Venous thromboembolism after laparoscopic cholecystectomy: clinical burden and prevention

Abstract Background The clinical benefit of prophylaxis for venous thromboembolism (VTE) in laparoscopic cholecystectomy is unclear. Objective To assess the clinical burden of venous thromboembolism and the efficacy and safety of antithrombotic prophylaxis during laparoscopic cholecystectomy. Data sources and study selection Studies were searched in MEDLINE and Embase using the terms ‘cholecystectomy and venous thrombosis’ and ‘cholecystectomy and venous thromboembolism’. Studies were considered for a systematic review and a meta-analysis if they reported on the methods for antithrombotic prophylaxis and on the incidence of objectively confirmed VTE in patients who had laparoscopic cholecystectomy. Data synthesis Overall, 15 studies in patients who had laparoscopic cholecystectomy were included in the systematic review. The incidence of VTE was lower after laparoscopic cholecystectomy compared to open cholecystectomy (OR 0.47; 95% CI 0.40 to 0.56). No statistically significant reduction of VTE was observed in patients receiving heparin prophylaxis after laparoscopic cholecystectomy (OR 0.86, 95% CI 0.12 to 5.82). Conclusions. The rate of VTE after laparoscopic cholecystectomy seems to be relatively low. The clinical benefit of heparin prophylaxis in patients undergoing laparoscopic cholecystectomy remains unclear.