The impact of hereditary thrombophilia on the incidence of postoperative venous thromboembolism in colorectal cancer patients: a prospective cohort study
- 20 Downloads
Hereditary thrombophilia may play an important role in the rate of postoperative venous thromboembolism (VTE). We focused on the impact of hereditary thrombophilia on VTE incidence in colorectal cancer surgery patients within a 1-year postoperative period.
Preoperatively, identifying of colorectal cancer patients with thrombotic mutations (PTM+) and without thrombotic mutations (PTM−) was performed by screening of factor V Leiden (FVL) and prothrombin G20210A mutation. Within prophylactic period (0–28 days postoperatively), coagulation markers (platelets, fibrinogen, D‑dimer) were measured and symptomatic VTE was observed. Within post-prophylactic period (2–12 months after surgery), symptomatic VTE was observed.
In all, 202 patients were assessed and hereditary thrombophilia was detected in 9.9% (FVL 8.4%; prothrombin G20210A mutation 1.5%). In the prophylactic period, VTE incidence in PTM+ and PTM− was 0.0% and 1.6%, respectively (p = 0.730). Levels of coagulation markers were comparable in both patient cohorts within 28 days postoperatively. In the post-prophylactic period, VTE incidence in PTM+ and PTM− was 15.0% and 5.5%, respectively (p = 0.125), and detailed incidence of deep vein thrombosis (DVT) in PTM+ and PTM− was 15.0% and 3.3%, respectively (p = 0.048). We observed significantly increased incidence of lower extremity DVT in such patients with FVL (17.6%).
The standard regimen of extended-duration VTE prophylaxis is adequate for colorectal cancer patients with thrombotic mutations and more intensified VTE prophylaxis within the 28-day postoperative period is not justified. However, the ongoing postoperative pharmacologic prophylaxis (>28 days) should be considered in patients with hereditary thrombophilia, especially with FVL.
KeywordsFactor V Leiden Prothrombin mutation Colorectal neoplasms Venous thrombosis Risk assessment
This work was supported by the project of the Ministry of Health, Czech Republic (RVO-VFN64165 and NT 13251-4).
Compliance with ethical guidelines
Conflict of interest
J. Ulrych, T. Kvasnicka, V. Fryba, M. Komarc, I. Malikova, R. Brzezkova, J. Kvasnicka Jr, Z. Krska, J. Briza, and J. Kvasnicka declare that they have no competing interests.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. The study was approved by the ethics committee of General University Hospital in Prague. Informed consent was obtained from all patients for being included in the study.
- 6.Gould MK, Garcia DA, Wren SM, American College of Chest Physicians, et al. 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. 2012;141(2):e227S–e77S. https://doi.org/10.1378/chest.11-2297.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Colorectal Writing Group for Surgical Care and Outcomes Assessment Program, Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative, Nelson DW, Simianu VV, Bastawrous AL, et al. Thromboembolic complications and prophylaxis patterns in colorectal surgery. JAMA Surg. 2015;150(8):712–20. https://doi.org/10.1001/jamasurg.2015.1057.CrossRefGoogle Scholar
- 19.Malinoski D, Ewing T, Bhakta A, et al. Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis: a prospective analysis of 2,128 catheter days in the surgical intensive care unit. J Trauma Acute Care Surg. 2013;74(2):454–60. https://doi.org/10.1097/TA.0b013e31827a0b2f. discussion 461–2.CrossRefPubMedGoogle Scholar
- 21.Mäkelburg AB, Veeger NJ, Middeldorp S, et al. Different risk of deep vein thrombosis and pulmonary embolism in carriers with factor V Leiden compared with non-carriers, but not in other thrombophilic defects. Results from a large retrospective family cohort study. Haematologica. 2010;95(6):1030–3. https://doi.org/10.3324/haematol.2009.017061.CrossRefPubMedGoogle Scholar