What Are the Impacts of Not Administering Extended VTE Prophylaxis in Oncology Patients After GIT Surgeries?
In a freshly published retrospective study, experts from the University of Arkansas investigated how well the professional recommendation that cancer patients undergo extended venous thromboembolism (VTE) prophylaxis after major gastrointestinal (GI) surgeries is being followed and what impact this has in real practice.
Analyzed Data
A random sample of 10% of patients from the IQVIA LifeLink PharMetrics Plus database, which includes data on the commercially insured population of the USA, was retrospectively analyzed for the period of 2009–2022. The authors evaluated data related to 2296 surgical procedures. These involved cancer patients undergoing major surgeries of the pancreas, liver, stomach, or esophagus. The median age was 49 years, and 44% were women.
The primary endpoints were the occurrence of VTE or bleeding within 90 days after discharge from the hospital.
Results
During hospitalization, 2.2% (52) of patients developed VTE, 3.2% (74) experienced postoperative bleeding, and 6.1% (140) stayed in the hospital for at least 28 days. The remaining 2069 surgeries included 833 pancreatectomies, 664 hepatectomies, 295 gastrectomies, and 277 esophagectomies. Extended VTE thromboprophylaxis was prescribed to 176 patients (10.4% undergoing pancreatic surgery, 8.1% with hepatectomy, 5.8% with stomach cancer, and 6.5% with esophageal cancer), and by far the most used substance was low molecular weight heparin (LMWH) enoxaparin (in 96% of cases).
Following discharge, 5.2% (108) of patients developed VTE within 90 days of surgery (48 cases of deep vein thrombosis and 73 of pulmonary embolism), and 5.2% (108) experienced bleeding (64 GI, 25 transfusions for any reason, 3 brain hemorrhages, 25 other types). There was no proven correlation between the type of surgery and the rate of VTE occurrence (pancreas 6.2%, liver 4.1%, stomach 5.8%, esophagus 4.3%) or bleeding (pancreas 6.4%, liver 3.8%, stomach 6.4%, esophagus 4.0%). The rate of VTE or bleeding did not differ between patients who received extended VTE prophylaxis and those who did not.
According to multivariate analysis, extended VTE prophylaxis was not independently associated with major bleeding or VTE. The Elixhauser Comorbidity Index was independently associated with the occurrence of VTE and bleeding 90 days after surgery (odds ratio [OR] for VTE 1.24; 95% confidence interval [CI] 1.15–1.34; OR for bleeding 1.25; 95% CI 1.16–1.35).
In an ad hoc analysis of data from the entire original cohort of 2296 patients, the highest incidence of VTE was observed during the 1st week after surgery (1.4%), and the rate remained significant during the follow-up period (3 months) (0.3–0.7% per week).
Conclusion
The above data suggest that most patients with malignant tumors who underwent complex GI tract surgery did not receive extended VTE prophylaxis, thus not following current professional guidelines. The incidence of VTE and bleeding in these patients was not higher compared to those who received the prophylaxis. According to the authors of the cited study, future research should more precisely identify patient groups that will benefit from extended prophylaxis.
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Source: Mavros M. N., Johnson L. A., Schootman M. et al. Adherence to extended venous thromboembolism prophylaxis and outcomes after complex gastrointestinal oncologic surgery. Ann Surg Oncol 2023 Sep; 30 (9): 5522–5531, doi: 10.1245/s10434-023-13677-z.
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