From the Research
Subcutaneous heparin administration before an appendectomy is a routine practice in many hospitals as part of venous thromboembolism (VTE) prophylaxis, with the most recent and highest quality study 1 suggesting that heparin can be used in certain clinical settings. The use of low molecular weight heparin (LMWH) such as enoxaparin or unfractionated heparin is standard for most surgical procedures, including appendectomy, as surgery increases the risk of blood clot formation due to immobility, tissue trauma, and inflammatory responses. Some key points to consider include:
- The timing of heparin administration, which is usually 1-2 hours before surgery for unfractionated heparin or 12 hours before for LMWH
- The continuation of prophylaxis postoperatively until the patient is fully mobile
- The benefit of heparin prophylaxis in preventing deep vein thrombosis and pulmonary embolism, which are potentially life-threatening complications
- The need to consider individual patient risk factors, such as age, weight, mobility status, and personal or family history of clotting disorders, when determining the specific regimen
- The possibility that some low-risk patients undergoing laparoscopic appendectomy with early mobilization may not require pharmacological prophylaxis, as noted in studies such as 2 and 3. However, the most recent study 1 provides the most up-to-date guidance on the use of heparin in clinical practice, and its findings should be prioritized when making decisions about VTE prophylaxis.