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Annals of Surgical Oncology

, Volume 23, Issue 5, pp 1422–1430 | Cite as

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

  • Andrei Fagarasanu
  • Ghazi S. Alotaibi
  • Ramona Hrimiuc
  • Agnes Y. Y. Lee
  • Cynthia WuEmail author
Healthcare Policy and Outcomes

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.

Keywords

Pulmonary Embolism Deep Vein Thrombosis Major Bleeding National Comprehensive Cancer Network Major Bleeding Event 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosures

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

Supplementary material

10434_2016_5127_MOESM1_ESM.jpg (123 kb)
Comparison of extended versus conventional thromboprophylaxis. Meta-analysis of the distal deep venous thrombosis events (JPEG 122 kb)
10434_2016_5127_MOESM2_ESM.jpg (179 kb)
Comparison of extended versus conventional thromboprophylaxis. Meta-analysis of pulmonary embolism events (JPEG 179 kb)
10434_2016_5127_MOESM3_ESM.jpg (176 kb)
Comparison of extended versus conventional thromboprophylaxis. Meta-analysis of all-cause mortality (JPEG 175 kb)
10434_2016_5127_MOESM4_ESM.docx (14 kb)
Summary of criterion scores and overall methodological quality of included studies based on the Newcastle-Ottawa Scale score (DOCX 14 kb)
10434_2016_5127_MOESM5_ESM.docx (50 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 (14 kb)
The most recent practice guidelines regarding postoperative thromboprophylaxis in cancer patients undergoing abdominal or pelvic surgery (DOCX 14 kb)

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Andrei Fagarasanu
    • 1
  • Ghazi S. Alotaibi
    • 1
  • Ramona Hrimiuc
    • 1
  • Agnes Y. Y. Lee
    • 2
  • Cynthia Wu
    • 1
    Email author
  1. 1.Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Vancouver Coastal Health, Vancouver General Hospital, British Columbia Cancer Agency, Department of MedicineUniversity of British ColumbiaVancouverCanada

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