Role of Extended Thromboprophylaxis After Abdominal and Pelvic Surgery in Cancer Patients: A Systematic Review and Meta-Analysis

Fagarasanu, Andrei; Alotaibi, Ghazi; Hrimiuc, Ramona; Lee, Agnes Y.Y.; Wu, Cynthia

doi:10.1245/s10434-016-5127-1

Cited by 108 publications

(91 citation statements)

References 27 publications

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“…44 27 Based upon these data, the current NCCN and ASCO guidelines recommend extended-duration prophylaxis for high-risk abdominal-pelvic cancer surgery patients. 23,24 In a prospective multicenter observational study of ambulatory cancer patients receiving chemotherapy, Khorana et al noted that 1.9% of patients developed VTE during a median follow up of 2.4 months.…”

Section: What Is the Risk Of Venous Thromboembolism (Vte) In Cancer Pmentioning

confidence: 99%

Thrombosis in the setting of cancer

Streiff

2016

Hematology

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Venous thromboembolism (VTE) is a common cause of adverse outcomes in patients with cancer. The risk of VTE varies with cancer type, stage and grade, cancer therapy, and supportive care, as well as patient characteristics including age, ethnicity, and inherited and acquired comorbid conditions. VTE prophylaxis should be provided to all hospitalized cancer patients and high-risk outpatients. Low-molecular-weight heparin (LMWH) remains the first-line therapy for VTE in patients with active cancer. Anticoagulation should be continued as long as there is evidence of active disease or patients are receiving cancer treatment. The efficacy of direct oral anticoagulants in the treatment of cancer-associated thrombosis remains incompletely defined. Central venous catheter (CVC)–associated VTE should be treated with anticoagulation alone, unless the CVC is no longer required. Recent studies indicate that anticoagulation may be appropriate for patients with persistent thrombocytopenia or solid tumor brain metastases. Management of recurrent VTE includes the identification of the cause(s) of the recurrence and solutions targeted at addressing the potential precipitants.

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Section: What Is the Risk Of Venous Thromboembolism (Vte) In Cancer Pmentioning

confidence: 99%

Thrombosis in the setting of cancer

Streiff

2016

Hematology

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“…Prolonged thromboprophylaxis with LMWH was also (42)(43)(44). It can therefore be inferred that extended prophylaxis is beneficial for surgical patients with high risk for VTE and especially those suffering from malignancy.…”

Section: Duration Of Prophylaxismentioning

confidence: 99%

Thromboprophylaxis in Elderly Surgical Patients: Current State and Future Considerations

Delimpalta¹,

Ponchietti²

2017

chr

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RezumatTromboembolismul venos reprezintã cea mai frecventã cauzã evitabilã de deces în rândul pacienţilor spitalizaţi. Pacienţii vârstnici care suferã intervenţii operatorii în sfera Chirurgiei Generale prezintã o susceptibilitate crescutã pentru Tromboza Venoasã Profundã /Tromboembolism Pulmonar Acut (TVP/TEPA). Riscul de TVP/TEPA creşte de altfel adiţional în prezenţa comorbiditãţilor prevalente în grupul pacienţilor vârstnici. Cu toate acestea, TVP/TEPA este de multe ori subdiagnosticat şi subtratat în acest grup de pacienţi. În prezent existã o serie de scoruri de risc clinice care clasificã pacienţii în categorii de risc scãzut/moderat/crescut pentru TVP/TEPA. Ghidurile clinice de bunã practicã pentru tromboprofilaxie propun fie o combinaţie de procedee mecanice (ciorapi elastici sau compresie gambiera penumaticã intermitentã), fie agenţi farmacologici (ex. Heparina cu greutate molecularã redusã sau anticoagulante orale). Dat fiind faptul cã riscul de sângerare ca efect secundar al tratamentului reprezintã o cauzã semnificativã de îngrijorare în ceea ce priveşte populaţia vârstnicã, metodele de tromboprofilaxie trebuie ajustate astfel încât acest risc sa fie cât mai scãzut. Atât opţiunea pentru un anumit tromboprofilactic, cât şi doza acestuia pot fi, de asemenea, influenţate de o alterare a funcţiei renale. Durata necesarã tromboprofilaxiei este încã neclarã, ea putând varia între c. o sãptãmânã şi o lunã, în funcţie de patologia pacientului şi evaluarea riscului individual de TVP/TEPA. AbstractVenous thromboembolism is the number one cause of preventable death for hospital inpatients. Aging general surgical patients are especially susceptible to DVT/PE and this risk increases in the presence of other comorbidities prevalent in the elderly. However, it is often unrecognised and undertreated. Various risk scores classify patients in low, moderate and high risk categories. Current guidelines for thromboprophylaxis advocate combination of mechanical methods in the form of elastic stockings or intermittent pneumatic leg compression and pharmacological agents such as low molecular weight heparins and oral anticoagulants. Increased bleeding risk is a concern in this population and the method of prophylaxis needs to be adjusted as a result. Decreased renal function also influences the choice and dosage of medication. The required duration of prophylaxis is unclear but can range from one week to more than a month depending on the underlying pathology and individual risk assessment.

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“…A recent meta‐analysis included 39 studies comparing perioperative pharmacological thromboprophylaxis in cancer patients undergoing surgery with no pharmacological prophylaxis (including mechanical prophylaxis or no prophylaxis), and demonstrated 50% reduction in the rate of deep vein thrombosis (DVT) with pharmacological prophylaxis, with an acceptable increase in the risk of bleeding, without a difference in mortality and pulmonary embolism (PE) 23. In addition, a systemic review and meta‐analysis on seven randomized studies (encompassing 4807 patients) showed that extended thromboprophylaxis (2‐6 weeks) after an abdominopelvic cancer surgery significantly reduced the risk of all VTE and proximal DVT by approximately 50%, when compared with conventional duration of thromboprophylaxis (<2 weeks) 24. No difference was found in the incidence of symptomatic PE, major bleeding events, and 3‐month all‐cause mortality 24.…”

Section: Primary Prevention Of Thrombosis In Cancer Patientsmentioning

confidence: 99%

“…In addition, a systemic review and meta‐analysis on seven randomized studies (encompassing 4807 patients) showed that extended thromboprophylaxis (2‐6 weeks) after an abdominopelvic cancer surgery significantly reduced the risk of all VTE and proximal DVT by approximately 50%, when compared with conventional duration of thromboprophylaxis (<2 weeks) 24. No difference was found in the incidence of symptomatic PE, major bleeding events, and 3‐month all‐cause mortality 24. Given this evidence, pharmacological thromboprophylaxis is recommended for most cancer patients undergoing surgery, with extended prophylaxis (4 weeks) for patients undergoing abdominopelvic cancer surgery 25, 26…”

Section: Primary Prevention Of Thrombosis In Cancer Patientsmentioning

confidence: 99%

Managing thrombosis in cancer patients

Wang

García

2018

Research and Practice in Thrombosis and Haemostasis

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Venous thromboembolism is a major complication in cancer patients. The basis for the strong association between cancer and thrombosis remains incompletely understood, and the optimal approaches to both the treatment and the prevention of cancer‐associated thrombosis are evolving. Here we review several important topics related to cancer‐associated thromboembolism, including the pathogenesis, prevention, and management of this disease. Wherever possible, we include evidence from clinical trials, including the results of recently published trials that compared direct oral anticoagulants to low‐molecular‐weight heparin for the treatment of cancer‐associated thrombosis.

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Role of Extended Thromboprophylaxis After Abdominal and Pelvic Surgery in Cancer Patients: A Systematic Review and Meta-Analysis

Cited by 108 publications

References 27 publications

Thrombosis in the setting of cancer

Thrombosis in the setting of cancer

Thromboprophylaxis in Elderly Surgical Patients: Current State and Future Considerations

Managing thrombosis in cancer patients

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