The impact of pharmacological thromboprophylaxis and disease-stage on postoperative bleeding following colorectal cancer surgery

Abstract

Background Pharmacological thromboprophylaxis after colorectal cancer (CRC) surgery is internationally recommended for venous thromboembolism (VTE) prevention. The aim of this retrospective study was to evaluate the risk factors of postoperative bleeding after elective surgery for patients with primary CRC receiving pharmacological thromboprophylaxis of fondaparinux or enoxaparin. Methods We experienced consecutive 266 patients who underwent elective surgery for CRC during the study period. Finally, the medical records of 218 patients with CRC administrated fondaparinux or enoxaparin following surgery were retrospectively reviewed to evaluate symptomatic VTE until 28 days and postoperative bleeding comparing perioperative D-dimer levels. Results The significant differences in TNM classification staging and type of thromboprophylaxis were observed between postoperative bleeding-negative and bleeding-positive group. There was no statistical significance among other backgrounds of patients between the two groups. One case (0.46%) of symptomatic VTE and total 11 cases (5%) of postoperative bleeding were observed. In the univariate analysis, fondaparinux thromboprophylaxis and early disease-stage CRC (stages 0 and I) were associated with risk for postoperative bleeding. Multivariate analysis revealed that fondaparinux thromboprophylaxis was identified as an independent risk factor of postoperative bleeding. Moreover, preoperative levels of D-dimer in patients with stage IV CRC were significantly higher than those with the other stages. The significant elevation in preoperative D-dimer was also observed in patients with stage II CRC compared to those with stage I CRC. Perioperative levels of D-dimer in patients with advanced disease-stage CRC (stages II, III, and IV) were significantly higher than those in patients with early disease-stage CRC. Conclusions Fondaparinux administration and early disease-stage CRC appeared to be risk factors for postoperative bleeding in patients with pharmacological thromboprophylaxis undergoing surgical treatment for CRC. Patients’ hypercoagulative condition depending on disease progression of CRC might be related to the occurrence of postoperative bleeding following CRC surgery.

Safety and Efficacy of Extended Postdischarge Venous Thromboembolism Prophylaxis in Microsurgical Breast Reconstruction

“…This may be due to a higher likelihood of patients with an increased baseline risk for VTE to receive prophylactic therapy, although this was not investigated in this study. However, hematoma rates were similar in the extended postoperative enoxaparin group compared with the entire MBR group ( P = 0.767), findings consistent with those of the 2014 study by Vedovati et al 15 and the 2019 study by Ohta et al, 16 which were prospective studies investigating extended postoperative thromboprophylaxis in colorectal surgery patients.…”

“…The benefits of extended VTE prophylaxis were first documented in colorectal surgery patients with multiple studies corroborating the results of the initial studies. 15 , 16 Improved outcomes with extended postoperative VTE prophylaxis have also been reported in urology in patients undergoing radical cystectomy, 17 in surgical oncology (oncologic liver surgery), 18 pancreatic surgery, 19 and oncologic gynecologic surgery. 20 , 21 Since these studies were published, many plastic surgeons have adopted extended postoperative VTE prophylaxis into their clinical protocols.…”

The ICU-venous thromboembolism score and tumor grade can predict inhospital venous thromboembolism occurrence in critical patients with tumors

“…It has been found that thromboprophylaxis can reduce the risk of VTE in inpatients of internal medicine and surgery [ 30 ], and another resent study showed that continuing aspirin can also protect patients with high thromboembolic risk from VTE without increasing bleeding complications during the perioperative period [ 31 ]. Meanwhile, Ohta H. reported that fondaparinux administration appeared to be risk factors for postoperative bleeding in patients after colorectal cancer surgery [ 32 ]. Therefore, it is necessary to evaluate the bleeding risk and benefits before perioperative antithrombotic therapy carefully.…”

Clinical application of interventional embolization in tumor-associated hemorrhage

“…Surgery is an important method of the treatment for early and middle stage tumors, and bleeding is often one of the most common complications of surgery (20). The complication of massive hemorrhage caused by surgery often endangers the life of patients, and needs timely hemostasis treatment (21)(22)(23)(24).…”