A Randomized Study on 1-Week Versus 4-Week Prophylaxis for Venous Thromboembolism After Laparoscopic Surgery for Colorectal Cancer
ABSTRACT To compare the efficacy and safety of antithrombotic prophylaxis given for 1 week or 4 weeks in patients undergoing laparoscopic surgery for colorectal cancer.
Extending antithrombotic prophylaxis beyond 1 week reduces the incidence of venous thromboembolism (VTE) after open abdominal surgery for cancer.
In consecutive patients who underwent laparoscopic surgery for colorectal cancer, complete compression ultrasonography of the lower limbs was performed after 8 ± 2 days of antithrombotic prophylaxis. Patients with no evidence of VTE were randomized to short (heparin withdrawal) or to extended (heparin continued for 3 additional weeks) prophylaxis. Complete compression ultrasonography was repeated at day 28 ± 2 after surgery by investigators blinded to treatment allocation. The primary outcome of the study was the composite of symptomatic and ultrasonography-detected VTE at day 28 ± 2 after surgery.
Overall, 301 patients were evaluated for inclusion in the study and 225 were randomized. VTE occurred in 11 of 113 patients randomized to short (9.7%) and in none of the 112 patients randomized to extended heparin prophylaxis (P = 0.001). The incidence of VTE at 3 months was 9.7% and 0.9% in patients randomized to short or to extended heparin prophylaxis, respectively (relative risk reduction: 91%, 95% confidence interval: 30%-99%; P = 0.005). The rate of bleeding was similar in the 2 treatment groups. Two patients died during the study period, 1 in each treatment group.
After laparoscopic surgery for colorectal cancer, extended antithrombotic prophylaxis is safe and reduces the risk for VTE as compared with 1-week prophylaxis (NCT01589146).
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ABSTRACT: Venous thromboembolism (VTE) is a common complication in patients with cancer. VTE is a main cause of morbidity and mortality in patients with cancer and has a significant impact on their quality of life. Preventing VTE in cancer patients reduces both morbidity and mortality. The level of evidence for antithrombotic prophylaxis of VTE in patients with cancer varies for hospitalized and ambulatory patients. Hospitalized patients with active cancer (for both medical or surgical indication) and reduced mobility should receive thromboprophylaxis throughout hospital stay. Prophylaxis of VTE is not routinely recommended for outpatients with cancer on chemotherapy. For these patients, current guidelines suggest that clinicians should consider antithrombotic prophylaxis on a case-by-case basis in highly selected outpatients. Different strategies for identification of high-risk outpatients with cancer who could benefit of thromboprophylaxis are under consideration. The new oral anticoagulants could have a role for VTE prevention in ambulatory patients with cancer who are on chemotherapy, as they are administered at a fixed dose without routine laboratory monitoring and may have fewer drug interactions with anticancer agents. © 2014 Elsevier Ltd. All rights reserved.Thrombosis Research 05/2014; 133 Suppl 2:S128-32. DOI:10.1016/S0049-3848(14)50022-9 · 2.45 Impact Factor
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ABSTRACT: Venous thromboembolism (VTE) is a common complication in surgical patients, especially those undergoing lower limb orthopaedic procedures as well as oncological resectional surgery. Numerous studies have evaluated the role of acetylsalicylic acid (ASA, aspirin) in primary VTE prevention, with contradictory results reflected in divergent guidelines. We reviewed current evidence for ASA as primary VTE prophylaxis. English language studies meeting our inclusion criteria were retrieved from PubMed, EMBASE and Cochrane databases. Six studies (3 meta-analyses and 3 randomized trials) comparing ASA with placebo and 7 studies (1 meta-analysis, 5 randomized trials, and 1 prospective) comparing ASA with other anticoagulants were included in the final analysis. Retrospective studies and case reports were excluded. ASA is more effective than placebo in primary VTE prevention. Although there is clinical equipoise when ASA is compared with other anticoagulants, studies specific to orthopaedic surgery suggest that ASA appears as effective as low molecular weight heparin (LMWH) and may reduce bleeding risk. Extended prophylaxis up to 4 weeks post surgery reduces VTE episodes. ASA may be considered as a potential strategy in primary VTE prophylaxis in orthopaedic patients at high-risk of bleeding complications. Further studies comparing ASA with LMWH/oral anticoagulants in primary thromboprophylaxis following non-orthopaedic surgery are warranted. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 06/2015; DOI:10.1016/j.surge.2015.05.001 · 2.18 Impact Factor