Impact of drugs on venous thromboembolism risk in surgical patients

Eur J Clin Pharmacol. 2019 Jun;75(6):751-767. doi: 10.1007/s00228-019-02636-x. Epub 2019 Feb 5.

Abstract

Purpose: This review focuses on the most common drugs administered to surgical patients during the perioperative period that affect the risk of venous thromboembolism (VTE).

Results: Among analgesics, the risk of VTE is increased in patients treated with diclofenac, ibuprofen, and rofecoxib, but not naproxen, while metamizole can confer a protective effect. The relationship between sedatives and VTE has not been sufficiently studied. Tricyclic antidepressants, low-potency serotonin reuptake inhibitors, and antipsychotics have been associated with increased risk of VTE. The use of diuretics in the perioperative period is poorly researched; however, hyponatremia is considered a risk factor. Other factors that may influence the risk of VTE include bridging anticoagulation, allogeneic transfusion, and hemostatic management before surgery. Pharmacotherapy for HIV or cancer may also increase VTE risk.

Conclusion: Increased monitoring for VTE is therefore advisable in surgical patients and those receiving antipsychotics, antidepressants, diuretics, or analgesics.

Keywords: Analgesics; Antidepressants; Antipsychotics; Bridging anticoagulation; Diuretics; Oral contraceptives; Surgery; Thromboprophylaxis; Transfusion; Venous thromboembolism.

Publication types

  • Review

MeSH terms

  • Analgesics / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Contraceptives, Oral, Hormonal / therapeutic use
  • Diuretics / therapeutic use
  • Hormone Replacement Therapy
  • Humans
  • Hypnotics and Sedatives / therapeutic use
  • Perioperative Care*
  • Risk Factors
  • Venous Thromboembolism / chemically induced*

Substances

  • Analgesics
  • Antidepressive Agents
  • Antipsychotic Agents
  • Contraceptives, Oral, Hormonal
  • Diuretics
  • Hypnotics and Sedatives