Duration of Prophylaxis against Venous Thromboembolism with Enoxaparin after Surgery for Cancer

Bergqvist, David; Agnelli, Giancarlo; Cohen, AT; Eldor, Amiram; Nilsson, Patric; Moigne-Amrani, A Le; Dietrich-Neto, F

doi:10.1056/nejmoa012385

Cited by 963 publications

(524 citation statements)

References 18 publications

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“…6000 u of enoxaparin for BMI [30 kg/m 2 , 8000 u for BMI [40 kg/m 2 , 10,000 u for BMI [50 kg/m 2 ) has been shown to be safe without increased risk of bleeding [182][183][184]. Finally, many studies indicate prolonged risk of thrombotic events, not least due to unpredictable food intake in some patients, encouraging recommendation of 3-4 weeks treatment [185,186]. There are no data suggesting that the use of fondaparinux or other new oral anticoagulants should be recommended.…”

Section: Thromboprophylaxismentioning

confidence: 99%

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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Background During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based ''enhanced'' perioperative protocol. Methods The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. Results Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. Conclusions A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.

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Section: Thromboprophylaxismentioning

confidence: 99%

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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“…The ENOXACAN II study 12 found a relative risk reduction of 60% (p = 0.02); however, the benefit of extended treatment was predominantly in the reduction of asymptomatic distal DVT, which is of questionable significance. Another major limitation was that only about half of the patients recruited for the study were accounted for in the outcome assessment.…”

Section: Discussionmentioning

confidence: 99%

“…We estimated that incidence of VTE after discharge would be about 1%. 8,12,14 In order to be 95% confident that the true incidence is within ± 1%, 381 patients needed to be included in the sample. Therefore our study had more than enough power to reach its primary objective.…”

Section: Discussionmentioning

confidence: 99%

“…However, the existing literature has not reported an increased bleeding risk, 8,[12][13][14]21 and the consequences of VTE can be lethal. In the Cochrane meta-analysis, 14 the rate of bleeding events in the treatment group was 4.1% (25 of 614 patients) compared with 3.7% (23 of 628 patients) in the control group.…”

Section: Discussionmentioning

confidence: 99%

“…Much of the benefit in the ENOXACAN II study was seen in distal deep vein thromboses (DVT) picked up on routine venography. 12 A third study failed to show a protective effect of prolonged thromboprophylaxis with LMWH. 13 A recent Cochrane meta-analyis, 14 however, did show a benefit of extended prophylaxis in terms of both proximal and symptomatic VTE.…”

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confidence: 99%

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Diagnosis of VTE postdischarge for major abdominal and pelvic oncologic surgery: implications for a change in practice

et al. 2015

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Background: Extended thromboprophylaxis after hospital discharge following cancer surgery has been shown to reduce the incidence of venous thromboembolism (VTE); however, this practice has not been universally adopted. We conducted a populationbased analysis to determine the proportion of patients with symptomatic VTE diagnosed within 90 days after initial discharge following major abdominopelvic cancer surgery who might have benefited from extended thromboprophylaxis. Methods:We used the Manitoba Cancer Registry to identify patients who underwent major abdominopelvic cancer surgery between 2004 and 2009. The proportion in whom VTE was diagnosed during the initial hospital stay was determined by accessing the Hospital Separations Abstracts. The proportion in whom VTE was diagnosed after discharge was determined by examining repeat admissions within 90 days and by accessing Drug Programs Information Network records for newly prescribed anticoagulants. Detailed tumour and treatment-specific data allowed calculation of VTE predictors.Results: Of 6612 patients identified, 106 (1.60%) had VTE diagnosed during the in itial stay and 96 (1.45%) presented with VTE after discharge. Among patients in whom VTE developed after discharge, 33.3% had a pulmonary embolus, 24% had deep vein thrombosis, and 6.3% had both. Predictors of presenting with VTE after discharge within 90 days of surgery included advanced disease, presence of other complications, increased hospital resource utilization, primary tumours of noncolorectal gastrointestinal origin and age younger than 45 years. The development of VTE was an independent predictor of decreased 5-year overall survival. Conclusion:The cumulative incidence of VTE within 90 days of major abdominopelvic oncologic surgery was 3.01%, with about half (1.45%) having been diagnosed within 90 days after discharge.Contexte : La thromboprophylaxie prolongée après le congé hospitalier suite à une chirurgie pour cancer a permis de réduire l'incidence de la thrombo-embolie veineuse (TEV); or, cette pratique n'a pas été universellement adoptée. Nous avons procédé à une analyse de population afin de déterminer la proportion de patients qui ont reçu un diagnostic de TEV symptomatique dans les 90 jours suivant leur congé à la suite d'une chirurgie majeure pour cancer abdomino-pelvien et qui auraient pu bénéficier d'une thromboprophylaxie prolongée.

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Duration of Prophylaxis Against Venous Thromboembolism With Fondaparinux After Hip Fracture Surgery<subtitle>A Multicenter, Randomized, Placebo-Controlled, Double-blind Study</subtitle>

Eriksson

Lassen²

2003

Arch Intern Med

339

191

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Duration of Prophylaxis against Venous Thromboembolism with Enoxaparin after Surgery for Cancer

Abstract: Enoxaparin prophylaxis for four weeks after surgery for abdominal or pelvic cancer is safe and significantly reduces the incidence of venographically demonstrated thrombosis, as compared with enoxaparin prophylaxis for one week.

Cited by 963 publications

References 18 publications

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Diagnosis of VTE postdischarge for major abdominal and pelvic oncologic surgery: implications for a change in practice

Duration of Prophylaxis Against Venous Thromboembolism With Fondaparinux After Hip Fracture Surgery<subtitle>A Multicenter, Randomized, Placebo-Controlled, Double-blind Study</subtitle>

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