Extended thromboprophylaxis following major abdominal/pelvic cancer-related surgery: A systematic review and meta-analysis of the literature

Knoll, William; Fergusson, Nathan; Ivankovic, Victoria; Wang, Tzu‐Fei; Caiano, Lucia; Auer, R; Carrier, Marc

doi:10.1016/j.thromres.2021.06.010

Cited by 19 publications

(13 citation statements)

References 74 publications

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“…The rates of venous thromboembolism were low (<2%) without significant differences between the two groups. These low rates of venous thromboembolism are consistent with a recent meta-analysis of randomised trials reporting a 30 day incidence of clinical venous thromboembolism of 1.4% in patients receiving extended duration and 0.3% in patients receiving thromboprophylaxis in hospital after major abdominal or pelvic surgery 19. In our study, no significant reduction in symptomatic venous thromboembolism was reported between the extended duration and in-hospital thromboprophylaxis groups (2% v 1%).…”

Section: Discussionsupporting

confidence: 92%

Efficacy and safety of extended duration to perioperative thromboprophylaxis with low molecular weight heparin on disease-free survival after surgical resection of colorectal cancer (PERIOP-01): multicentre, open label, randomised controlled trial

Auer

Ott

Karanicolas

et al. 2022

BMJ

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Objective To determine the efficacy and safety of extended duration perioperative thromboprophylaxis by low molecular weight heparin when assessing disease-free survival in patients undergoing resection for colorectal cancer. Design Multicentre, open label, randomised controlled trial. Settings 12 hospitals in Quebec and Ontario, Canada, between 25 October 2011 and 31 December 2020. Participants 614 adults (age ≥18 years) were eligible with pathologically confirmed invasive adenocarcinoma of the colon or rectum, no evidence of metastatic disease, a haemoglobin concentration of ≥8 g/dL, and were scheduled to undergo surgical resection. Interventions Random assignment to extended duration thromboprophylaxis using daily subcutaneous tinzaparin at 4500 IU, beginning at decision to operate and continuing for 56 days postoperatively, compared with in-patient postoperative thromboprophylaxis only. Main outcome measures Primary outcome was disease-free survival at three years, defined as survival without locoregional recurrence, distant metastases, second primary (same cancer), second primary (other cancer), or death. Secondary outcomes included venous thromboembolism, postoperative major bleeding complications, and five year overall survival. Analyses were done in the intention-to-treat population. Results The trial stopped recruitment prematurely after the interim analysis for futility. The primary outcome occurred in 235 (77%) of 307 patients in the extended duration group and in 243 (79%) of 307 patients in the in-hospital thromboprophylaxis group (hazard ratio 1.1, 95% confidence interval 0.90 to 1.33; P=0.4). Postoperative venous thromboembolism occurred in five patients (2%) in the extended duration group and in four patients (1%) in the in-hospital thromboprophylaxis group (P=0.8). Major surgery related bleeding in the first postoperative week was reported in one person (<1%) in the extended duration and in six people (2%) in the in-hospital thromboprophylaxis group (P=0.1). No difference was noted for overall survival at five years in 272 (89%) patients in the extended duration group and 280 (91%) patients in the in-hospital thromboprophylaxis group (hazard ratio 1.12; 95% confidence interval 0.72 to 1.76; P=0.1). Conclusions Extended duration to perioperative anticoagulation with tinzaparin did not improve disease-free survival or overall survival in patients with colorectal cancer undergoing surgical resection compared with in-patient postoperative thromboprophylaxis alone. The incidences of venous thromboembolism and postoperative major bleeding were low and similar between groups. Trial registration ClinicalTrials.gov NCT01455831 .

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Section: Discussionsupporting

confidence: 92%

Efficacy and safety of extended duration to perioperative thromboprophylaxis with low molecular weight heparin on disease-free survival after surgical resection of colorectal cancer (PERIOP-01): multicentre, open label, randomised controlled trial

Auer

Ott

Karanicolas

et al. 2022

BMJ

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“…New data support the grade 1A recommendation for extended-duration LMWHs prophylaxis for 4 weeks after major cancer abdominal or pelvic surgery (laparotomy or laparoscopy) in patients without a high-bleeding risk. 40 There are no new data for fondaparinux and there is insufficient evidence to support the use of apixaban, despite one small randomised controlled trial. 41 Similarly, no evidence currently exists to support the use of other direct oral anticoagulants in this setting.…”

Section: Vte Prophylaxis In Patients With Cancermentioning

confidence: 99%

“…The 2019 ITAC recommendation for extended-duration prophylaxis with LMWH in patients undergoing cancer surgery (laparotomy and laparoscopic) is unchanged (grade 1A). 5 A new meta-analysis (18 studies, 7495 patients) 40 showed a significantly reduced risk of symptomatic VTE (1·0% vs 2·0%; RR 0·48, 95% CI 0·31–0·74), without increased risk of clinically relevant non-major bleeding (4·0% vs 4·9%; 1·00, 0·66–1·50). One randomised controlled trial compared apixaban, 2·5 mg twice-daily, with enoxaparin, 40 mg daily, for 28 days for postoperative prophylaxis (400 patients, 19·3% of benign tumours).…”

Section: Vte Prophylaxis In Patients With Cancermentioning

confidence: 99%

2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

Farge

Frère

Connors

et al. 2022

The Lancet Oncology

194

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“…при отсутствии высокого риска кровотечений. Метаанализ 18 исследований, включивший в общей сложности 7 495 онкопациентов [18], показал значительное снижение риска симптомных ВТЭО на фоне продления медикаментозной тромбопрофилактики после операции до 4 нед. (1,0% против 2,0%; ОР = 0,48; 95% ДИ 0,31-0,74), без повышенного риска клинически значимого кровотечения (4,0% против 4,9%; ОР = 1,00; 95% ДИ 0,66-1,50).…”

Section: профилактика венозных тромбоэмболических осложнений у пациен...unclassified

Modern approaches to the prevention of venous thromboembolic complications in patients with active cancer

Fedotkina

Panchenko

2023

Aterotromboz

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Cancer is one of the most significant risk factors for venous thromboembolic complications (VTEC), which combines deep vein thrombosis and pulmonary embolism. Of the many well-known risk factors for VTEC, only cancer is associated with a 4-fold increased risk of venous thrombosis, and in cancer patients receiving chemotherapy the risk increases by up to 6.5-fold. Venous thrombosis is increasingly common in cancer patients and contributes significantly to the course of the underlying disease and mortality, especially when combined with additional risk factors, the most significant of which are surgery and chemotherapy treatment. The prevention and treatment of VTEC in cancer patients is a challenge, primarily due to the pathogenesis of cancer-associated thrombosis, the presence of additional risk factors associated with cancer, the high risk of haemorrhagic complications, reduced renal function and the recurrent nature of VTEC. Aspects of safe prevention remain an integral part of the management of patients with active cancer. The most vulnerable periods for the development of VTEC are the periods when the patient is hospitalised for surgical or therapeutic treatment and the long period of chemotherapy treatment on an outpatient basis. A comprehensive approach to the prevention of VTEC in patients with cancer should primarily involve careful selection of high-risk patients at each stage of treatment of the malignancy; these patients are the ones who will benefit most from drug thromboprophylaxis. The treatment of an already confirmed VTEC in a cancer patient always involves the additional challenges of drug interactions and increased haemorrhagic risk due to prolonged use of treatment doses of anticoagulants, which may in turn affect the effectiveness of chemotherapy or the efficiency and safety of anticoagulant therapy.

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Extended thromboprophylaxis following major abdominal/pelvic cancer-related surgery: A systematic review and meta-analysis of the literature

Cited by 19 publications

References 74 publications

Efficacy and safety of extended duration to perioperative thromboprophylaxis with low molecular weight heparin on disease-free survival after surgical resection of colorectal cancer (PERIOP-01): multicentre, open label, randomised controlled trial

Efficacy and safety of extended duration to perioperative thromboprophylaxis with low molecular weight heparin on disease-free survival after surgical resection of colorectal cancer (PERIOP-01): multicentre, open label, randomised controlled trial

2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

Modern approaches to the prevention of venous thromboembolic complications in patients with active cancer

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