Caprini Risk Model Decreases Venous Thromboembolism Rates in Thoracic Surgery Cancer Patients

Sterbling, Helene M.; Rosen, Amy K.; Hachey, Krista J.; Vellanki, Niru S.; Hewes, Philip D.; Rao, Sowmya R.; Pinjic, Emma; Fernando, Hiran C.; Litle, Virginia R.

doi:10.1016/j.athoracsur.2017.10.013

Cited by 52 publications

(39 citation statements)

References 21 publications

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“…The Caprini RAM is mainly used for risk stratification and indicating the launch of anticoagulant treatment in a surgical context, and it has been demonstrated to reduce symptomatic VTE by extended prophylaxis within two months after discharge from the thoracic department. 43 However, in most cases, scores alter only as patients finish their surgical procedure, which means that it is mainly determined by surgical procedure, but not VTE development, in most in-patient cases. Based on this acknowledgement, we preferred to tracing the alterable parameter, that is D-dimer, as a major indicator to complement imaging examinations.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of D‐dimer in non‐small cell lung cancer patients receiving radical surgery and its association with postoperative venous thromboembolism

Cui

Chen

et al. 2020

Thoracic Cancer

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Background Venous thromboembolism (VTE) occurs at a high rate after lung cancer surgery and can be attributed to various clinical risk factors. Here, we aimed to determine whether early detection of perioperative D‐dimer and risk‐stratified cutoff values would improve the diagnostic efficacy of VTE. Methods In this case‐control study, D‐dimer results were acquired from 171 non‐small cell lung cancer (NSCLC) patients preoperatively and at the first, third, and fifth day after surgery. VTE was confirmed by Doppler ultrasonography and computer tomography pulmonary angiography (CTPA). Repeated measures ANOVA was used to analyze how D‐dimer changed with time and the effects of risk factors on D‐dimer levels. We then compared sensitivity, specificity and negative predictive value, using both adjusted and unadjusted cutoff values. Results VTE occurred in 23 patients (13.5%) of the study population. D‐dimer levels increased unsustainably after lung cancer surgery (P < 0.001) due to a trough on the third day, and patients who had undergone thoracotomy (P < 0.001) and those at a more advanced tumor stage (P = 0.037) had higher D‐dimer levels. Area under the curve of D‐dimer was greatest on the third day (0.762 [P < 0.001, 95% CI: 0.643–0.882]). Applying stratified cutoff values improved the specificity in the video‐assisted thoracoscopy surgery (VATS) (P = 0.004) and thoracotomy groups (P < 0.001). Conclusions D‐dimer levels elevated with fluctuation in NSCLC patients after surgery. Surgical options and tumor stages had an impact on D‐dimer levels. With regard to VTE diagnosis, stratified cutoff values by these two factors showed better accuracy compared with a collective one.. Key points Significant findings of the study The changing pattern of perioperative D‐dimer levels in NSCLC patients who received surgical therapy in a major teaching hospital in Beijing, China was revealed. What this study adds Risk‐stratified D‐dimer cutoff values adjusted to surgical methods and disease stages would benefit the exclusion of postoperative venous thromboembolism.

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Section: Discussionmentioning

confidence: 99%

Dynamics of D‐dimer in non‐small cell lung cancer patients receiving radical surgery and its association with postoperative venous thromboembolism

Cui

Chen

et al. 2020

Thoracic Cancer

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“…Patient-specific risk factors for VTE include age, gender, smoking history, race, BMI >25 kg/m 2 , prolonged immobility, higher performance status, past medical history, presence of varicose veins, serious lung disease or chronic respiratory insufficiency, pre-existing cardiac conditions, pregnancy, thrombophilia, previous history of PE, congestive heart failure, or trauma (14,18,(20)(21)(22)(23). Asian population may have a lower incidence of VTE which may be due to lower prevalence of factor V Leiden mutation and possibly lower levels of fibrinogen, factor VIIc and factor VIIIc (24).…”

Section: Risk Factorsmentioning

confidence: 99%

“…Adverse side effects of LMWH may be thrombocytopaenia, epistaxis, gastrointestinal bleeding and wound haematoma (20). Unfractioned heparin is effective in preventing postoperative VTE without adverse events related to epidural catheters or heparin-induced thrombocytopaenia (39).…”

Section: Perioperative Preventionmentioning

confidence: 99%

Deep vein thrombosis and pulmonary embolism following lung resection

Kolokotroni¹

2021

Shanghai Chest

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Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common complications in cancer. Patients with lung cancer have a risk of venous thromboembolism (VTE) of around 3% over 2 years.The incidence of DVT after thoracic surgery is estimated to be between 0.4% and 51% and the incidence of PE between 1% and 5%. The risk factors for VTE may be patient-related, cancer-related or treatmentrelated. Pneumonectomy is associated with a 3-fold increase in post discharge VTE events compared to lobectomy. The diagnosis of VTE may be challenging as it has few specific symptoms. For this reason, prophylactic treatment with low molecular weight heparin or unfractioned heparin and antiembolism stockings or intermittent pneumatic compression devices are widely recommended for patients at risk for VTE. Patients who undergo thoracic surgery are deemed at high risk for postoperative VTE as a significant proportion of them have cancer, underlying respiratory and cardiovascular comorbidities, and are of advanced age. Extended VTE prophylaxis may be considered as there is a risk of developing VTE post discharge. Risk-assessment models for VTE can be utilized in thoracic surgery and the Caprini riskassessment model has been used successfully in the USA. Postoperative PE needs to be diagnosed and treated promptly as delay may be fatal. It is managed with anticoagulants but thrombolysis should be considered in compromised patients.

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“…gov, NCT0311554). The Boston University group has extensively studied risk stratification of thoracic surgery patients with a Caprini scoring system in which moderate and high-risk patients receive prolonged postoperative chemoprophylaxis with LMWH to decrease the risk of VTE (36)(37)(38)(39). The group from Beijing Chao-Yang Hospital, Capital Medical University has been studying the incidence of perioperative VTE in thoracic surgery patients not receiving perioperative chemical prophylaxis (Dr. Hui Li, unpublished data, see ESTS 2018 abstracts for more details).…”

Section: Contemporary Research Activities On Vte In Thoracic Surgerymentioning

confidence: 99%

European perspectives in Thoracic Surgery, the ESTS venous thromboembolism (VTE) working group

Shargall¹,

Litle²

2018

J. Thorac. Dis.

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Venous thromboembolism (VTE), composed of deep vein thrombosis (DVT) and PE is a well-recognized cause for significant perioperative morbidity and mortality. While in orthopedic surgery and general oncology surgery there are well established guidelines regarding VTE prophylaxis, based on carefully conducted high level studies, in thoracic surgery the level of evidence and overall knowledge in the field is still lacking, The European Society of Thoracic Surgeons have established an international working group in 2016, whose task was the define contemporary best practice, coordinate research efforts and eventually define best practice guidelines. This collaboration has matured into a multi-organizational effort, with participation of the American Association for Thoracic Surgery, the International Society on Thrombosis and Haemostasis and Chinese and Japanese thoracic societies. Two major projects (International practice survey and an expert group Delphi process re best practice and VTE risk factors) have been completed so far. For 2018, the working group goals will be to establish VTE prophylaxis guidance in Thoracic Surgery.

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Caprini Risk Model Decreases Venous Thromboembolism Rates in Thoracic Surgery Cancer Patients

Cited by 52 publications

References 21 publications

Dynamics of D‐dimer in non‐small cell lung cancer patients receiving radical surgery and its association with postoperative venous thromboembolism

Dynamics of D‐dimer in non‐small cell lung cancer patients receiving radical surgery and its association with postoperative venous thromboembolism

Deep vein thrombosis and pulmonary embolism following lung resection

European perspectives in Thoracic Surgery, the ESTS venous thromboembolism (VTE) working group

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