Low Risk of Thromboembolic Complications After Fast-Track Abdominal Surgery With Thrombosis-Prophylaxis Only During Hospital Stay

Abstract

BackgroundSubcutaneous low molecular weight heparin (LMWH) reduces the risk of thromboembolic complications after abdominal surgery. With enhanced recovery after surgery (ERAS), median hospital stay after abdominal surgery may be as short as 3 - 4 days. The aim of our study was to investigate whether thrombosis prophylaxis during the short hospital stay was sufficient to maintain a low frequency of thromboembolic complications.MethodsNinety-eight patients, median age 67 years, were enrolled in a prospective two-center observational study of colorectal resections following the ERAS principles. Seventy-seven patients (78.6%) were resected for colonic cancer, the rest for benign colonic diseases. Fifty percent of the patients were discharged from hospital within three days after surgery. Follow-up examinations took place at 8 and 30 days after surgery with clinical examination for thromboembolism. The patients enrolled at one of the centers were also scheduled for a routine venography at day 8. Seventeen of these were evaluated.ResultsClinical follow-up at day 8 of 72 patients (73.5%) revealed no venous thromboembolism (VTE), and the 17 venograms did not show any thromboses. Clinical follow-up at day 30 of 74 patients (75.5%) showed no deep venous thrombosis (DVT), whereas pulmonary embolus (PE) was suspected and verified in one patient (1.3%) with pulmonary metastases and pneumonia.ConclusionsProphylaxis until full mobilization seems to be sufficient following major surgery in patients treated with the principles of ERAS who remain in hospital for 3 - 4 days.

Venous thromboembolism following colectomy for diverticular disease: an English population-based cohort study

“…These clear high-risk groups identified within patients with surgically managed diverticular disease may also be potential targets for future interventional studies in mitigating this increased risk. Minimally invasive alternatives as well as the implementation of ERAS have been shown to reduce the risk of developing post-colectomy VTE and have better surgical outcomes [ 42 – 44 , 49 – 54 ].…”

Preoperative Preparation in Colorectal Surgery

“…For patients having cancer, the incidence slightly rise to 30-40%. [89][90][91][92][93] Fatal embolism occurred in about 1%. After low molecular weight heparin (LMWH) the incidence of VTE is 6% and fatal embolism 0,01%.…”

Extended versus inpatient thromboprophylaxis with heparins following major open abdominopelvic surgery for malignancy: a systematic review of efficacy and safety

“…Chandra et al (2013),Sanderson et al (2011),Mohn et al (2011), andVarpe et al (2009) all published cohort studies on the efficacy of inpatient heparin VTE prophylaxis following colorectal procedures, with all reporting low VTE rates in these patients with a range between 0.6(Varpe et al 2009) and 1.35%(Mohn et al 2011). While these papers were comparable not only in their population (colorectal cancer patients) and length of follow-up (1 to 3 months), all were limited by a small sample size.KlimowiczWhite et al (2015),Sun et al (2015),Jeong et al (2010), andBeyer et al (2009) also all included a cohort of patients receiving inpatient heparin, with comparisons made to mechanical prophylaxis and no prophylaxis, as well as comparison to therapeutic enoxaparin inSchmitges et al (2012) and warfarin anticoagulation bySun et al (2015).…”