venous thromboembolism and bleeding in abdominal surgery: factors to consider in personalising thromboprophylaxis

Patients undergoing abdominal surgery are at risk of both venous thromboembolic (VTE) and bleeding complications perioperatively. To reduce VTE risk, the routine administration of pharmacologic thromboprophylaxis has been recommended by certain regulatory bodies (1). As a result, many institutions have adopted a one-size fits all approach to thromboprophylaxis prescription (2) which protects against VTE but may risk increased bleeding events. It is clear that there remains significant variation in both the use and timing of thromboprophylaxis prescription across healthcare, with much of this attributed to individual experiences and surgical dogma (3). This unrationalised variation in practice has been well demonstrated to confer harm (4-6) and clearly a personalised approach to VTE prophylaxis prescription balancing an individual’s risks of VTE and bleeding is required.