Extended thromboprophylaxis with low-molecular weight heparin (LMWH) following abdominopelvic cancer surgery

Marc Carrier; Alon D Altman; Normand Blais; Artemis Diamantouros; Deanna McLeod; Uthaman Moodley; Christine Nguyen; Stephanie Young; Frank Schwenter

doi:10.1016/j.amjsurg.2018.11.046

Extended thromboprophylaxis with low-molecular weight heparin (LMWH) following abdominopelvic cancer surgery

Am J Surg. 2019 Sep;218(3):537-550. doi: 10.1016/j.amjsurg.2018.11.046. Epub 2018 Dec 16.

Authors

Marc Carrier¹, Alon D Altman², Normand Blais³, Artemis Diamantouros⁴, Deanna McLeod⁵, Uthaman Moodley⁶, Christine Nguyen⁷, Stephanie Young⁸, Frank Schwenter⁹

Affiliations

¹ Ottawa Hospital Research Institute, Ottawa Hospital - General Campus, 501 Smyth Road, Box 201a, Ottawa, Ontario, K1H 8L6, Canada. Electronic address: mcarrier@toh.on.ca.
² University of Manitoba, CancerCare Manitoba, Health Sciences Center, 810 Sherbrooke St., Rs406, Winnipeg, Manitoba, R3A-1R9, Canada. Electronic address: alon.altman@cancercare.mb.ca.
³ Centre Hospitalier de l'Université de Montreal (CHUM), 1051, rue Sanguinet, Montreal, QC, H2X 0C1, Canada. Electronic address: n.blais@umontreal.ca.
⁴ Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Office: E 242, Toronto, ON, M4N 3M5, Canada.
⁵ Kaleidoscope Strategic, Inc., 146 Marion St., Toronto, Ontario, M6R 1E7, Canada. Electronic address: deanna@kstrategic.com.
⁶ University of Saskatchewan, Saskatchewan Cancer Agency, 108 Hospital Drive, Apt/Suite/Office 2615, Saskatoon, Saskatchewan, S7N 0W8, Canada.
⁷ Foothills Medical Centre, Anticoagulation management services Clinic and Intensive Care Unit, 1403 29 Street NW, Office: 4801, Calgary, Alberta, T2N 2T9, Canada.
⁸ Memorial University, 300 Prince Philip Drive, 1759F St. John's, Newfoundland and Labrador, A1B 3V6, Canada.
⁹ Department of Surgery, Centre Hospitalier de l'Université de Montreal (CHUM), Surgical Division, Montreal University, 850 rue Saint-Denis, Montreal, Quebec, H2X 0A9, Canada. Electronic address: frank.schwenter.chum@ssss.gouv.qc.ca.

PMID: 30595331
DOI: 10.1016/j.amjsurg.2018.11.046

Abstract

Background: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Certain abdominopelvic cancer surgeries are associated with a six to 14-fold increased risk of DVT versus surgeries for benign disease, and extended thromboprophylaxis using perioperative LMWHs may further reduce VTE rates over standard duration administration. This review assesses the value of extended low molecular weight heparin (LMWH) thromboprophylaxis as a recommended strategy after abdominopelvic cancer surgery.

Data sources: Six eligible randomized controlled trials (RCTs), seven meta-analyses (MAs), and five non-randomized cohort studies were identified evaluating extended versus standard thromboprophylaxis following abdominopelvic cancer surgery.

Findings and conclusions: Available evidence showed significantly reduced rates of VTE for extended versus standard LMWH thromboprophylaxis following abdominopelvic cancer surgery, with some studies showing trends toward reduced rates of symptomatic VTE events. Many of these studies showed significantly reduced rates of proximal DVT and some showed trends toward reduced PE, suggesting potentially important clinical benefits.

Keywords: Abdominopelvic; Hemorrhage; Heparin; Low-molecular-weight; Neoplasms; Surgery; Venous thromboembolism.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Abdominal Neoplasms / surgery*
Anticoagulants / therapeutic use*
Heparin, Low-Molecular-Weight / therapeutic use*
Humans
Pelvic Neoplasms / surgery*
Postoperative Complications / prevention & control*
Venous Thromboembolism / prevention & control*

Substances

Anticoagulants
Heparin, Low-Molecular-Weight