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Role of Extended Thromboprophylaxis After Abdominal and Pelvic Surgery in Cancer Patients: A Systematic Review and Meta-Analysis

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Abdominopelvic cancer surgery increases the risk of postoperative venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) thromboprophylaxis is recommended, and the role of extended thromboprophylaxis (ETP) is controversial. We performed a systematic review to determine the effect of ETP on deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and all-cause mortality after abdominal or pelvic cancer surgery.

Methods

A search of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was undertaken, and studies were included if they compared extended duration (2–6 weeks) with conventional duration of thromboprophylaxis (2 weeks or less) after cancer surgery. Pooled relative risk (RR) was estimated using a random effects model.

Results

Seven randomized and prospective studies were included, comprising 4807 adult patients. ETP was associated with a significantly reduced incidence of all VTEs [2.6 vs. 5.6 %; RR 0.44, 95 % confidence interval (CI) 0.28–0.70, number needed to treat (NNT) = 39] and proximal DVT (1.4 vs. 2.8 %; RR 0.46, 95 % CI 0.23–0.91, NNT = 71). There was no statistically significant difference in the incidence of symptomatic PE (0.8 vs. 1.3 %; RR 0.56, 95 % CI 0.23–1.40), major bleeding (1.8 vs. 1.0 %; RR 1.19, 95 % CI 0.47–2.97), and all-cause mortality (4.2 vs. 3.6 %; RR 0.79, 95 % CI 0.47–1.33). None of the outcomes differed if randomized trials were analyzed independently.

Conclusions

ETP after abdominal or pelvic surgery for cancer significantly decreased the incidence of all VTEs and proximal DVTs, but had no impact on symptomatic PE, major bleeding, or 3-month mortality. ETP should be routinely considered in the setting of abdominal and pelvic surgery for cancer patients.

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Disclosures

Agnes Lee and Cynthia Wu received honoraria and consultancy fees from Pfizer and LEO Pharma.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Andrei Fagarasanu MD, PhD, FRCPC, Ghazi S. Alotaibi MD, Ramona Hrimiuc MD, FRCPC & Cynthia Wu MD, FRCPC

  2. Vancouver Coastal Health, Vancouver General Hospital, British Columbia Cancer Agency, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    Agnes Y. Y. Lee MD, MSc, FRCPC

Authors
  1. Andrei Fagarasanu MD, PhD, FRCPC
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  2. Ghazi S. Alotaibi MD
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  3. Ramona Hrimiuc MD, FRCPC
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  4. Agnes Y. Y. Lee MD, MSc, FRCPC
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  5. Cynthia Wu MD, FRCPC
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Corresponding author

Correspondence to Cynthia Wu MD, FRCPC.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2016_5127_MOESM1_ESM.jpg

Comparison of extended versus conventional thromboprophylaxis. Meta-analysis of the distal deep venous thrombosis events (JPEG 122 kb)

Comparison of extended versus conventional thromboprophylaxis. Meta-analysis of pulmonary embolism events (JPEG 179 kb)

Comparison of extended versus conventional thromboprophylaxis. Meta-analysis of all-cause mortality (JPEG 175 kb)

10434_2016_5127_MOESM4_ESM.docx

Summary of criterion scores and overall methodological quality of included studies based on the Newcastle-Ottawa Scale score (DOCX 14 kb)

Comparison between the RR of ETP versus CTP between RCT analysis and observational study analysis (DOCX 49 kb)

10434_2016_5127_MOESM6_ESM.docx

The most recent practice guidelines regarding postoperative thromboprophylaxis in cancer patients undergoing abdominal or pelvic surgery (DOCX 14 kb)

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Fagarasanu, A., Alotaibi, G.S., Hrimiuc, R. et al. Role of Extended Thromboprophylaxis After Abdominal and Pelvic Surgery in Cancer Patients: A Systematic Review and Meta-Analysis. Ann Surg Oncol 23, 1422–1430 (2016). https://doi.org/10.1245/s10434-016-5127-1

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  • DOI: https://doi.org/10.1245/s10434-016-5127-1

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