Symptomatic Venous Thromboembolism in Asian Colorectal Cancer Surgery Patients

Yang, Song-Soo; Yu, Chang Sik; Yoon, Yong Sik; Yoon, Sang Nam; Lim, Seok‐Byung; Kim, Jin Cheon

doi:10.1007/s00268-011-0957-2

Cited by 33 publications

(35 citation statements)

References 51 publications

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“…A search of PubMed, PubMed Central, and Google Scholar for the terms “colon or colorectal surgery” and “VTE” and of reference lists of retrieved articles identified 20 relevant papers . Many of these studies were retrospective analyses that relied on database searches.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of anticoagulant prophylaxis for prevention of postoperative venous thromboembolism in Japanese patients undergoing laparoscopic colorectal cancer surgery

Hata

Yasui

Ikeda

et al. 2019

Annals of Gastroent Surgery

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Aim To investigate the efficacy and safety of anticoagulant prophylaxis to prevent postoperative venous thromboembolism (VTE) during laparoscopic colorectal cancer (CRC) surgery, which is unknown in Japanese patients. Methods We conducted this randomized controlled trial at nine institutions in Japan from 2011 to 2015. It included 302 eligible patients aged 20 years or older who underwent elective laparoscopic surgery for CRC. Patients were randomly assigned to an intermittent pneumatic compression (IPC) therapy group or to an IPC + anticoagulation therapy group. Anticoagulation therapy comprised fondaparinux or enoxaparin for postoperative VTE prophylaxis. Postoperative VTE was diagnosed based on enhanced multi‐detector helical computed tomography. The primary endpoint was VTE incidence, including asymptomatic cases, the secondary endpoint was incidence of major bleeding, and we conducted an intention‐to‐treat analysis. This study is registered in UMINCTR (UMIN000008435). Results Postoperative VTE incidence was 5.10% with IPC therapy (n = 157) and 2.76% with IPC + anticoagulant therapy (n = 145; P = .293). We identified no symptomatic VTE cases. The major bleeding rates were 1.27% with IPC alone and 1.38% with the combination (P = .936). The overall bleeding rates were 7.69% for enoxaparin and 13.6% for fondaparinux (P = .500), and there were no bleeding‐related deaths. Conclusion Anticoagulant prophylaxis did not reduce the incidence of VTE and the incidence of major bleeding was comparable between the two groups. Usefulness of perioperative anticoagulation was not demonstrated in this study. Pharmacological prophylaxis must be restricted in Japanese patients with higher risk of VTE.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of anticoagulant prophylaxis for prevention of postoperative venous thromboembolism in Japanese patients undergoing laparoscopic colorectal cancer surgery

Hata

Yasui

Ikeda

et al. 2019

Annals of Gastroent Surgery

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“…It occurs more frequently after colorectal surgery than after any other type of surgery 1) . The mortality rate is high (4.3-56.7%) [1][2][3][4][5] and perioperative prophylaxis is essential.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for bleeding in patients receiving fondaparinux after colorectal cancer surgery

Pak

Ikeda

Uemura

et al. 2017

J Anus Rectum Colon

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Abstract:Objective: The aim of this study was to identify risk factors for bleeding complications in patients who receive Venous thromboembolism (VTE) prophylaxis with fondaparinux (FPX) after colorectal cancer surgery. Methods: Records of 546 patients who underwent VTE prophylaxis with intermittent pneumatic compression and FPX after colorectal cancer surgery between January 2009 and May 2014 were reviewed. Patient characteristics, surgical procedures, and patient laboratory data were examined to identify risk factors for bleeding complications using univariate and multivariate logistic regression. Results: We reviewed the records of 324 males and 222 females. Median age and BMI were 68.5 years and 22.7 kg/m 2 , respectively. The number of laparoscopic surgeries was 366. Median operative time and blood loss were 188.5 min and 20 ml, respectively. The incidence (%) of bleeding events was 5.3%. In univariate analysis, age !80 years, BMI !25.0 kg/m 2 , hypertension, and antithrombotic therapy were associated with a significantly higher incidence of bleeding events. Multivariate analysis identified age !80 years (odds ratio 5.814; 95% confidence interval 2.502-13.278) as an independent risk factor. Conclusion: Age !80 is a risk factor for bleeding in patients who receive FPX for VTE prophylaxis after colorectal cancer surgery.

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“…Some studies did analyze subgroups of DVT versus PE rates and symptomatic versus asymptomatic VTE. Both Yang et al (2011) and Sakon et al (2010) reported the addition of inpatient pharmacological prophylaxis to reduce the risk of VTE compared to mechanical only prophylaxis (0.72% compared to 0.91% (Yang et al 2001) and 1.2% compared to 19.4% (Sakon et al 2010)). The large difference in VTE rate reported in Sakon et al (2010) could be attributed to its broad inclusion criteria for operative type-including any laparotomy with curative intent for a malignancy, whereas Unsurprisingly, Sakon et al (2010) and Jeong et al (2010) both report total bleeding events to be greater in patients receiving pharmacological prophylaxis (total bleeding complication rates of 9.17% and 13.4% in patients receiving heparin compared with 7.89% and 5.5% in those receiving mechanical and no prophylaxis).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background:Patients undergoing open abdominopelvic procedures for malignancy are at high risk of postoperative venous thromboembolism (VTE). This risk can be mitigated with prophylaxis; however, optimum duration in this population remains unknown. Our objective was to conduct a systematic review of contemporary literature on the use of heparin thromboprophylaxis following major open pelvic surgery for malignancy, comparing the efficacy and safety of extended duration to inpatient treatment. Methods: A study protocol describing search strategy and inclusion and exclusion criteria was developed and registered with PROSPERO. A literature review was conducted in accordance with the protocol. Results: Literature review identified only 4 studies directly comparing extended and inpatient duration prophylaxis, with a combined population of 3198 and 3135 patients for VTE rate and bleeding events, respectively. Despite many studies reporting lower VTE rates in patients receiving extended prophylaxis, no statistically significant difference in rates of postoperative VTE (p = 0.18) or bleeding complications (p = 0.43) was identified between patients receiving extended duration prophylaxis and those receiving inpatient only prophylaxis. Conclusion: On the review of contemporary literature, no significant difference was found in rates of postoperative VTE or bleeding complications between patients receiving extended duration heparin VTE prophylaxis and those receiving inpatient prophylaxis after open abdominopelvic surgery for malignancy. This raises the question of how extended duration prophylaxis has become common practice in this population, and whether this needs to be re-evaluated.

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Symptomatic Venous Thromboembolism in Asian Colorectal Cancer Surgery Patients

Cited by 33 publications

References 51 publications

Efficacy and safety of anticoagulant prophylaxis for prevention of postoperative venous thromboembolism in Japanese patients undergoing laparoscopic colorectal cancer surgery

Efficacy and safety of anticoagulant prophylaxis for prevention of postoperative venous thromboembolism in Japanese patients undergoing laparoscopic colorectal cancer surgery

Risk factors for bleeding in patients receiving fondaparinux after colorectal cancer surgery

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

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