Should all patients receive extended thromboprophylaxis after resection of primary lung cancer?

Kho, Jason; Mitchell, Jenny; Curry, Nicola; Chiara, Francesco Di; Stavroulias, Dionisios; Belcher, Elizabeth

doi:10.1016/j.jtcvs.2022.06.016

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Lung cancer is associated with a higher risk of VTE than other malignant solid organ tumors [ 41 , 42 ]. Extended thromboprophylaxis reduced the tenfold risk of pulmonary embolism in patients who underwent resection of primary lung cancer and was independently associated with a reduction in postoperative PE [ 43 ]. Therefore, DOACs might be an efficacious alternative to LMWH for extended thromboprophylaxis to reduce risk of VTE in patients undergoing lung cancer resection surgery, and further studies are warranted.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of direct oral anticoagulants versus low-molecular-weight heparin for thromboprophylaxis after cancer surgery: a systematic review and meta-analysis

Zhou,

Chen,

et al. 2024

World J Surg Onc

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Background Direct oral anticoagulants (DOACs) used as an alternative to low-molecular-weight heparin (LMWH) for thromboprophylaxis after cancer surgery for venous thromboembolic events (VTE) remains unclear. This study aimed to investigate the efficacy and safety of DOACs versus LMWH in these patients. Materials and methods A search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science was carried out and included all randomized controlled trials (RCTs) and observational studies that directly compared DOACs with LMWH for thromboprophylaxis in patients after cancer surgery through July 25, 2023. The primary efficacy and safety outcomes were VTE, major bleeding, and clinically relevant non-major bleeding (CRNMB) within 30 days of surgery. The risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) tool for RCTs and ROBINS-I tool for non-randomized studies. This study was registered in PROSPERO (CRD42023445386). Results We retrieved 5149articles, selected 27 for eligibility, and included 10 studies (three RCTs and seven observational studies) encompassing 3054 patients who underwent postoperative thromboprophylaxis with DOACs (41%) or LMWH (59%). Compared to LMWH thromboprophylaxis, DOACs had a comparable risk of VTE (RR:0.69[95% CI:0.46–1.02], I2 = 0%), major bleeding (RR:1.55 [95% CI:0.82–2.93], I2 = 2%), and CRNMB (RR, 0.89 [95% CI, 0.4–1.98], I2 = 31%) during the 30-day postoperative period. Subgroup analysis of VTE and major bleeding suggested no differences according to study type, extended thromboprophylaxis, tumor types, or different types of DOAC. Conclusion DOACs are potentially effective alternatives to LMWH for thromboprophylaxis in patients undergoing cancer surgery, without increasing the risk of major bleeding events.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of direct oral anticoagulants versus low-molecular-weight heparin for thromboprophylaxis after cancer surgery: a systematic review and meta-analysis

Zhou,

Chen,

et al. 2024

World J Surg Onc

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“…The characteristics of the included population can significantly affect the reported rates. Population-based studies involving heterogeneous cancer sites generally report different incidence rates, and the risk of VTE varies considerably among lung cancer patients ( 2 , 18 ). However, the composition of the study population can significantly affect those reported rates.…”

Section: Discussionmentioning

confidence: 99%

“…There is also evidence of a probable association between the risk of VTE and bed rest time ( 2 , 18 ). Consistent with our results, Darzi et al ( 18 ) found a slightly stronger association between immobility, defined as bed rest for >7 days, and the risk of VTE, as compared to immobility, defined as bed rest for >3 days, and the risk of VTE.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, surgery is regarded as the most reliable radical treatment for primary early-stage lung cancer. Among the various complications after lung surgery, thromboembolism requires serious attention because of its impact on morbidity and mortality ( 2 , 3 ). Postoperative venous thromboembolism (VTE) after lung resection as cancer treatment leads to a nearly eight-fold increase in mortality, which is higher than that reported for other cancer surgeries ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

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Risk assessment for postoperative venous thromboembolism using the modified Caprini risk assessment model in lung cancer

Ding¹,

Yao²,

Tan³

et al. 2023

J Thorac Dis

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Background Postoperative venous thromboembolism (VTE) is a well-documented cause of morbidity and mortality in lung cancer patients. However, risk identification remains limited. In this study, we sought to analyze the risk factors for VTE and verify the predictive value of the modified Caprini risk assessment model (RAM). Methods This prospective single-center study included patients with resectable lung cancer who underwent resection between October 2019 and March 2021. The incidence of VTE was estimated. Logistic regression was used to analyze the risk factors for VTE. Receiver operating characteristic (ROC) curve analysis was performed to test the ability of the modified Caprini RAM to predict VTE. Results The VTE incidence was 10.5%. Several variables, including age, D-dimer, hemoglobin (Hb), bleeding, and patient confinement to bed were significantly associated with VTE after surgery. The difference between the VTE and non-VTE groups in the high-risk levels was statistically significant (P<0.001), while the low and moderate risk levels showed no significant difference. The combined use of the modified Caprini score and the Hb and D-dimer levels showed an area under the curve (AUC) was 0.822 [95% confidence interval (CI): 0.760–0.855. P<0.001]. Conclusions The risk-stratification approach of the modified Caprini RAM is not particularly valid after lung resection in our population. The use of the modified Caprini RAM combined with Hb and D-dimer levels shows a good diagnostic performance for VTE prediction in patients with lung cancer undergoing resection.

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Should all patients receive extended thromboprophylaxis after resection of primary lung cancer?

Cited by 6 publications

References 26 publications

Efficacy and safety of direct oral anticoagulants versus low-molecular-weight heparin for thromboprophylaxis after cancer surgery: a systematic review and meta-analysis

Efficacy and safety of direct oral anticoagulants versus low-molecular-weight heparin for thromboprophylaxis after cancer surgery: a systematic review and meta-analysis

Risk assessment for postoperative venous thromboembolism using the modified Caprini risk assessment model in lung cancer

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