2022-RA-933-ESGO Risk of venous thromboembolism and major bleeding in gynaecological cancer surgery: series of systematic reviews and meta-analyses

Lavikainen, Lauri I; Guyatt, Gordon; Luomaranta, Anna; Cartwrigth, Rufus; Kalliala, Ilkka EJ; Couban, Rachel; Aaltonen, Riikka; Aro, Karoliina M; Cárdenas, Jovita L.; Devereaux, P. J.; Galambosi, Päivi; Ge, Fang Zhou; Halme, Alex LE; Haukka, Jari; Izett-Kay, Matthew; Joronen, Kirsi; Karjalainen, P; Khamani, N. M.; Nystén, Carolina; Oksjoki, Sanna; Pourjamal, Negar; Singh, Tino; Tähtinen, Riikka M.; Vernooij, Robin W.M.; Violette, Philippe D.; Tikkinen, Kari A.O.

doi:10.1136/ijgc-2022-esgo.420

Cited by 3 publications

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“…For patients who received prophylaxis, the reported incidence was multiplied by the relative risk (RR) of thromboprophylaxis for the duration of prophylaxis use 21 . The updated meta-analyses 22 informed the RR estimates of thromboprophylaxis as follows: for pharmacological prophylaxis (heparin), RR 0.46 for VTE; for any mechanical prophylaxis, RR 0.43 for VTE; and for combination therapy of pharmacological plus mechanical ( versus pharmacological alone), RR 0.59 for VTE. Finally, it was inferred that preoperative thromboprophylaxis provided no extra benefit for VTE prevention 11 .…”

Section: Methodsmentioning

confidence: 99%

Timing of symptomatic venous thromboembolism after surgery: meta-analysis

Singh

Lavikainen

Halme

et al. 2023

British Journal of Surgery

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Background The timing at which venous thromboembolism (VTE) occurs after major surgery has major implications for the optimal duration of thromboprophylaxis. The aim of this study was to perform a systematic review and meta-analysis of the timing of postoperative VTE up to 4 weeks after surgery. Methods A systematic search of MEDLINE, Scopus, and CINAHL databases was performed between 1 January 2009 and 1 April 2022. Prospective studies that recruited patients who underwent a surgical procedure and reported at least 20 symptomatic, postoperative VTE events by time were included. Two reviewers independently selected studies according to the eligibility criteria, extracted data, and evaluated risk of bias. Data were analysed with a Poisson regression model, and the GRADE approach was used to rate the certainty of evidence. Results Some 6258 studies were evaluated, of which 22 (11 general, 5 urological, 4 mixed, and 2 orthopaedic postoperative surgical populations; total 1 864 875 patients and 24 927 VTE events) were eligible. Pooled evidence of moderate certainty showed that 47.1 per cent of the VTE events occurred during the first, 26.9 per cent during the second, 15.8 per cent during the third, and 10.1 per cent during the fourth week after surgery. The timing of VTE was consistent between individual studies. Conclusion Although nearly half of symptomatic VTE events in first 4 weeks occur during the first postoperative week, a substantial number of events occur several weeks after surgery. These data will inform clinicians and guideline developers about the duration of postoperative thromboprophylaxis.

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Section: Methodsmentioning

confidence: 99%

Timing of symptomatic venous thromboembolism after surgery: meta-analysis

Singh

Lavikainen

Halme

et al. 2023

British Journal of Surgery

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“…Although prior work exists on procedure-specific risks of thrombosis and bleeding in surgery (with variable certainty evidence), the optimal starting time and duration of thromboprophylaxis remains unclear owing to insufficient statistical power of existing randomized trials in the field and the changing nature of surgery (eg, earlier mobilization and less-invasive surgery) . This has contributed to substantial practice variation in thromboprophylaxis worldwide .…”

Section: Discussionmentioning

confidence: 99%

Timing of Major Postoperative Bleeding Among Patients Undergoing Surgery

Halme,

Roshanov,

Tornberg

et al. 2024

JAMA Netw Open

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ImportanceAlthough major bleeding is among the most common and prognostically important perioperative complications, the relative timing of bleeding events is not well established. This information is critical for preventing bleeding complications and for informing the timing of pharmacologic thromboprophylaxis.ObjectiveTo determine the timing of postoperative bleeding among patients undergoing surgery for up to 30 days after surgery.Design, Setting, and ParticipantsThis is a secondary analysis of a prospective cohort study. Patients aged 45 years or older who underwent inpatient noncardiac surgery were recruited in 14 countries between 2007 and 2013, with follow-up until December 2014. Data analysis was performed from June to July 2023.ExposureNoncardiac surgery requiring overnight hospital admission.Main Outcomes and MeasuresThe primary outcome (postoperative major bleeding) was a composite of the timing of the following bleeding outcomes: (1) bleeding leading to transfusion, (2) bleeding leading to a postoperative hemoglobin level less than 7 g/dL, (3) bleeding leading to death, and (4) bleeding associated with reintervention. Each of the components of the composite primary outcome (1-4) and bleeding independently associated with mortality after noncardiac surgery, which was defined as a composite of outcomes 1 to 3, were secondary outcomes.ResultsAmong 39 813 patients (median [IQR] age, 63.0 [54.8-72.5] years; 19 793 women [49.7%]), there were 5340 major bleeding events (primary outcome) in 4638 patients (11.6%) within the first 30 days after surgery. Of these events, 42.7% (95% CI, 40.9%-44.6%) occurred within 24 hours after surgery, 77.7% (95% CI, 75.8%-79.5%) by postoperative day 7, 88.3% (95% CI, 86.5%-90.2%) by postoperative day 14, and 94.6% (95% CI, 92.7%-96.5%) by postoperative day 21. Within 48 hours of surgery, 56.2% of major bleeding events, 56.2% of bleeding leading to transfusion, 56.1% of bleeding independently associated with mortality after noncardiac surgery, 51.8% of bleeding associated with hemoglobin less than 7 g/dL, and 51.8% of bleeding associated with reintervention had occurred.Conclusions and RelevanceIn this cohort study, of the major postoperative bleeding events in the first 30 days, more than three-quarters occurred during the first postoperative week. These findings are useful for researchers for the planning future clinical research and for clinicians in prevention of bleeding-related surgical complications and in decision-making regarding starting of pharmacologic thromboprophylaxis after surgery.

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“…хворих із ТЕЛА майже кожний пʼятий має злоякісне захворювання [6,9], тому в рекомендаціях з ведення хворих із ТЕЛА відзначено обовʼязкове обстеження цих хворих для спростування онкопатології, особливо у випадку відсутності явних причин тромбозу [2][3][4][5][6]. Розвиток ВТЕУ значно погіршує прогноз хворих на онкологічну патологію і часто стає причиною смерті [14][15]19]. У сучасних рекомендаціях [3][4][5][6]15] запропоновано критерії високого ризику смерті хворих із гострою ТЕЛА в госпітальний період, які відображають стабільність гемодинамічних показників.…”

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“…Розвиток ВТЕУ значно погіршує прогноз хворих на онкологічну патологію і часто стає причиною смерті [14][15]19]. У сучасних рекомендаціях [3][4][5][6]15] запропоновано критерії високого ризику смерті хворих із гострою ТЕЛА в госпітальний період, які відображають стабільність гемодинамічних показників. Запропо но вана шкала PESI [5][6][7][8][9], яка дає змогу в гемодинамічно стабільних пацієнтів з «невисоким ризиком» провести стратифікацію вірогідності смерті в госпітальний період.…”

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The course of the pulmonary embolism in patients with oncological diseases

Целуйко,

Шило,

Романенко

2024

CSIC

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The aim – to identify factors associated with in-hospital mortality among patients with acute pulmonary embolism (PE) and oncological diseases. Materials and methods. A retrospective analysis of 647 medical records of patients with acute PE treated at one center from January 1, 2018, to January 1, 2020, was conducted. Among them, 115 patients had verified oncological diseases. PE diagnosis in all patients was confirmed by computed tomography and/or autopsy results. Alongside laboratory studies, patients underwent ultrasound examination. Results and discussion. A comparative assessment of clinical and anamnestic parameters in patients with PE, depending on the presence of oncological diseases, was conducted. The analysis revealed that patients with PE associated with oncological process were on average 5 years older, with higher proportion of elderly patients, and less frequently had anamnestic episodes of venous thrombosis (13.9 % vs. 24.6 %), but predictably more often had additional risk factors, such as blood transfusions, central venous catheters, and laparoscopic interventions. According to the results of the multifactorial regression analysis, factors independently influencing the risk of in-hospital death in patients with acute PE and oncological diseases included decrease of blood pressure, saturation, an increase of the pulmonary artery pressure, leukocytosis and presence of atrial fibrillation. The ROC analysis results allowed determining threshold values of parametric indicators associated with the risk of death during the hospital period in a patient with PE and oncological diseases, i.e. blood pressure ≤ 105 mm Hg, SpO2 ≤ 87 %, pulmonary artery pressure > 48 mm Hg, and leukocyte count > 9.8  109/l. Conclusion. The risk factors of in-hospital death in patients with PE associated with oncological disease are atrial fibrillation, increased pulmonary artery pressure, leukocyte count, low blood pressure and saturation.

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2022-RA-933-ESGO Risk of venous thromboembolism and major bleeding in gynaecological cancer surgery: series of systematic reviews and meta-analyses

Abstract: were less TEs (3.6%) when intensive dose was applied (p<0.001), without increasing bleeding events (2.8% and 1.8% vs. 1.4% in the current study).

Cited by 3 publications

References 0 publications

Timing of symptomatic venous thromboembolism after surgery: meta-analysis

Timing of symptomatic venous thromboembolism after surgery: meta-analysis

Timing of Major Postoperative Bleeding Among Patients Undergoing Surgery

The course of the pulmonary embolism in patients with oncological diseases

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