Pharmacological prophylaxis of venous thromboembolism in surgical patients

Venous thromboembolism is the third most common cardiovascular disease after myocardial infarction and stroke, affecting a significant percentage of the population. Surgery is a well-known risk factor for venous thromboembolism, and the more serious the surgical procedure, the higher the risk of developing it. This review provides an analysis of the main risk factors for venous thromboembolism in operated patients, the role of optimizing the balance of thromboembolism/bleeding risk in determining the individual risks of surgical patients, and a comparative analysis of therapy for venous thromboembolism using drugs with antiplatelet and anticoagulant activity. A summary of the data available in the scientific literature shows that, despite the existing variety of antiplatelet and anticoagulant drugs, the second-generation low-molecular-weight heparins, with bemiparin as A prominent representative, are currently the first-line drugs for the pharmacoprophylaxis of venous thromboembolism in the context of major surgical interventions, which has been confirmed by numerous clinical trials conducted around the world. Special clinical studies have confirmed the equivalence of efficacy and safety, and in some cases, also certain advantages of second-generation drugs (for example, bemiparin) in comparison with enoxaparin, the most common first-generation drug currently used in clinical practice in surgical/oncological patients. The duration of bleeding prophylaxis with bemiparin and other low-molecular-weight heparins in surgical/oncological patients, according to the data of most clinical trials with an appropriate level of evidence, may range from 1–2 weeks up to 35 days, depending on the individually assessed balance of thromboembolism/bleeding risks.