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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2016

01-05-2016 | Healthcare Policy and Outcomes

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

Authors: Andrei Fagarasanu, MD, PhD, FRCPC, Ghazi S. Alotaibi, MD, Ramona Hrimiuc, MD, FRCPC, Agnes Y. Y. Lee, MD, MSc, FRCPC, Cynthia Wu, MD, FRCPC

Published in: Annals of Surgical Oncology | Issue 5/2016

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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.
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Metadata
Title
Role of Extended Thromboprophylaxis After Abdominal and Pelvic Surgery in Cancer Patients: A Systematic Review and Meta-Analysis
Authors
Andrei Fagarasanu, MD, PhD, FRCPC
Ghazi S. Alotaibi, MD
Ramona Hrimiuc, MD, FRCPC
Agnes Y. Y. Lee, MD, MSc, FRCPC
Cynthia Wu, MD, FRCPC
Publication date
01-05-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5127-1

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