Clinical question: When do venous thromboembolism (VTE) events occur after cancer surgery?
Background: Cancer is a known risk factor for VTE. Prophylaxis for VTE after cancer surgery is commonly stopped at the time of hospital discharge despite evidence for extended-duration treatment.
Study design: Retrospective cohort.
Setting: Patients reported to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.
Synopsis: The authors examined the records of 46,656 patients who underwent surgery for one of nine specified cancers. Overall VTE rate was 1.6% (1.0% deep venous thrombosis and 0.6% pulmonary embolism), with 33.4% of VTE events occurring after hospital discharge. VTE risk was highest after esophagogastric and hepatopancreaticobiliary surgery, followed by lung, rectum, ovary/uterus, colon, and prostate. Breast and thyroid/parathyroid surgeries had the lowest incidence of VTE. VTE was associated with increased 30-day mortality. Use of VTE prophylaxis during or after hospitalization was not recorded.
Bottom line: Elevated VTE risk persists following hospital discharge after cancer surgery and consideration should be given to extended-duration thromboprophylaxis. Optimal duration of prophylaxis and its risks and benefits remain poorly defined.
Citation: Merkow RP, Bilimoria KY, McCarter MD, et al. Post-discharge venous thromboembolism after cancer surgery: extending the case for extended prophylaxis. Ann Surg. 2011;254:131-137.
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