Impact of Perioperative Buyang Huanwu-Based Traditional Chinese Medicine Intervention on Postoperative Venous Thromboembolism, Coagulation Markers and Systemic Inflammation: A Propensity Score-Weighted Retrospective Cohort Study.

OBJECTIVE: This study aimed to (1) evaluate, in a propensity-score-weighted retrospective cohort, the effectiveness and safety of a standardised perioperative Buyang Huanwu-based traditional Chinese medicine (TCM) decoction combined with standard low-molecular-weight heparin (LMWH) prophylaxis on the 30-day incidence of symptomatic and asymptomatic venous thromboembolism (VTE), (2) characterise the longitudinal trajectories of coagulation (D-dimer, fibrinogen) and inflammatory (C-reactive protein [CRP]) biomarkers and (3) quantify the net clinical benefit of this integrative approach.

METHODS: We conducted a retrospective cohort study of 1847 adult patients undergoing major general-surgical or gynaecological procedures between January 2020 and December 2024 at a tertiary integrative-medicine centre. Patients receiving a standardised perioperative TCM decoction based on the modified Buyang Huanwu Tang in addition to standard LMWH prophylaxis (n = 892) were compared with patients receiving standard prophylaxis alone (n = 955). The TCM decoction comprised seven herbal components dispensed at fixed daily doses (Huangqi, 60 g; Danggui, 9 g; Chishao, 6 g; Chuanxiong, 6 g; Honghua, 3 g; Taoren, 6 g; Dilong, 9 g) supplemented with 15 g of Danshen; granules were prepared as a single-batch good manufacturing practice-certified concentrated formulation, with the principal bioactive markers astragaloside IV, ferulic acid, paeoniflorin and salvianolic acid B quantified by high-performance liquid chromatography and required to fall within ±10% of the label content to ensure dose standardisation. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. The primary outcome was 30-day VTE confirmed by duplex ultrasonography or computed tomography pulmonary angiography, with symptomatic and asymptomatic events recorded separately. Secondary outcomes included major bleeding, length of stay, patient-reported pain and 90-day all-cause mortality. Linear mixed-effects models were used to analyse longitudinal trajectories of D-dimer, fibrinogen and CRP measured at baseline and on postoperative days 1, 3 and 7.

RESULTS: After IPTW adjustment, TCM intervention was associated with significantly reduced 30-day VTE incidence (hazard ratio [HR]: 0.58, 95% confidence interval [CI]: 0.41-0.82, p = 0.002), with consistent protection observed for both symptomatic VTE (HR: 0.55, 95% CI: 0.34-0.89) and ultrasound-detected asymptomatic distal deep-vein thrombosis (HR: 0.61, 95% CI: 0.39-0.94). Landmark analysis revealed sustained protection during both hospitalisation (HR: 0.52, 95% CI: 0.33-0.81) and the post-discharge period (HR: 0.67, 95% CI: 0.42-0.93). Linear mixed-effects modelling demonstrated significant group-by-time interactions for D-dimer (p < 0.001) and CRP (p = 0.003), indicating accelerated biomarker clearance in the TCM group: 42% faster D-dimer resolution and 38% faster CRP normalisation than in controls. No significant difference was observed for major bleeding (2.1% vs 2.4%, p = 0.68) or 90-day all-cause mortality (1.6% vs 2.0%, p = 0.51). Decision-curve analysis confirmed superior net clinical benefit across the clinically relevant threshold-probability range.

CONCLUSION: Perioperative Buyang Huanwu-based TCM combined with standard LMWH prophylaxis significantly reduces postoperative VTE risk - for both symptomatic and ultrasound-detected asymptomatic events - through accelerated resolution of coagulation and inflammatory cascades, without increasing bleeding or 90-day all-cause mortality. These findings support the integration of standardised TCM into enhanced-recovery-after-surgery protocols, particularly for moderate- to high-risk surgical patients in whom anticoagulation intensification may be contraindicated.