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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2018

01-08-2018 | Gastrointestinal Oncology

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

Authors: 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

Published in: Annals of Surgical Oncology | Issue 8/2018

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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.
Appendix
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Metadata
Title
Prophylaxis of Postoperative Venous Thromboembolism Using Enoxaparin After Esophagectomy: A Prospective Observational Study of Effectiveness and Safety
Authors
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
Publication date
01-08-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6552-0

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