Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis

Smith, David; Raíces, Micaela; Diego, Carolina; Drago, Julián; Montagne, Juan; Dietrich, Alexander

doi:10.1007/s11239-020-02277-3

Cited by 3 publications

(5 citation statements)

References 30 publications

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“…The general incidence of VTE is reported to be 0.2-20% after lung resection, owing to the varying choice of pharmacological and mechanical thromboprophylaxis (8).…”

Section: Discussionmentioning

confidence: 99%

“…Compared with video-assisted thoracoscopic surgery (VATS), open approach was significantly associated with postoperative bleeding, which probably because VATS patients usually composed of selected groups with more peripheral, smaller and safer resection lesions (32). There seems to be no statistically significant association between prevention time and thrombosis or bleeding (8). In our study, no major bleeding occurred in either the mechanical prophylaxis group or the LMWH plus mechanical prophylaxis group, which may be related to the early stage of lung cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The absolute risk of VTE depends on multiple factors (7), including surgery, cancer and immobilization. One of the most important being surgical intervention, especially for lung cancer patients undergoing major surgery, because the main pathogenic factors of VTE, such as vascular wall damage, hypercoagulable state and venous stasis, may be promoted during surgery (8). It is essential to prevent VTE in patients following pulmonary lobectomy.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of venous thromboembolism and hemorrhage in Chinese patients after pulmonary lobectomy: mechanical prophylaxis or mechanical prophylaxis combined with pharmacological prophylaxis: a randomized controlled trial

et al. 2021

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Background: Venous thromboembolism (VTE) and postoperative bleeding are important complications of lung resection surgery. We investigated the preventive effect of mechanical prophylaxis versus pharmacological prophylaxis after lobectomy, and evaluated the effect of both on the incidence of hemorrhagic events.Methods: A prospective study of 424 lobectomies with moderate to high risk of VTE (Caprini risk score <5) in a single center was performed from April 2020 to March 2021. Patients were 1:1 randomly allocated to mechanical prophylaxis or to the low-molecular-weight heparin (LMWH)-combination-prophylaxis.The incidence of postoperative thrombotic and bleeding events and relevant factors of the two groups were analyzed.Results: A total of 410 participants, with 202 and 208 in the mechanical prophylaxis and LMWHcombination-prophylaxis groups respectively, were selected for analysis. Both groups had similar baseline and clinical characteristics. There were no cases of VTE or major bleeding during the study, but the incidence rate of minor bleeding in the LMWH-combination-prophylaxis group was significantly higher than mechanical prophylaxis group [odds ratio (OR) 0.035, 95% confidence interval (CI): 0.011-0.113].Conclusions: A case-by-case risk assessment of VTE and hemorrhage remains necessary to determine the most appropriate method of thrombosis prophylaxis for patients undergoing pulmonary surgery. Mechanical prophylaxis may be preferable for lung cancer patients with moderate to high risk of VTE (Caprini risk score <5) undergoing lobectomy.

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“…The general incidence of VTE is reported to be 0.2-20% after lung resection, owing to the varying choice of pharmacological and mechanical thromboprophylaxis (8).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence of venous thromboembolism and hemorrhage in Chinese patients after pulmonary lobectomy: mechanical prophylaxis or mechanical prophylaxis combined with pharmacological prophylaxis: a randomized controlled trial

et al. 2021

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“…Compliance with VTE prophylaxis guidelines is essential. 74 In a pilot randomised control trial (RCT) of 103 patients who underwent oncological lung resections, 30-day VTE incidence and 90-day survival rate were compared between the intervention group (n=52) which received post-discharge LMWH and placebo group (n=51) which received post-discharge placebo, once daily for 30 days. Three segmental PE (5.8%) were detected in the intervention group, whereas two segmental PE and one DVT (5.9%) were detected in the placebo group.…”

Section: Thromboprophylaxismentioning

confidence: 99%

“…A retrospective observational study of 358 patients who underwent lobectomies demonstrated that the use of thromboprophylaxis and timing of its initiation were not associated with the postoperative thrombotic or haemorrhagic events. Compliance with VTE prophylaxis guidelines is essential 74. In a pilot randomised control trial (RCT) of 103 patients who underwent oncological lung resections, 30-day VTE incidence and 90-day survival rate were compared between the intervention group (n=52) which received post-discharge LMWH and placebo group (n=51) which received post-discharge placebo, once daily for 30 days.…”

Section: Thromboprophylaxismentioning

confidence: 99%

Management of venous thromboembolism in patients with lung cancer: a state-of-the-art review

Xiong

Guo

et al. 2023

BMJ Open Resp Res

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Venous thromboembolism (VTE) is common and life-threatening in patients with lung cancer. Management of VTE is critical for patients with lung cancer. Risk assessment, thromboprophylaxis and treatment of VTE constitute the core issues of VTE management in patients with lung cancer. Although its overall principles should follow recommendations in authoritative guidelines, VTE management in patients with lung cancer may be slightly special in some specific aspects. Despite the extensive validation of Khorana score for patients with all cancer types, its value in VTE risk assessment of patients with lung cancer is controversial. It is important to determine the VTE risk assessment score that can accurately and specifically assess the VTE risk of patients with lung cancer. Clinical practice patterns of thromboprophylaxis may vary by cancer types, since different sites of cancer may have different levels of VTE risk. To understand the thromboprophylaxis specific for lung cancer is of vital importance for patients with lung cancer. Although it is essential to comply with authoritative guidelines, the duration and timing of initiation of thromboprophylaxis in surgical patients with lung cancer may need further study. Taken together, the purpose of this review is to provide an overview of state-of-the-art VTE stewardship specific for patients with lung cancer.

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Risk factor analysis for early development of calf muscular vein thrombosis after thoracic surgery:a prospective observational study

Xu,

Miao,

She

et al. 2023

Preprint

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Background: Venous thromboembolism is a common complication after thoracic surgery. The early development of calf muscular vein thrombosis (CMVT) after thoracic surgery is not well understood. The purpose of our study was to find the incidence and risk factors of early CMVT after thoracic surgery. Methods: We performed a prospective observational study in patients who received thoracic surgery from December 2021 to January 2023. The patients were assigned to either the CMVT or non-CMVT group based on their early postoperative lower extremity venous Doppler ultrasound results. The clinical characteristics of CMVT patients and non-CMVT patients would be compared and analyzed.Multivariate logistic regression analysis was conducted to identify independent risk factors associated with CMVT development. The area under the receiver operating characteristic curve was also calculated. Results: A total of 745 patients were included in the final analysis, with 185 (24.8%) and 560 (75.2%) patients in the CMVT and non-CMVT groups, respectively. In the CMVT group, 7 (3.8%) and 87 (47.1%) patients had concurrent proximal deep vein thrombosis and bilateral lower extremity thrombosis, respectively.Multivariate logistic regression analysis showed that age (OR = 1.092, 95% CI = 1.064–1.120, P = 0.000), Caprini score (moderate and high risks) (OR = 2.029, 95% CI = 1.276–3.227, P= 0.003), non-anticoagulation (OR = 1.859, 95% CI = 1.147–3.013, P = 0.012), operative duration >135 minutes (OR = 1.697, 95% CI = 1.135–2.538, P= 0.010), and postoperative day 1 D-dimer level (OR = 1.342, 95% CI = 1.232–1.462, P = 0.000) were independent risk factors for early postoperative CMVT. The receiver operating characteristic curve analysis showed that the areas under the curve for age and postoperative day 1 D-dimer were 0.715 (cut off value of 58.5) and 0.781 (cut off value of 1.445), respectively. Conclusions: The incidence of early CMVT after thoracic surgery was 24.8%. Nearly half of the CMVT patients had bilateral involvement. The risk of early CMVT was reduced after perioperative anticoagulation prophylaxis. In addition, older age, moderate and high Caprini risk score, operative time >135 minutes, and high postoperative day 1 D-dimer level were independent risk factors for the early development of CMVT after thoracic surgery.

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Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis

Cited by 3 publications

References 30 publications

Incidence of venous thromboembolism and hemorrhage in Chinese patients after pulmonary lobectomy: mechanical prophylaxis or mechanical prophylaxis combined with pharmacological prophylaxis: a randomized controlled trial

Incidence of venous thromboembolism and hemorrhage in Chinese patients after pulmonary lobectomy: mechanical prophylaxis or mechanical prophylaxis combined with pharmacological prophylaxis: a randomized controlled trial

Management of venous thromboembolism in patients with lung cancer: a state-of-the-art review

Risk factor analysis for early development of calf muscular vein thrombosis after thoracic surgery:a prospective observational study

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