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

Abdominal Neoplasms / surgery Anticoagulants / therapeutic use Heparin, Low-Molecular-Weight / therapeutic use Humans Pelvic Neoplasms / surgery Postoperative Complications / prevention & control Venous Thromboembolism / prevention & control
Abdominopelvic Hemorrhage Heparin Low-molecular-weight Neoplasms Surgery Venous thromboembolism

Journal

American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473

Informations de publication

Date de publication:
09 2019
Historique:
received: 10 10 2018
revised: 23 11 2018
accepted: 29 11 2018
pubmed: 1 1 2019
medline: 24 1 2020
entrez: 1 1 2019
Statut: ppublish

Résumé

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. 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. 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.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.amjsurg.2018.11.046 PMID: 30595331
pubmed: 30595331
pii: S0002-9610(18)31377-1
doi: 10.1016/j.amjsurg.2018.11.046
pii:
doi:

Substances chimiques

Anticoagulants 0
Heparin, Low-Molecular-Weight 0

Types de publication

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

Langues

eng

Sous-ensembles de citation

IM

Pagination

537-550

Informations de copyright

Copyright © 2018 Elsevier Inc. All rights reserved.

Auteurs

Marc Carrier (M)

Ottawa Hospital Research Institute, Ottawa Hospital - General Campus, 501 Smyth Road, Box 201a, Ottawa, Ontario, K1H 8L6, Canada. Electronic address: mcarrier@toh.on.ca.

Alon D Altman (AD)

University of Manitoba, CancerCare Manitoba, Health Sciences Center, 810 Sherbrooke St., Rs406, Winnipeg, Manitoba, R3A-1R9, Canada. Electronic address: alon.altman@cancercare.mb.ca.

Normand Blais (N)

Centre Hospitalier de l'Université de Montreal (CHUM), 1051, rue Sanguinet, Montreal, QC, H2X 0C1, Canada. Electronic address: n.blais@umontreal.ca.

Artemis Diamantouros (A)

Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Office: E 242, Toronto, ON, M4N 3M5, Canada.

Deanna McLeod (D)

Kaleidoscope Strategic, Inc., 146 Marion St., Toronto, Ontario, M6R 1E7, Canada. Electronic address: deanna@kstrategic.com.

Uthaman Moodley (U)

University of Saskatchewan, Saskatchewan Cancer Agency, 108 Hospital Drive, Apt/Suite/Office 2615, Saskatoon, Saskatchewan, S7N 0W8, Canada.

Christine Nguyen (C)

Foothills Medical Centre, Anticoagulation management services Clinic and Intensive Care Unit, 1403 29 Street NW, Office: 4801, Calgary, Alberta, T2N 2T9, Canada.

Stephanie Young (S)

Memorial University, 300 Prince Philip Drive, 1759F St. John's, Newfoundland and Labrador, A1B 3V6, Canada.

Frank Schwenter (F)

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.

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Classifications MeSH

questionsmedicales.fr › Tumeurs › Tumeurs par siège › Tumeurs de l'abdomen › Extended thromboprophylaxis with low-molecular...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Extended thromboprophylaxis with low-molecular...
questionsmedicales.fr › Glucides › Polyosides › Glycosaminoglycanes › Héparine › Héparine bas poids moléculaire › Extended thromboprophylaxis with low-molecular...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Extended thromboprophylaxis with low-molecular...
questionsmedicales.fr › Tumeurs › Tumeurs par siège › Tumeurs du bassin › Extended thromboprophylaxis with low-molecular...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Extended thromboprophylaxis with low-molecular...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Thromboembolie › Thromboembolisme veineux › Extended thromboprophylaxis with low-molecular...