Reducing the risk for post-op VTE
Major abdominal and pelvic surgery carries a high risk of venous thromboembolism (VTE)
Patients subjected to major abdominal surgery are at considerable risk of deep vein thrombosis (DVT), which may lead to the following complications:
• Impaired venous function leading to chronic leg edema and potential ulceration;
• Potential for pulmonary embolism, which may result in sudden death.
The majority of symptomatic VTEs occur post-discharge and the mean time to VTE is 24 days post-cancer surgery.3 Studies have revealed an incidence of postoperative DVT as high as 25% four to six weeks after surgery. Over 60% of VTEs occur during the first month post-cancer surgery.
A recent Cochrane Review examined four studies involving patients undergoing abdominal or pelvic surgery, and found that prolonged thromboprophylaxis with low-molecular weight heparin (LMWH) significantly reduces the risk of VTE compared to LMWH administered during hospital stay only.
In cancer patients undergoing major cancer surgery, prophylaxis with LWMH or unfractioned heparin is recommended. The European Society for Medical Oncology (ESMO) 2008 guidelines recommend “cancer patients undergoing elective major abdominal or pelvic surgery should receive post-discharge prophylaxis with LMWH for up to 1 month after surgery”(Level of Evidence Grade 1A).
Similarly, the Australia and New Zealand Best Practice Recommendations (2010) for patients with a prior history of VTE or active cancer recommend LMWH be continued for 28-35 days following major abdominal cancer surgery.
To support this evidence, the National Institute for Clinical Excellence (NICE) guidelines recommend LMWH be administered for 28 days after major cancer surgery of the abdomen or pelvis.
Given that prolonged treatment with LMWH provides significant VTE reduction without increasing bleeding complications after major abdominal surgery compared to thromboprophylaxis during hospital admittance only. The benefits of prolonged thromboprophylaxis with LMWH clearly outweigh the risks.
Useful URLs
Guidelines for download - National Health and Medical Research Council
www.nhmrc.gov.au
National Institute for Clinical Excellence
www.nice.org.uk