Guidelines questioned.

And confirmed. NCCN and ASCO recommend routine use of perioperative clot prophylaxis with heparin. Koreans disagreed so they designed the PROTECTOR trial that prospectively randomized nearly 700 patients undergoing oncologic gastrectomy to compression devices +/- daily heparin injections from day of surgery to day of discharge. All patients underwent US on post-op day 4 to reveal the rate of venous thromboemboli was 6x higher in the heparin-free arm (3.6%) than in the standard heparin arm (0.6%), though at the cost of >7x the rate of bleeding complications. | Jung, JAMA Surg 2018