Preoperative Enoxaparin Versus Postoperative Semuloparin Thromboprophylaxis in Major Abdominal Surgery

Kakkar, Ajay K.; Agnelli, Giancarlo; Fisher, William D.; George, Daniel J.; Lassen, Michael R.; Mismetti, Patrick; Mouret, P; Murphy, James; Lawson, Francesca; Turpie, Alexander G.G.

doi:10.1097/sla.0000000000000430

Cited by 31 publications

(19 citation statements)

References 16 publications

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“…Similarly, the SAVE-ABDO study showed comparable efficacy between enoxaparin and semuloparin for the primary outcome of any VTE and all-cause mortality (5.5 vs. 6.3%; OR: 1.16, 95% CI: 0.84-1.59). 48 Fewer bleeding events were observed with semuloparin (4.5 vs. 2.9%; OR: 0.63, 95% CI: 0.46-0.87) in that study.…”

Section: Colorectal Surgerymentioning

confidence: 56%

“…46 At least two clinical trials have demonstrated similar efficacy but different rates of bleeding between various types of LMWHs. 47,48 In a study by Simonneau et al, colorectal cancer patients received either nadroparin or enoxaparin, both commencing prior to surgery. 47 All VTE events (both symptomatic and asymptomatic) at day 12 were reported to be 15.9% with nadroparin versus 12.6% with enoxaparin (relative risk [RR]: 1.27, 95% CI: 0.93-1.74).…”

Section: Colorectal Surgerymentioning

confidence: 99%

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Thromboprophylaxis in Cancer Patients Undergoing Surgery

Htun

Lee

2017

Semin Thromb Hemost

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Venous thromboembolism (VTE) is a common, complex, and costly complication in cancer patients undergoing surgery. VTE risk varies with types of cancer surgery as well as patient-, cancer-, and treatment-associated factors. Current VTE preventive measures with pharmacological, mechanical, and combination of both are shown to be effective. Clinical questions remain and more research is needed, focusing on the role of thromboprophylaxis for minimally invasive surgery and major cancer surgery other than abdominal/pelvic surgery, as well as optimal duration of thromboprophylaxis in high-risk patients. Routine individual VTE risk assessment and better adherence to thromboprophylaxis guidelines may offer improved outcomes in cancer patients undergoing surgery. A summary of currently available evidence and consensus guidelines on the primary prevention of VTE in cancer patients undergoing various types of surgery is presented here.

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Section: Colorectal Surgerymentioning

confidence: 56%

Section: Colorectal Surgerymentioning

confidence: 99%

Thromboprophylaxis in Cancer Patients Undergoing Surgery

Htun

Lee

2017

Semin Thromb Hemost

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“…15 In CRS procedures, tumor burden, extensive surgical resection, and the risk of perioperative coagulopathy are common challenges in peritoneal metastasis patients, and surgeons have to weigh the risks and benefits of delaying heparin-based VTE prophylaxis, which was the strategy reported by Lanuke et al 15 This series reported a VTE rate of 10 per cent, whereas strategies using preoperative pharmacologic VTE prophylaxis report rates as low as 5 per cent similar to what we observed in this series. 49,50 The hypercoagulable impact of surgery is well established in abdominal surgery, but PM patients have additional factors including extended surgical time and extensive cancer burden. Accruing data suggests that the metastatic cancer burden can increase VTE events through multiple, concomitant biological mechanisms driving a hypercoagulable state such as: increased tissue factor expression, an imbalance of pro and anticoagulation factors, cytokine derangements, and chemotherapy induced damage to vascular endothelium.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Dextran-40 as a Venous Thromboembolism Prophylaxis Strategy in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Foster

Watley

Wahlmeier

et al. 2017

The American Surgeon

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The incidence of venous thromboembolism (VTE) in peritoneal malignancies can approach 30 to 50 per cent without prophylaxis. Prophylaxis in cytoreductive surgeries (CRS) presents a challenge to preoperative heparin-based therapy because of an increased risk of coagulopathy and potential for bleeding. Herein, we report the large series of CRS and hyperthermic intraperitoneal chemotherapy receiving dextran-40 prophylaxis. Retrospective chart review of peritoneal malignancies patients undergoing CRS at University of Nebraska Medical Center identified 69 individuals who received dextran-40 between 2010 and 2013. The incidences of VTEs, perioperative bleeding, complications, morbidity, and mortality were determined in-hospital and at 90 days. Of the 69 patients treated, the 30-day VTE rate was 8.7 per cent, and no pulmonary embolisms, bleeding, anaphylactoid reaction, or mortality were observed with dextran usage. The specific VTE events included three upper extremity and three lower extremity VTEs. No additional VTE events were identified between 30 and 90 days. In conclusion, dextran-40 prophylaxis was not associated with any perioperative bleeding events, and the observed incidence of VTE was comparable to reported heparin-based prophylaxis in CRS/hyperthermic intraperitoneal chemotherapy patients. This data supports further exploration of dextran-40 as a VTE prophylactic agent in complex surgical oncology cases.

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“…While the development of VTE usually occurs in the early postoperative period, some studies have indicated a high occurrence rate of VTE even after hospital discharge in colorectal surgery [9,11,12]. Therefore, the ideal schedule and dosage of anticoagulants for perioperative chemical thromboprophylaxis remains controversial [12,[19][20][21].…”

Section: Sustained Hyper-coagulation and Development Of Dvtmentioning

confidence: 99%

Perioperative coagulofibrinolytic responses in colorectal surgery patients without chemical thromboprophylaxis: a retrospective observational study

et al. 2021

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Purpose During the perioperative period, coagulofibrinolytic activation occurs, which occasionally results in thromboembolic complications. However, natural perioperative coagulofibrinolytic responses have not been well investigated. The present study examined perioperative coagulofibrinolytic changes and their association with the development of venous thromboembolism (VTE). Methods We retrospectively analyzed the changes in coagulofibrinolytic markers for 7 days in 70 patients undergoing elective colorectal surgery. To explore the natural coagulofibrinolytic response, we investigated patients not undergoing perioperative chemical thromboprophylaxis. Results Coagulation activation occurred from just after surgery to postoperative day (POD) 1, followed by a gradual decrease, but persisted to even POD 7. Fibrinolytic activity showed a tri-phasic response: activation, shutdown and reactivation. Consequently, fibrin/fibrinogen degradation product (FDP) and D-dimer levels continued to increase until POD 7. The development of deep vein thrombosis (DVT) was observed in 11 patients (15.7%). Postoperative sustained hyper-coagulation [soluble fibrin (SF) or thrombin–antithrombin complex (TAT) values on POD 7 > their normal limits] was significantly associated with the development of DVT (SF, p < 0.001; TAT, p = 0.001). Conclusion We found initial coagulation activation and a tri-phasic response of fibrinolytic activity after colorectal surgery. Thus, physicians need to pay attention to these responses when attempting to prevent or treat VTE.

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Preoperative Enoxaparin Versus Postoperative Semuloparin Thromboprophylaxis in Major Abdominal Surgery

Abstract: Semuloparin commenced postoperatively did not demonstrate noninferiority to enoxaparin initiated preoperatively for thromboprophylaxis after major abdominal surgery. Study registered with clinicaltrials.gov: NCT00679588.

Cited by 31 publications

References 16 publications

Thromboprophylaxis in Cancer Patients Undergoing Surgery

Thromboprophylaxis in Cancer Patients Undergoing Surgery

The Efficacy of Dextran-40 as a Venous Thromboembolism Prophylaxis Strategy in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Perioperative coagulofibrinolytic responses in colorectal surgery patients without chemical thromboprophylaxis: a retrospective observational study

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