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Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis

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Abstract

Venous thromboembolism (VTE) is an important postoperative complication after major lung cancer resective surgery, such as lobectomy. It is recommended to start chemical thromboprophylaxis within the first 12 h following the procedure. Postoperative bleeding is also a relevant complication in patients with predisposing conditions. However, the criterion for classifying a patient as “high risk of bleeding” is not standardized and is left to the expertise of the attending physician or surgeon. We aim to describe the incidence and risk factors for postoperative VTE and hemorrhage after pulmonary lobectomy; and to assess the impact of the timing of thromboprophylaxis on the incidence of postoperative thrombotic or hemorrhagic events. A retrospective observational study of 358 lobectomies performed in a single center was performed, analyzing the rates of postoperative thrombotic and hemorrhagic events and predisposing factors, including postoperative thromboprophylaxis management. Cumulative incidence of VTE was 3.07% (95% CI 1.54–5.43), and early postoperative bleeding was 10.05% (95% CI 7.14–13.64). Underlying pulmonary disease was associated with VTE (p = 0.001) and open approach was associated with hemorrhagic events (p = 0.01). The use of thromboprophylaxis and timing of its initiation were not associated with a higher incidence of events. VTE and postoperative hemorrhage are relevant complications following pulmonary lobectomy. Compliance with VTE prophylaxis guidelines is essential. Even so, a case-by-case risk evaluation of VTE and bleeding remains preferable and safe in order to decide on the most suitable timing of thromboprophylaxis.

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Authors and Affiliations

  1. Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina

    Micaela Raices, Carolina Diego & Drago Julián

  2. Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina

    David Smith, Juan Montagne & Agustín Dietrich

Authors
  1. David Smith
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  2. Micaela Raices
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  3. Carolina Diego
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  4. Drago Julián
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  5. Juan Montagne
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  6. Agustín Dietrich
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MR, CD and JD. The first draft of the manuscript was written by MR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Micaela Raices.

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This study was performed in line with the principles of the Declaration of Helsinki. The institutional Ethics Committee for Investigative Protocols approved the study’s conduct.

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Upon hospital admission all patients consent to their medical information being used for research purposes without revealing their identity.

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Smith, D., Raices, M., Diego, C. et al. Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis. J Thromb Thrombolysis 51, 997–1004 (2021). https://doi.org/10.1007/s11239-020-02277-3

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  • DOI: https://doi.org/10.1007/s11239-020-02277-3

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