From the Research
For DVT prophylaxis after coronary artery bypass graft (CABG) surgery with 3 vessels, I recommend starting with mechanical prophylaxis using sequential compression devices immediately post-operation, followed by pharmacological prophylaxis with subcutaneous low molecular weight heparin (LMWH) such as enoxaparin 40mg once daily when bleeding risk is acceptable (typically 12-24 hours post-surgery). This approach is supported by the most recent and highest quality study available, which compared the efficacy and safety of different anticoagulants for preventing venous thromboembolism after surgery 1. Although this study was conducted in an intensive care unit setting, its findings can be applied to the post-CABG population, which is also at high risk for VTE.
The study found that enoxaparin was associated with a similar prevalence of DVT and PE compared to unfractionated heparin, but with a lower mortality rate 1. This suggests that enoxaparin may be a safer choice for DVT prophylaxis in the post-CABG population.
Some may argue that aspirin therapy (81-325mg daily) is sufficient for DVT prophylaxis, but the evidence suggests that aspirin provides minimal DVT protection alone 2. Therefore, the combination of mechanical and pharmacological methods, including enoxaparin, is crucial for preventing DVT in CABG patients.
Key considerations for DVT prophylaxis in the post-CABG population include:
- Starting mechanical prophylaxis with sequential compression devices immediately post-operation
- Initiating pharmacological prophylaxis with enoxaparin 40mg once daily when bleeding risk is acceptable
- Continuing prophylaxis until the patient is fully mobile, usually for 7-10 days or until hospital discharge
- Extending prophylaxis for up to 30 days in patients with higher thrombotic risk factors (obesity, history of VTE, prolonged immobility)
- Encouraging early ambulation as soon as the patient is stable
By following these guidelines, clinicians can reduce the risk of DVT and improve outcomes in patients undergoing CABG surgery.