Evaluation of perioperative fatal pulmonary embolism and death in cancer surgical patients

Abstract

Cancer patients undergoing surgery are at a high risk of venous thromboembolism, but few studies have described the rate of autopsy-confirmed fatal pulmonary embolism after heparin thromboprophylaxis. In a post hoc analysis of a randomized study (MC-4), which compared the efficacy and safety of certoparin (3000 anti-Xa IU, subcutaneously, once-daily) with unfractionated heparin (5000 IU, subcutaneously, three-times daily) in 23078 patients undergoing surgery lasting more than 30 min, the incidence of autopsy-confirmed fatal pulmonary embolism, death and bleeding in the cancer patients (n=6124) was compared with non-cancer patients (n=16954). Fatal pulmonary embolism was significantly more frequent in cancer patients (0.33% [20/6124]) than in non-cancer patients (0.09% [15/16954], relative risk (RR), 3.7 [95% confidence intervals (CI), 1.80, 7.77], p=0.0001) at 14 days post-prophylaxis. Perioperative mortality was also significantly higher in cancer patients than in noncancer patients (3.14% [192/6124] vs. 0.71% [120/16954], RR, 4.54 [95% CI, 3.59, 5.76], p=0.0001), as were blood loss (p<0.0001), and transfusion requirements (p<0.0001). Prevention of venous thromboembolism in cancer surgical patients remains a clinical challenge.

Profilaxia para tromboembolia venosa em um hospital geral

“…(8) Among cancer patients, VTE is one of the most common complications, patients who are hospitalized and patients who are receiving chemotherapy being at higher risk, (9) as are postsurgical patients. (10) Regarding surgical patients, there is, in addition to clinical risk of VTE, the risk related to the type of surgery these patients are undergoing. This becomes important because surgical risk of venous thromboembolic events is low in outpatient procedures and minimally invasive procedures, whereas it is higher in major surgical procedures.…”

“…(14) Cancer patients undergoing surgical procedures have a two times higher risk of DVT and a three times higher risk of PTE than do patients without cancer undergoing similar procedures. (10) There is evidence that primary prophylaxis substantially reduces the incidence of VTE without increasing the risk of major bleeding. (1,7) In one meta-analysis, (15) the use of prophylaxis with unfractionated heparin (UFH) in medical inpatients reduced the number of cases of fatal PTE by 64%, that of symptomatic PTE by 58%, and that of symptomatic DVT by 53%.…”

Use of Bemiparin in Patients Undergoing Major Surgery for Esophageal and Gastric Cancer

“…В условиях подобной эндогенной гиперкоагуляции внешние факторы, включая лечебные воздействия, спо-собны критично повлиять на сдвиг гомеостаза. Зарубежные исследователи сообщают о риске ВТЭО на фоне радио-и химиотерапии, включая ее относительно облегченный амбулаторный вариант [12][13][14].…”

Venous Thromboembolism Prophylaxis in Cancer Patients

“…Surgical interventions, both elective and emergency, increase VTE risk in cancer patients compared to similar interventions in non-cancer patients (Gallus, 1997;Kakkar et al, 2005;White et al, 2003;). Despite the utilization of VTE prophylaxis, one multicenter prospective study showed that VTE was the most frequent cause of 30-day mortality in cancer patients undergoing surgical procedures (Agnelli et al, 2006).…”

“…The issue of extended out-of-hospital prophylaxis in high risk surgical patients was addressed in major clinical trials (Gallus, 1997;Kakkar et al, 2005). In one double-blind, multicenter trial (ENOXACAN II), 322 patients undergoing planned curative open surgery for abdominal or pelvic cancer received enoxaparin (40 mg subcutaneously) daily for 6 to 10 days and were then randomly assigned to receive either enoxaparin (at the same dose) or placebo for another 21 days.…”