Skip to main content

Advertisement

SpringerLink
Log in

Extended venous thromboembolism prophylaxis after colorectal cancer surgery: the current state of the evidence

  • Review Paper
  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

There is level one evidence to support combined mechanical and chemical thromboprophylaxis for 7–10 days after colorectal cancer surgery, but there remains a paucity of data to support extended prophylaxis after discharge. The aim of this clinical review is to summarise the currently available evidence for extended venous thromboprophylaxis after elective colorectal cancer surgery. Clinical review of the major clinical guidelines and published clinical data evaluating extended venous thromboprophylaxis after elective colorectal cancer surgery. Five major guideline recommendations are outlined, and the results of the five published randomised controlled trials are summarised and reviewed with a specific focus on the efficacy and cost-effectiveness of extended heparin prophylaxis to prevent clinically relevant post-operative venous thromboembolism (VTE) after colorectal cancer surgery. Extended VTE prophylaxis after colorectal cancer surgery reduces the incidence of asymptomatic screen detected deep venous thrombosis (DVT) only, with no demonstrable reduction in symptomatic DVT, symptomatic PE, or VTE related death. Evidence for cost-effectiveness is limited. As the incidence of clinical VTE is very low in this patient subgroup overall, future research should be focused on higher risk patient subgroups in whom a reduction in VTE may be both more demonstrable and clinically relevant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Holwell A, McKenzie JL, Holmes M, Woods R, Nandurkar H, Tam CS, Bazargan A (2014) Venous thromboembolism prevention in patients undergoing colorectal surgery for cancer. ANZ J Surg 84(4):284–288. doi:10.1111/ans.12296

    Article  PubMed  Google Scholar 

  2. Becattini C, Rondelli F, Vedovati MC, Camporese G, Giustozzi M, Boncompagni M, Pucciarelli S, Balzarotti R, Mariani E, Filippucci E, Donini A, Agnelli G (2015) Incidence and risk factors for venous thromboembolism after laparoscopic surgery for colorectal cancer. Haematologica 100(1):e35–e38. doi:10.3324/haematol.2014.109843

    Article  PubMed  PubMed Central  Google Scholar 

  3. Colorectal Writing Group for the Surgical C, Outcomes Assessment Program-Comparative Effectiveness Research Translation Network C, Nelson DW, Simianu VV, Bastawrous AL, Billingham RP, Fichera A, Florence MG, Johnson EK, Johnson MG, Thirlby RC, DR Flum, Steele SR (2015) Thromboembolic complications and prophylaxis patterns in colorectal surgery. JAMA Surg 150(8):712–720. doi:10.1001/jamasurg.2015.1057

    Article  Google Scholar 

  4. Wille-Jorgensen P, Rasmussen, Andersen BR, Borly L (2003) Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev 4:CD001217. doi:10.1002/14651858.CD001217

    PubMed  Google Scholar 

  5. Smart P, Burbury K, Lingaratnam S, Lynch AC, Mackay J, Heriot A (2013) Thromboprophylaxis among Australasian colorectal surgeons. ANZ J Surg 83(9):646–650. doi:10.1111/j.1445-2197.2012.06245.x

    Article  PubMed  Google Scholar 

  6. Srinivasaiah N, Arsalani-Zadeh R, Monson JR (2012) Thrombo-prophylaxis in colorectal surgery: a National Questionnaire Survey of the members of the Association of Coloproctology of Great Britain and Ireland. Colorectal Dis 14(7):e390–e393. doi:10.1111/j.1463-1318.2012.02974.x

    Article  CAS  PubMed  Google Scholar 

  7. Merkow RP, Bilimoria KY, Sohn MW, Oh EH, Sellers MM, Paruch JL, Chung JW, Bentrem DJ (2014) Adherence with postdischarge venous thromboembolism chemoprophylaxis recommendations after colorectal cancer surgery among elderly Medicare beneficiaries. Ann Surg 260(1):103–108. doi:10.1097/SLA.0000000000000296

    Article  PubMed  Google Scholar 

  8. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr, American College of Chest P (2012) Prevention of VTE in orthopedic surgery patients: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e278S–e325S. doi:10.1378/chest.11-2404

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lyman GH, Bohlke K, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, Clarke JM, Flowers CR, Francis CW, Gates LE, Kakkar AK, Key NS, Levine MN, Liebman HA, Tempero MA, Wong SL, Somerfield MR, Falanga A (2015) Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014. J Clin Oncol 33(6):654–656. doi:10.1200/JCO.2014.59.7351

    Article  CAS  PubMed  Google Scholar 

  10. National Comprehensive Cancer Network: Cancer-associated Venous Thromboembolic Disease. NCCN Clinical Practice Guidelines in Oncology Version 2.2014. www.nccn.org/professionals/physician_gls/PDF/vte.pdf

  11. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM, American College of Chest P (2012) Prevention of VTE in nonorthopedic surgical patients: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e227S–e277S. doi:10.1378/chest.11-2297

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. National Institute for Health and Care Excellence (NICE) (2010) Venous thromboembolism: reducing the risk. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital

  13. National Health and Medical Research Council. Australian Government (2009) Clinical practice guideline for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals

  14. Vedovati MC, Becattini C, Rondelli F, Boncompagni M, Camporese G, Balzarotti R, Mariani E, Flamini O, Pucciarelli S, Donini A, Agnelli G (2014) A randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer. Ann surg 259(4):665–669. doi:10.1097/SLA.0000000000000340

    Article  PubMed  Google Scholar 

  15. Pai A, Hurtuk MG, Park JJ, Marecik SJ, Prasad LM (2014) A randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer. Ann surg. doi:10.1097/SLA.0000000000000901

    Google Scholar 

  16. Vedovati MC, Becattini C, Rondelli F, Agnelli G (2014) Reply to letter: “a randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer”. Ann surg. doi:10.1097/SLA.0000000000000904

    PubMed  Google Scholar 

  17. Kakkar VV, Balibrea JL, Martinez-Gonzalez J, Prandoni P, Group CS (2010) Extended prophylaxis with bemiparin for the prevention of venous thromboembolism after abdominal or pelvic surgery for cancer: the CANBESURE randomized study. J Thromb Haemost 8(6):1223–1229. doi:10.1111/j.1538-7836.2010.03892.x

    Article  CAS  PubMed  Google Scholar 

  18. Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, Dietrich-Neto F, Investigators EI (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346(13):975–980. doi:10.1056/NEJMoa012385

    Article  CAS  PubMed  Google Scholar 

  19. Rasmussen MS, Jorgensen LN, Wille-Jorgensen P, Nielsen JD, Horn A, Mohn AC, Somod L, Olsen B, Investigators F (2006) Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost 4(11):2384–2390. doi:10.1111/j.1538-7836.2006.02153.x

    Article  CAS  PubMed  Google Scholar 

  20. Lausen I, Jensen R, Jorgensen LN, Rasmussen MS, Lyng KM, Andersen M, Raaschou HO, Wille-Jorgensen P (1998) Incidence and prevention of deep venous thrombosis occurring late after general surgery: randomised controlled study of prolonged thromboprophylaxis. Eur J Surg 164(9):657–663. doi:10.1080/110241598750005534

    Article  CAS  PubMed  Google Scholar 

  21. Jorgensen LN, Lausen I, Rasmussen MS, Wille-Jorgensen P, Bergqvist D (2002) Prolonged thromboprophylaxis with lowmolecular weight heparin following major general surgery: an individual patient data meta-analysis (poster). Blood 100:1952

    Google Scholar 

  22. Rasmussen, Jorgensen LN, Wille-Jorgensen P (2009) Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev 1:CD004318. doi:10.1002/14651858.CD004318.pub2

    PubMed  Google Scholar 

  23. Bottaro FJ, Elizondo MC, Doti C, Bruetman JE, Perez Moreno PD, Bullorsky EO, Ceresetto JM (2008) Efficacy of extended thrombo-prophylaxis in major abdominal surgery: what does the evidence show? A meta-analysis. Thromb Haemost 99(6):1104–1111. doi:10.1160/TH07-12-0759

    CAS  PubMed  Google Scholar 

  24. Iannuzzi JC, Young KC, Kim MJ, Gillespie DL, Monson JR, Fleming FJ (2013) Prediction of postdischarge venous thromboembolism using a risk assessment model. J Vasc Surg 58(4):1014–1020. doi:10.1016/j.jvs.2012.12.073

    Article  PubMed  Google Scholar 

  25. Chandra R, Melino G, Thomas M, Lawrence MJ, Hunter RA, Moore J (2013) Is extended thromboprophylaxis necessary in elective colorectal cancer surgery? ANZ J Surg 83(12):968–972. doi:10.1111/ans.12244

    Article  PubMed  Google Scholar 

  26. Bradley CT, Brasel KJ, Miller JJ, Pappas SG (2010) Cost-effectiveness of prolonged thromboprophylaxis after cancer surgery. Ann Surg Oncol 17(1):31–39. doi:10.1245/s10434-009-0671-6

    Article  PubMed  Google Scholar 

  27. Iannuzzi JC, Rickles AS, Kelly KN, Fleming FJ, Dolan JG, Monson JR, Noyes K (2014) Defining high risk: cost-effectiveness of extended-duration thromboprophylaxis following major oncologic abdominal surgery. J Gastrointest Surg 18(1):60–68. doi:10.1007/s11605-013-2373-4

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author contribution

All authors have made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, drafting the article or revising it critically for important intellectual content; and have approved the final version to be published.

Author information

Author notes

    Authors and Affiliations

    1. Colorectal Fellow, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia

      Tarik Sammour

    2. Colorectal Surgeon, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia

      Raaj Chandra

    3. Colorectal Surgeon and Head of Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia

      James W. Moore

    Authors
    1. Tarik Sammour
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Raaj Chandra
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. James W. Moore
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Tarik Sammour.

    Additional information

    Tarik Sammour, Raaj Chandra and James W. Moore have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Sammour, T., Chandra, R. & Moore, J.W. Extended venous thromboembolism prophylaxis after colorectal cancer surgery: the current state of the evidence. J Thromb Thrombolysis 42, 27–32 (2016). https://doi.org/10.1007/s11239-015-1300-9

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s11239-015-1300-9

    Keywords

    Search

    Navigation