A Prospective Study on the Incidence of Postoperative Venous Thromboembolism in Korean Gastric Cancer Patients: An Inquiry into the Application of Western Guidelines to Asian Cancer Patients

Abstract

Several Western guidelines recommend the routine use of pharmacologic thromboprophylaxis for cancer surgery patients to prevent venous thromboembolism (VTE). However, the necessity of routine pharmacologic perioperative thromboprophylaxis in Asian gastric cancer (GC) patients has not been clearly determined. To determine the necessity of routine perioperative pharmacologic thromboprophylaxis in Korean gastric cancer patients, the incidence of postoperative VTE was prospectively evaluated in gastric cancer patients receiving surgery. Among 610 GC patients who had received surgery, 375 patents underwent routine duplex Doppler ultrasonography (DUS) on days 5–12 following surgery to detect VTE and then VTE-related symptoms and signs were checked at 4 weeks after surgery (cohort A). The 235 patients that declined DUS were registered to cohort B and the occurrence of postoperative VTE was retrospectively analyzed. In cohort A, symptomatic or asymptomatic VTE until 4 weeks after surgery was detected in 9 patients [2.4%; 95% confidence interval (CI); 0.9–3.9]. Tumor stage was a significant factor related to VTE development [stage I, 1.4%; stage II/III, 2.4%; stage IV, 9.7% (P = 0.008)]. In multivariate analysis, patients with stage IV had a higher postoperative VTE development [odds ratio, 8.18 (95% CI, 1.54–43.42)] than those with stage I. In cohort B, a low incidence of postoperative VTE was reaffirmed; only one postoperative VTE case (0.4%) was observed. In conclusion, the incidence of postoperative VTE in Korean GC patients was only 2.4%. Risk-stratified applications of perioperative pharmacologic thromboprophylaxis are thought to be more appropriate than the routine pharmacologic thromboprophylaxis in Korean GC patients receiving surgery.

Incidence of venous thromboembolism following major surgery in Korea: from the Health Insurance Review and Assessment Service database

“…Although perioperative pharmacologic thromboprophylaxis in cancer patients has not been routine practice in Korea, the present study demonstrated considerably low rates of postoperative VTE, which was consistent with previous retrospective studies reporting a VTE incidence of approximately 0.2% with stomach or colorectal cancer [31][32][33]. Moreover, Kim et al [34] recently reported a prospective study investigating the postoperative incidence of VTE in Korean patients with gastric cancer using routine Doppler ultrasonography between 5 and 12 days following surgery. In this study, postoperative VTE was detected in 9 (2.4%) of 375 patients.…”

“…Although the postoperative VTE rate was low in Korean cancer patients, previous studies have highlighted that disease stage was a predictor of VTE development [31,32,[35][36][37]. In the prospective study conducted by Kim et al [34], stage IV disease was an independent risk factor for developing postoperative VTE with an 8.18-fold increased risk when compared to stage I disease. Therefore, despite the apparent protection against VTE conferred by the Asian ethnicity, patients with advanced stage cancers might have an increased risk of VTE during the postoperative period.…”

“…Moreover, Kim et al . recently reported a prospective study investigating the postoperative incidence of VTE in Korean patients with gastric cancer using routine Doppler ultrasonography between 5 and 12 days following surgery. In this study, postoperative VTE was detected in 9 (2.4%) of 375 patients.…”

The incidence of clinically significant venous thromboembolism in an Asian population after major hepatobiliary and pancreatic surgery

“…Such low rates were found despite the fact that vast majority (82%) of patients were classified as high risk (based on Caprini Risk Score) and the majority did not receive VTE pharmacoprophylaxis (Table The majority of VTE occurred in patients who had undergone surgery for malignancy (83% versus 17% for benign disease). This is consistent with literature, where both the presence of a malignancy (especially in advanced stage) was associated with the development of postoperative VTE [11].…”

DVT Prophylaxis- Is It Mandatory for Major General Surgical Operations?

“…There were reports from India and other Asian countries regarding low incidence of DVT in malignancy following surgery. 7,21,22 Limitations of the Study Limitations of our study were small sample size and short follow up period, even though our results correlate with the reported incidence in Indian population. Further studies are needed including larger cohort and longer follow up.…”