Is extended thromboprophylaxis necessary in elective colorectal cancer surgery?

Chandra, Raaj; Melino, Giovanni; Thomas, Michelle; Lawrence, Matthew; Hunter, Ronald; Moore, James W.

doi:10.1111/ans.12244

Cited by 13 publications

(7 citation statements)

References 42 publications

(93 reference statements)

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“…Reasons for exclusion are in Figure . Eleven articles reported the incidence of VTE at 3 months (primary outcome) following surgery . However, we were able to find 13 articles that reported the incidence of VTE at 1 month from surgery (secondary outcome).…”

Section: Resultsmentioning

confidence: 93%

Incidence of delayed venous thromboembolic events in patients undergoing abdominal and pelvic surgery for cancer: a systematic review and meta‐analysis

Serrano

Parpia

Valencia

et al. 2019

ANZ Journal of Surgery

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Background: Incidence of venous thromboembolism (VTE) following discharge for abdominal cancer surgery is uncertain. Methods: We searched MEDLINE and Embase for studies evaluating the incidence of VTE at 3 months from surgery. Studies indicating use of post-hospital VTE prophylaxis were excluded. Two independent reviewers performed study selection, data abstraction and risk of bias. Random-effects model was used to estimate pooled incidence, and weights were estimated using inverse variance method. Statistical heterogeneity was explored via subgroup analysis. Results: Of 4215 abstracts retrieved, 11 reported the incidence of VTE at 3 months. There were three randomized trials (n = 520), one prospective cohort study (n = 284) and seven retrospective cohort studies (n = 65 308). VTE incidence among prospective studies was 9.6% (95% confidence interval (CI) 2.9-16.4), while for retrospective studies was 2.2% (95% CI 1.4-3.0). Heterogeneity was high (I 2 = 92% and 81%, respectively). The incidence of symptomatic VTE was 1.3% (95% CI 0.4-2.3) for prospective studies. VTE was diagnosed by screening venography in most of the prospective studies, whereas retrospective studies did not use a screening method. Subgroup analysis based on the type of organ surgery performed explained the heterogeneity. Conclusions: VTE incidence following abdominal cancer surgery varies greatly depending on the study type, with differences largely explained by the method of assessment of VTE. The fact that VTE incidence among retrospective studies was closer to the incidence of symptomatic events (non-screen detected) in the prospective studies, suggests that the screened events were mostly asymptomatic and their clinical significance is unclear.

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Section: Resultsmentioning

confidence: 93%

Incidence of delayed venous thromboembolic events in patients undergoing abdominal and pelvic surgery for cancer: a systematic review and meta‐analysis

Serrano

Parpia

Valencia

et al. 2019

ANZ Journal of Surgery

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“…Hata et al reported no symptomatic VTEs within 7 days of surgery in 619 Japanese patients given FPX after CRC surgery [10]. Other studies have reported that the incidence of symptomatic VTE within 30 days of CRC surgery in patients receiving LMWH or UFH range from 0 to 1.8% [11,12,13]. FPX significantly reduces the incidence of VTE in patients undergoing major abdominal surgery with IPC [5], and it is as effective as perioperative LMWH in patients undergoing high-risk abdominal surgery [4].…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Fondaparinux for Prophylaxis of Venous Thromboembolism after Colorectal Cancer Resection: A Propensity Score Matched Analysis

et al. 2015

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Background/Aims: The aim of this study was to examine the safety and efficacy of fondaparinux (FPX) for venous thromboembolism (VTE) prophylaxis after colorectal cancer surgery. Methods: Records of 953 patients with colorectal cancer who underwent resection between 2006 and 2013 were reviewed. Patients were divided into two groups: the FPX group (n = 362), treated with subcutaneous FPX plus intermittent pneumatic compression (IPC) and the IPC group (n = 591), treated with IPC alone. The incidence of symptomatic VTE, major bleeding, minor bleeding, and other postoperative complications were compared using propensity score matching. Results: Symptomatic VTE occurred only in one patient (0.2%) in the IPC group. In the FPX group, the incidence of major and minor bleeding was 0.55% (2 of 362) and 9.4% (34 of 362), respectively. After propensity score matching, there were no differences between the two groups in the incidence of symptomatic VTE, major bleeding, and other common postoperative complications. Only the incidence of minor bleeding was significantly higher in the FPX group compared to the IPC group. Conclusion: FPX is potentially an effective form of VTE prophylaxis; it is safe in terms of both postoperative bleeding and other common complications after colorectal cancer surgery.

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“…Our study focussed on patients in an ERAS programme who were undergoing surgery for Stage I--III colon cancer, and it emphasizes the need for randomized trials of prolonged VTE prophylaxis for these patients before making national recommendations. Chandra et al [19] found, in a single-centre study, a similar low risk of post-discharge symptomatic VTE after colorectal cancer surgery without prolonged VTE prophylaxis, but within an ERAS programme. The differences in risk of VTE observed by us and Chandra et al, and the studies [5,6,16] on which the national guidelines [9,10] are based, may possibly be the result of use of an ERAS programme, with early mobilization.…”

Section: Discussionmentioning

confidence: 86%

Incidence of venous thromboembolic events in enhanced recovery after surgery for colon cancer: a retrospective, population‐based cohort study

et al. 2017

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Is extended thromboprophylaxis necessary in elective colorectal cancer surgery?

Abstract: We have demonstrated excellent compliance with in-hospital thromboprophylaxis. Hence, we have low VTE rates in-particular, post-discharge VTE. The infrequency of post-discharge VTE means that the cost-effectiveness of extended prophylaxis might be questioned.

Cited by 13 publications

References 42 publications

Incidence of delayed venous thromboembolic events in patients undergoing abdominal and pelvic surgery for cancer: a systematic review and meta‐analysis

Incidence of delayed venous thromboembolic events in patients undergoing abdominal and pelvic surgery for cancer: a systematic review and meta‐analysis

Safety and Efficacy of Fondaparinux for Prophylaxis of Venous Thromboembolism after Colorectal Cancer Resection: A Propensity Score Matched Analysis

Incidence of venous thromboembolic events in enhanced recovery after surgery for colon cancer: a retrospective, population‐based cohort study

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