Safety profile of preoperative administration of low-molecular-weight heparin on minimally invasive lung cancer surgery: a randomized controlled trial

Abstract

Background Venous thromboembolism remains a common but preventable complication for cancerous lung surgical patients. Current guidelines recommend thromboprophylaxis for lung patients at high risk of thrombosis, while a consensus about specific administration time is not reached. This study was designed to investigate the safety profile of preoperative administration of low-molecular-weight-heparin (LMWH) for lung cancer patients. Methods From July 2017 to June 2018, patients prepared to undergo lung cancer surgery were randomly divided into the preoperative LMWH-administration group (PRL) for 4000 IU per day and the postoperative LMWH-administration group (POL) with same dosage, all the patients received thromboprophylaxis until discharge. Baseline characteristics including demographics and preoperative coagulation parameters were analyzed, while the endpoints included postoperative coagulation parameters, postoperative drainage data, hematologic data, intraoperative bleeding volume and reoperation rate. Results A total of 246 patients were collected in this RCT, 34 patients were excluded according to exclusion criterion, 101 patients were assigned to PRL group and 111 patients belonged to POL group for analysis finally. The baseline characteristic and preoperative coagulation parameters were all comparable except the PRL group cost more operation time (p = 0.008) and preoperative administration duration was significantly longer (p < 0.001). The endpoints including postoperative day 1 coagulation parameters, mean and total drainage volume, drainage duration, intraoperative bleeding volume and reoperation rate were all similar between the two groups. Moreover, coagulation parameters for postoperative day 3 between the two groups demonstrated no difference. Conclusion Preoperative administration of low-molecular-weight-heparin demonstrated safety and feasibility for lung cancer patients intended to receive minimally invasive surgery. Trial registration: ChiCTR2000040547 (www.chictr.org.cn), 2020/12/1, retrospectively registered.

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Guideline Update

“…For the question on perioperative thromboprophylaxis, the search identified eight eligible RCTs. Five of the eight [13][14][15][16][17] assessed low molecular weight heparin (LMWH) and did not alter recommendations from the 2019 guideline. 9 The remaining three trials assessed a direct factor Xa inhibitor either during hospitalization 18 or for extended postoperative thromboprophylaxis.…”

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

“…The trial revealed that preoperative start of LMWH was safe and feasible compared with postoperative start of LMWH for minimally invasive lung cancer surgery patients. 76 …”

“…The trial revealed that preoperative start of LMWH was safe and feasible compared with postoperative start of LMWH for minimally invasive lung cancer surgery patients. 76 TREATMENT Studies specific for VTE treatment of patients with lung cancer are scarce in recent years. In the recent RCTs with respect to VTE treatment in patients with various types of cancer, DOACs which are oral factor Xa inhibitors played a pivotal role in VTE treatment.…”

“…In another RCT, 212 patients prepared to undergo minimally invasive lung cancer surgery were randomly divided into the preoperative LMWH-administration group and the postoperative LMWH-administration group both of which received 4000 IU/day, until discharge. The trial revealed that preoperative start of LMWH was safe and feasible compared with postoperative start of LMWH for minimally invasive lung cancer surgery patients 76…”