In the UK, current NICE guidance for venous thromboembolism (VTE) prevention does not give specific advice about patients undergoing otolaryngology/head and neck surgery (OHNS). This systematic review provides up-to-date information based on available, although limited, evidence about the incidence of VTE and of bleeding risks associated with chemical VTE prophylaxis in this patient group. This review group from the US used PubMed and Scopus databases and identified 26 relevant OHNS trials published in the English language. No randomised trials were identified, and the only prospective study was the smallest, with 100 patients. Meta-analysis revealed that the incidence of VTE (including both deep vein thrombosis and pulmonary embolism) in all studies was 0.4%. The overall risk of bleeding complications was 0.9%. The authors attempted to account for the wide heterogeneity between study populations using various statistical analyses. Analysis of the three studies that directly compared the risks of VTE between patients who did and did not receive chemoprophylaxis found that VTE was not reduced but bleeding was increased in the chemoprophylaxis groups.

Of particular interest to readers of this review is the subgroup analysis of patients undergoing head and neck cancer surgery and/or undergoing free flaps. Meta-analysis found that these patients have a 0.9% risk of VTE compared with other otolaryngology patients who have a 0.1% risk.

Only one study provided information on the risk reduction provided by VTE chemoprophylaxis in this group when directly compared to no chemoprophylaxis, and identified a 75% decrease in the incidence of VTE. The conclusion of the authors of this review is that the risk of bleeding in OHNS patients is non-negligible and should be taken into consideration when prescribing chemoprophylaxis, as the evidence available would indicate that the risk of VTE in this patient group is overall extremely low, although slightly higher in head and neck cancer patients.

Systematic review and meta-analysis of venous thromboembolism in otolaryngology–head and neck surgery.
Moubayed SP, Eskander A, WM Mourad, Most SP.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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