Incidence of and risk factors for preoperative deep venous thrombosis in patients undergoing gastric cancer surgery

Wada, Takuya; Fujiwara, Hisashi; Morita, Shinji; Fukagawa, Takeo; Katai, Hitoshi

doi:10.1007/s10120-017-0690-0

Cited by 20 publications

(10 citation statements)

References 29 publications

(37 reference statements)

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“…After full‐text examination, 18 were excluded because outcome data could not be extracted separately for patients receiving neoadjuvant treatment ( n = 4) or the article reported a mix of arterial and venous thrombotic events ( n = 14). Twenty‐eight records (19 full texts and nine abstracts) including a total study population of 7827 cancer patients (range 11 to 1398 patients) were finally included in the review (Table ) . All studies but two were single center and were conducted during a time period that spanned from 1994 to 2015.…”

Section: Resultsmentioning

confidence: 99%

Venous thromboembolism in cancer patients receiving neoadjuvant chemotherapy: a systematic review and meta‐analysis

Nisio

Candeloro

Rutjes

et al. 2018

Journal of Thrombosis and Haemostasis

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Background Venous thromboembolism (VTE) is a frequent complication in cancer patients receiving adjuvant treatment. The risk of VTE during neoadjuvant chemo-radiotherapy remains unclear. Objectives This systematic review evaluated the incidence of VTE in patients with cancer receiving neoadjuvant treatment. Methods MEDLINE and EMBASE databases were searched from inception to October 2017. Search results were supplemented with screening of conference proceedings of the American Society of Clinical Oncology (2009-2016) and the International Society of Thrombosis and Haemostasis (2003-2016). Two review authors independently screened titles and abstracts, and extracted data onto standardized forms. Results Twenty-eight cohort studies (7827 cancer patients, range 11 to 1398) were included. Twenty-five had a retrospective design. Eighteen cohorts included patients with gastrointestinal cancer, representing over two-thirds of the whole study population (n = 6002, 78%). In total, 508 of 7768 patients were diagnosed with at least one VTE during neoadjuvant treatment, for a pooled VTE incidence of 7% (95% CI, 5% to 10%) in the absence of substantial between-study heterogeneity. Heterogeneity was not explained by site of cancer or study design characteristics. VTE presented as pulmonary embolism in 22% to 96% of cases (16 cohorts), and it was symptomatic in 22% to 100% of patients (11 cohorts). The highest VTE rates were observed in patients with bladder (10.6%) or esophageal (8.4%) cancer. Conclusions This review found a relatively high incidence of VTE in cancer patients receiving neoadjuvant therapy in the presence of some between-study variation, which deserves further evaluation in prospective studies.

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Section: Resultsmentioning

confidence: 99%

Venous thromboembolism in cancer patients receiving neoadjuvant chemotherapy: a systematic review and meta‐analysis

Nisio

Candeloro

Rutjes

et al. 2018

Journal of Thrombosis and Haemostasis

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“…Multiple logistic regression analysis revealed that sex, age >80 years, PS≥1, preoperative chemotherapy history, and central venous catheter insertion significantly correlated with preoperative DVT (31). Another study of 976 consecutive patients who underwent gastric cancer surgery and preoperative D-dimer screening showed that 176 patients were positive for D-dimer (>1.0 μg/ml), and 13 (7.4%) were diagnosed as having DVT (32). Actually, in the present study, 5 patients (6.9%) had thrombosis in the soleal vein before surgery.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Enoxaparin for Prophylaxis of Postoperative Venous Thromboembolism After Esophagectomy: A Single-center Prospective Randomized Controlled Phase II Study

et al. 2019

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Background/Aim: This study aimed to assess whether low-molecular-weight heparin (LMWH) is effective and safe in preventing postoperative venous thromboembolism (VTE) in patients undergoing esophageal cancer surgery. Patients and Methods: In this single-institution, prospective, randomized trial, 73 patients with esophageal cancer undergoing esophagectomy were randomly divided into the enoxaparin group (E group) and intermittent pneumatic compression group (I group). The primary endpoint was efficacy of enoxaparin, and secondary endpoints were evidence of bleeding and serum anti-Xa activity in the E group. Results: The E group comprised 42 patients and the I group comprised 31 patients. Deep vein thrombosis was observed in 0 (0%) patients in the E group and 7 (22.6%) patients in the I group (p=0.002). Soluble fibrin monomer complex was significantly lower in the E versus I group on day 8 (p<0.001). D-dimer was significantly lower in the E versus I group on days 2, 8, and 15 (p=0.008, p<0.001, p<0.001, respectively). Conclusion: VTE was significantly reduced by using enoxaparin. Venous thromboembolism (VTE) is the second leading cause of death in cancer patients receiving outpatient chemotherapy (1). As represented by Trousseau's syndrome, multiple pathophysiologic mechanisms contribute to the hypercoagulability associated with cancer (2). The Japan VTE Treatment Registry revealed the maximal risk factor for VTE to be cancer (3). Major surgery for cancer located in the abdomen or chest is associated with a high incidence of VTE, as the major postoperative complication, including deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) (4). According to previous reports, the incidence of symptomatic VTE after esophagectomy is reported to range from 2.9 to 3.8%, (5, 6), whereas that of asymptomatic VTE after esophagectomy ranges from 5.9 to 23.3% (7-9). Thus, the prevalence of asymptomatic VTE is not small after esophageal cancer surgery, and occasionally, unfortunate outcomes can occur; thus, prevention of VTE is very important. The use of low-molecular-weight heparin (LMWH) was recommended to prevent VTE after cancer surgery (10). Lee et al. reported that in patients with cancer and acute VTE, LMWH was more effective than an oral anticoagulant in reducing the risk of recurrent VTE, without increasing the risk of bleeding (11). However, an optimal strategy of thromboprophylaxis for esophagectomy has not been formulated, and to the best of our knowledge, there are no reports comparing the effects of LMWH through randomized controlled trials (RCTs). Enoxaparin is a LMWH that functions as an anticoagulant agent by forming a complex with antithrombin 3 (AT-III) and promoting AT-III activity. The evidence for enoxaparin in orthopedic, gynecologic malignancy and abdominal or pelvic malignancy has already been established (12-14). In 2615 This article is freely accessible online.

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“…18 Gastric cancer patients are also at high risk of venous thromboembolism (VTE), with an incidence of 1.3-18.3%. [19][20][21][22] Furthermore, both Myat Moe et al and den Exter et al found that patients with advanced gastric cancer were more predisposed to developing IPE than patients with other types of cancers. 13,23 However, anticoagulant therapy for gastric cancer patients with VTE poses a higher bleeding risk than other cancer types.…”

Section: Introductionmentioning

confidence: 99%

Concurrence of Gastric Cancer and Incidental Pulmonary Embolism May Be a Prognostic Factor for Advanced Gastric Cancer Patients with Incidental Pulmonary Embolism

Qiu¹,

Meng²,

Wang³

et al. 2021

CMAR

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Objective: Cancer is well known as the most important risk factor for the emergence of pulmonary embolism (PE). The incidence of incidental PE (IPE) has increased with widely use of multi-detector-row computed tomography (CT) technology. Simultaneously, more new cancer patients diagnosed concomitantly with IPE are found. No study has examined the presentation and prognosis of incidental pulmonary embolism (IPE) in gastric cancer patients. The aim of this study was to analyse prognostic factors in patients with advanced gastric cancer complicated with IPE. Patients and Methods: Ninety patients with histologically confirmed advanced gastric adenocarcinoma diagnosed with IPE were enrolled. Continuous variables were compared using Student's t-test or the Mann-Whitney U-test if non-normally distributed. The Chisquared test (or Fisher's exact test where appropriate) was used to compare categorical variables. The Kaplan-Meier method and the Log rank test were used for survival analysis. Independent prognostic factors for survival were determined using a Cox proportional hazards model. A two-sided P-value < 0.05 was considered statistically significant. Results: Nineteen patients were diagnosed with IPE concomitantly with gastric cancer. Concurrence of gastric cancer and IPE, lack of anticoagulation therapy, and location of IPE were associated with survival. After adjusting for age and sex, the concurrence of gastric cancer and IPE, lack of anticoagulation, and central IPE independently influenced the survival of advanced gastric cancer patients with IPE. Subgroup analysis of patients with peripheral pulmonary embolisms confirmed that anticoagulant therapy provided a survival benefit. Conclusion: Concurrence of gastric cancer and IPE may be a prognostic factor for advanced gastric cancer patients with IPE.

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Incidence of and risk factors for preoperative deep venous thrombosis in patients undergoing gastric cancer surgery

Cited by 20 publications

References 29 publications

Venous thromboembolism in cancer patients receiving neoadjuvant chemotherapy: a systematic review and meta‐analysis

Venous thromboembolism in cancer patients receiving neoadjuvant chemotherapy: a systematic review and meta‐analysis

Efficacy and Safety of Enoxaparin for Prophylaxis of Postoperative Venous Thromboembolism After Esophagectomy: A Single-center Prospective Randomized Controlled Phase II Study

Concurrence of Gastric Cancer and Incidental Pulmonary Embolism May Be a Prognostic Factor for Advanced Gastric Cancer Patients with Incidental Pulmonary Embolism

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