Prospective implementation of a standardized screening protocol for deep venous thrombosis in abdominal surgical oncology patients

Sinnamon, Andrew J.; Tong, Jason; Brown, Caitlin S.; Colbert, Latesha; Murray, Shannon; Jackson, Benjamin M.; Roses, Robert E.

doi:10.1002/jso.25151

Cited by 9 publications

(11 citation statements)

References 33 publications

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“…70 VTE was the outcome in 81 studies, 114,[117][118][119][120][121][122][123] ATE in 4 studies, 34,62,69,109 and a combination of ATE and VTE in 15 studies. 37,38,44,49,65,71,89,[93][94][95]102,103,111,115,116 The patents received thromboprophylaxis in 10 studies, 30,33,41,50,67,78,87,106,119,121 some patients received thromboprophylaxis in 19 studies, 3,44,59,61,66,73,81,85,86,90-92,99,101,104,108 111,113,115 and no thromboprophylaxis was used in 25 studies. 14,35,36,[38][39][40]42,43,46,…”

Section: Resultsmentioning

confidence: 99%

Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis

Malte

Højbjerg

Larsen

2023

Semin Thromb Hemost

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Cancer-associated thrombosis (CAT) is a major cause of both morbidity and mortality in cancer patients. Platelet count has been investigated as a predictor of CAT in various settings while knowledge on platelet activation parameters is sparse. This report provides a systematic review and meta-analysis on available literature on associations between platelet count and/or function and arterial and venous thrombosis in adult cancer patients. The review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed and Embase were searched up to March 2022. The National Heart, Lung, and Blood Institute's tools were used for quality assessment. In total, 100 studies were included which investigated the association between CAT and platelet count (n = 90), platelet indices (n = 19), and platelet function/activation markers (n = 13) in patients with solid cancers (n = 61), hematological cancers (n = 17), or mixed cancer types (n = 22). Eighty-one studies had venous thrombosis as their outcome measure, while 4 had arterial thrombosis and 15 studies had both. We found significantly elevated odds ratio of 1.50 (95% confidence interval: 1.19–1.88) for thrombosis with higher platelet counts. We saw a tendency toward an association between markers of platelet activation in forms of mean platelet volume and soluble P selectin and both arterial and venous thrombosis. Only one study investigated dynamic platelet function using flow cytometry. In conclusion, platelet count is associated with CAT across different cancer types and settings. Platelet function or activation marker analysis may be valuable in assisting thrombosis risk assessment in cancer patients but is sparsely investigated so far.

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Section: Resultsmentioning

confidence: 99%

Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis

Malte

Højbjerg

Larsen

2023

Semin Thromb Hemost

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“…Abdominal procedures may overlap with oncologic surgery, a group of patients among which the incidence of VTE is high, with one study detecting occult postoperative DVT by surveillance duplex in 9.8% of patients despite the use of perioperative thromboprophylaxis. 17 For vascular surgery patients, who have a high incidence of postoperative VTE, the use of both mechanical and pharmacologic prophylaxis in the preoperative period led to a 75% reduction in postoperative VTE in one single center study. 18 Further study is necessary to investigate whether initiation of intensive preoperative prophylaxis, and extended post-operative pharmacologic therapy would be beneficial following these highest risk procedures.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Postoperative Venous Thromboembolism risk prediction model

Woo

Rhoades

Ackermann

et al. 2020

Preprint

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Background: VTE is a serious postoperative complication after surgery with resultant higher morbidity and mortality. Despite years of experience with current risk models, rates continue to be high and more information is needed on individual patient risk in the prophylaxis era. Research Questions: Can we assess the individualized risk of postoperative venous thromboembolism (VTE) for broad categories of surgery? Methods: This study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database. Patient data (n=2,875,190) from 2015-2017 were used for study analysis. Eight predictors were selected for the model: age, preoperative platelet count≥450 (x109/L), disseminated cancer, corticosteroid use, serum albumin ≤2.5 g/dL, preoperative sepsis, hospital length of stay and surgery type. The second model included 7 predictors without hospital length of stay. A predictive model was trained using ACS-NSQIP data from 2015-2016 (n=1,859,227) and tested using data from 2017 (n= 1,015,963). Primary outcomes are postoperative 30-day VTE, including deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Results: VTE occurred in 23,249 patients (0.81%) and 49.9% of VTE occurred after discharge from index hospitalization. The risk prediction model had high AUC (area under the receiver operating characteristic curve) for postoperative VTE of 0.78 (training cohort) and 0.78 (test cohort). Interpretation: This clinical prediction model is a validated, practical and easy-to-use tool to identify surgical patients at the highest risk of postoperative VTE and provide an individualized assessment of risk based on clinical factors and type of surgery. This prediction model may be used as a tool to assess individualized risk of postoperative VTE and promote broader discussion and awareness of the VTE risk during the perioperative period.

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“…It was extensively reported that conventional open cholecystectomy is followed by activation of coagulation mechanism. 13,14 Bergqvist et al reported 7-10% incidence of VTE diagnosed by using the venography in patients having undergone conventional open cholecystectomy. 15 As opposed to conventional open cholecystectomy, LC is a minimally invasive procedure for gallbladder disease.…”

Section: Discussionmentioning

confidence: 99%

Effect of obesity on venous hemodynamics of the lower limbs during laparoscopic cholecystectomy

et al. 2022

Phlebology

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Objective The present study aims to compare the changes of venous flow parameters of the lower limbs under the assessment based on the duplex ultrasound scanning in obese and non-obese individuals by complying with body mass index during laparoscopic cholecystectomy. Methods A prospective cohort study was conducted in non-obese (body mass index <25 kg/m2) and obese individuals (body mass index >30 kg/m2) during laparoscopic cholecystectomy to analyze venous hemodynamics of the lower limbs. The assessment was conducted on Femoral vein diameter, Femoral vein cross-sectional area, Femoral vein peak velocity, and Femoral vein volume flow. The change values (%) of venous flow parameters of the lower limbs were calculated as a percentage by: (intra-operative parameter-pre-operative parameter)/ pre-operative parametersX100%. Results 45 right lower limbs were examined in 45 non-obese individuals and 33 right lower limbs in 33 obese individuals during laparoscopic cholecystectomy. The statistically significant difference was identified in the pre-operative and intra-operative values of Femoral vein diameter, Femoral vein cross-sectional area, Femoral vein peak velocity, as well as Femoral vein volume flow in both groups when these were analyzed independently ( p = .00). When the change values of venous flow parameters of the lower limbs of the two groups were compared, more changes were identified significantly in the obese group, Femoral vein diameter ( p = .042), Femoral vein cross-sectional area ( p = .013), Femoral vein peak velocity ( p = .002), and Femoral vein volume flow ( p = .032). Conclusion The changes of lower limb venous flow parameters showed more significant difference in obese than in non-obese individuals during laparoscopic cholecystectomy. The mentioned findings may in part explain why obese patients undergoing laparoscopic cholecystectomy have a higher rate of post op deep venous thrombosis.

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Prospective implementation of a standardized screening protocol for deep venous thrombosis in abdominal surgical oncology patients

Abstract: Despite prophylaxis, the prevalence of occult DVT in abdominal oncologic surgery patients is considerable. Postoperative screening duplex can identify these events to guide management.

Cited by 9 publications

References 33 publications

Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis

Platelet Parameters as Biomarkers for Thrombosis Risk in Cancer: A Systematic Review and Meta-analysis

Development and Validation of Postoperative Venous Thromboembolism risk prediction model

Effect of obesity on venous hemodynamics of the lower limbs during laparoscopic cholecystectomy

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