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Prophylaxis of Postoperative Venous Thromboembolism Using Enoxaparin After Esophagectomy: A Prospective Observational Study of Effectiveness and Safety

  • Gastrointestinal Oncology
  • Published:
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Abstract

Background

The incidence of venous thromboembolism (VTE) after esophagectomy is higher than in other gastroenterological cancer surgery. Although the effectiveness and safety of thromboprophylaxis using enoxaparin have been established in orthopedic, abdominal, and pelvic surgeries, no studies regarding esophagectomy are available.

Methods

A prospective observational study was conducted to elucidate the usefulness of enoxaparin for VTE prophylaxis after esophagectomy. The study enrolled 30 patients who underwent elective esophagectomy for esophageal cancer between April 2015 and October 2016. During postoperative days 2–11, the patients received a subcutaneous injection of enoxaparin (2000 IU) twice daily. The primary end point for the study was the incidence of postoperative VTE. In addition, the incidence of all enoxaparin treatment- and operation-related adverse events was investigated. The study identified VTE by VTE protocol-enhanced computed tomography, performed routinely during and after enoxaparin treatment.

Results

One pulmonary embolism (PE) (3.3%) and two deep vein thromboses (DVTs) (6.7%) were observed during enoxaparin treatment. In addition, one PE (3.6%) and four DVTs (14.3%) (one patient experienced both) were observed after treatment. All VTEs were asymptomatic. Regarding enoxaparin-related adverse events, four minor bleeds occurred but did not require discontinuation of enoxaparin. The incidence of postoperative morbidity was acceptable. In blood tests related to coagulation, no significant differences were observed between patients with and without VTE.

Conclusions

The authors believe that thromboprophylaxis using enoxaparin is safe and can prevent VTE after esophagectomy. However, its effectiveness is limited to the period of treatment, so additional prophylaxis may be recommended.

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Authors and Affiliations

  1. Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer, Kumamoto University Hospital, Kumamoto, Japan

    Naoya Yoshida MD, PhD, Takatsugu Ishimoto MD, PhD & Hideo Baba MD, PhD

  2. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan

    Naoya Yoshida MD, PhD, Yoshifumi Baba MD, PhD, Yuji Miyamoto MD, PhD, Masaaki Iwatsuki MD, PhD, Yukiharu Hiyoshi MD, PhD, Takatsugu Ishimoto MD, PhD, Yu Imamura MD, PhD, Masayuki Watanabe MD, PhD & Hideo Baba MD, PhD

  3. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Yu Imamura MD, PhD & Masayuki Watanabe MD, PhD

Authors
  1. Naoya Yoshida MD, PhD
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  2. Yoshifumi Baba MD, PhD
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  3. Yuji Miyamoto MD, PhD
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  4. Masaaki Iwatsuki MD, PhD
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  5. Yukiharu Hiyoshi MD, PhD
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  6. Takatsugu Ishimoto MD, PhD
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  8. Masayuki Watanabe MD, PhD
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  9. Hideo Baba MD, PhD
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Corresponding author

Correspondence to Hideo Baba MD, PhD.

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Disclosure

Drs. Naoya Yoshida and Takatsugu Ishimoto have course affiliation with Chugai Pharmaceutical Co., Ltd and Yakuruto Honsya Co., Ltd. Hideo Baba and the other co-authors (Y.B., Y.M., M.I., Y.H., Y.I., M.W.) have no conflicts of interest or financial ties to disclose.

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Yoshida, N., Baba, Y., Miyamoto, Y. et al. Prophylaxis of Postoperative Venous Thromboembolism Using Enoxaparin After Esophagectomy: A Prospective Observational Study of Effectiveness and Safety. Ann Surg Oncol 25, 2434–2440 (2018). https://doi.org/10.1245/s10434-018-6552-0

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  • DOI: https://doi.org/10.1245/s10434-018-6552-0

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