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

Abstract

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.

Comparison of dextran and albumin on blood coagulation in patients undergoing major gynaecological surgery

“…Perioperative TEG hypercoagulation has also been suggested to reflect the degree of malignancy of ovarian masses (Amirkhosravi et al 2013 ). Dextran has been suggested to reduce thromboembolism in cancer surgery (Foster et al 2017 ). Dextrans have also been used in vascular surgery to diminish the risk of stroke associated with carotid endarterectomy and in “difficult” infragenicular lower extremity bypasses (Abir et al 2004 ).…”

Chloroquine-Modified Hydroxyethyl Starch as a Polymeric Drug for Cancer Therapy

“…Modified polysaccharides have shown great promise in the biomedical field. 1−8 A few nonsynthetic and semisynthetic formulations of glucans such as dextran and hydroxyethyl starch (HES) have been used clinically for the past few decades, 9,10 and their biocompatibility, biodegradability, low immunogenicity, and ability to be readily modified by various functional moieties make them attractive starting materials in the field of drug delivery. 11−19 Modification with hydrophobic moieties such as cholesterol or hydrophobic drugs allows for assembly of the polysaccharides into nanoparticles that may improve the efficacy and safety of drug delivery.…”

“…Modified polysaccharides have shown great promise in the biomedical field. − A few nonsynthetic and semisynthetic formulations of glucans such as dextran and hydroxyethyl starch (HES) have been used clinically for the past few decades, , and their biocompatibility, biodegradability, low immunogenicity, and ability to be readily modified by various functional moieties make them attractive starting materials in the field of drug delivery. − Modification with hydrophobic moieties such as cholesterol or hydrophobic drugs allows for assembly of the polysaccharides into nanoparticles that may improve the efficacy and safety of drug delivery. , For example, modifying HES with fatty acids allowed for assembly of HES micelles, and subsequently it was shown that propylating starch facilitates the assembly of large nanoparticles for encapsulation of doxetaxel . Using pentadecylphenol-modified dextran, Pramod et al synthesized a dual delivery nanovesicle of camptothecin and doxorubicin, which displayed synergistic improvement in anticancer activity .…”