Cancer Res Treat.  2016 Jul;48(3):978-989. 10.4143/crt.2015.311.

Prospective Study on the Incidence of Postoperative Venous Thromboembolism in Korean Patients with Colorectal Cancer

• Lee E
• Kang SB
• Choi SI
• Chun EJ
• Kim MJ
• Kim DW
• Oh HK
• Ihn MH
• Kim JW
• Bang SM
• Lee JO
• Kim YJ
• Kim JH
• Lee JS
• Lee KW

• KMID: 2344071
• DOI: http://doi.org/10.4143/crt.2015.311

Abstract

PURPOSE
Pharmacologic thromboprophylaxis is routinely recommended for Western cancer patients undergoing major surgery for prevention of venous thromboembolism (VTE). However, it is uncertainwhetherroutine administration of pharmacologic thromboprophylaxis is necessary in all Asian surgical cancer patients. This prospective study was conducted to examine the incidence of and risk factors for postoperative VTE in Korean colorectal cancer (CRC) patients undergoing major abdominal surgery.
MATERIALS AND METHODS
This study comprised two cohorts, and none of patients received perioperative pharmacologic thromboprophylaxis. In cohort A (n=400), patients were routinely screened for VTE using lower-extremity Doppler ultrasonography (DUS) on postoperative days 5-14. In cohort B (n=148), routine DUS was not performed, and imaging was only performed when there were symptoms or signs that were suspicious for VTE. The primary endpoint was the VTE incidence at 4 weeks postoperatively in cohort A.
RESULTS
The postoperative incidence of VTE was 3.0% (n=12) in cohort A. Among the 12 patients, eight had distal calf vein thromboses and one had symptomatic thrombosis. Age ≥ 70 years (odds ratio [OR], 5.61), ≥ 2 comorbidities (OR, 13.42), and white blood cell counts of > 10,000/μL (OR, 17.43) were independent risk factors for postoperative VTE (p < 0.05). In cohort B, there was one case of VTE (0.7%).
CONCLUSION
The postoperative incidence of VTE, which included asymptomatic cases, was 3.0% in Korean CRC patients who did not receive pharmacologic thromboprophylaxis. Perioperative pharmacologic thromboprophylaxis should be administered to Asian CRC patients on a risk-stratified basis.

Keyword

Asia; Colorectal neoplasms; Incidence; Colorectal surgery; Venous thromboembolism

MeSH Terms

Asia
Asian Continental Ancestry Group
Cohort Studies
Colorectal Neoplasms*
Colorectal Surgery
Comorbidity
Humans
Incidence*
Leukocyte Count
Prospective Studies*
Risk Factors
Thrombosis
Ultrasonography, Doppler
Veins
Venous Thromboembolism*

Figure

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  Fig. 1. Flow diagram of the study.

Reference

References

1. Kim IG, Kim KH, Seo HJ, Kim JI, Ahn CH, Kim JS, et al. Deep vein thrombosis after surgery for gastrointestinal cancer: incidence and correlation with risk factors. J Korean Soc Vasc Surg. 2004; 20:237–41.

2. Kim JW, Chun EJ, Choi SI, Park DJ, Kim HH, Bang SM, et al. A prospective study on the incidence of postoperative venous thromboembolism in Korean gastric cancer patients: an inquiry into the application of Western guidelines to Asian cancer patients. PLoS One. 2013; 8:e61968.

3. Shukla PJ, Siddachari R, Ahire S, Arya S, Ramani S, Barreto SG, et al. Postoperative deep vein thrombosis in patients with colorectal cancer. Indian J Gastroenterol. 2008; 27:71–3.

4. Choi S, Lee KW, Bang SM, Kim S, Lee JO, Kim YJ, et al. Different characteristics and prognostic impact of deep-vein thrombosis/pulmonary embolism and intraabdominal venous thrombosis in colorectal cancer patients. Thromb Haemost. 2011; 106:1084–94.

5. Weida D, Patrick LY, Andrew YW. Is it safe to perform operation for colorectal malignancy in Chinese patients without DVT prophylaxis? An 8-year experience from a regional hospital in Hong Kong. Chin Med J (Engl). 2010; 123:1973–5.

6. Yeo DX, Junnarkar S, Balasubramaniam S, Tan YP, Low JK, Woon W, et al. Incidence of venous thromboembolism and its pharmacological prophylaxis in Asian general surgery patients: a systematic review. World J Surg. 2015; 39:150–7.

7. Yhim HY, Jang MJ, Bang SM, Kim KH, Kim YK, Nam SH, et al. Incidence of venous thromboembolism following major surgery in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost. 2014; 12:1035–43.

8. Mandala M, Falanga A, Roila F; ESMO Guidelines Working Group. Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2011; 22 Suppl 6:vi85–92.

9. Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013; 31:2189–204.

10. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008; 133(6 Suppl):381S–453S.

11. Shin A, Kim KZ, Jung KW, Park S, Won YJ, Kim J, et al. Increasing trend of colorectal cancer incidence in Korea, 1999-2009. Cancer Res Treat. 2012; 44:219–26.

12. Righini M, Perrier A, De Moerloose P, Bounameaux H. D-Dimer for venous thromboembolism diagnosis: 20 years later. J Thromb Haemost. 2008; 6:1059–71.

13. Simonneau G, Laporte S, Mismetti P, Derlon A, Samii K, Samama CM, et al. A randomized study comparing the efficacy and safety of nadroparin 2850 IU (0.3 mL) vs. enoxaparin 4000 IU (40 mg) in the prevention of venous thromboembolism after colorectal surgery for cancer. J Thromb Haemost. 2006; 4:1693–700.

14. Vedovati MC, Becattini C, Rondelli F, Boncompagni M, Camporese G, Balzarotti R, et al. A randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer. Ann Surg. 2014; 259:665–9.

15. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians EvidenceBased Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e227S–77S.

16. Yang SS, Yu CS, Yoon YS, Yoon SN, Lim SB, Kim JC. Symptomatic venous thromboembolism in Asian colorectal cancer surgery patients. World J Surg. 2011; 35:881–7.

17. Bergqvist D. Venous thromboembolism: a review of risk and prevention in colorectal surgery patients. Dis Colon Rectum. 2006; 49:1620–8.

18. Ay C, Dunkler D, Marosi C, Chiriac AL, Vormittag R, Simanek R, et al. Prediction of venous thromboembolism in cancer patients. Blood. 2010; 116:5377–82.

19. Stender MT, Frokjaer JB, Larsen TB, Lundbye-Christensen S, Thorlacius-Ussing O. Preoperative plasma D-dimer is a predictor of postoperative deep venous thrombosis in colorectal cancer patients: a clinical, prospective cohort study with one-year follow-up. Dis Colon Rectum. 2009; 52:446–51.

20. Cui G, Wang X, Yao W, Li H. Incidence of postoperative venous thromboembolism after laparoscopic versus open colorectal cancer surgery: a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2013; 23:128–34.

21. Kimura Y, Oki E, Ando K, Saeki H, Kusumoto T, Maehara Y. Incidence of venous thromboembolism following laparoscopic surgery for gastrointestinal cancer: a single-center, prospective cohort study. World J Surg. 2015; Aug. 28. [Epub]. http://dx.doi.org/10.1007/s00268-015-3234-y.

22. Sakon M, Maehara Y, Yoshikawa H, Akaza H. Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan. J Thromb Haemost. 2006; 4:581–6.

23. Lee FY, Chu W, Chan R, Leung YF, Liu KH, Ng SM, et al. Incidence of deep vein thrombosis after colorectal surgery in a Chinese population. ANZ J Surg. 2001; 71:637–40.

24. Cheung HY, Chung CC, Yau KK, Siu WT, Wong SK, Chiu E, et al. Risk of deep vein thrombosis following laparoscopic rectosigmoid cancer resection in chinese patients. Asian J Surg. 2008; 31:63–8.

25. Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost. 2011; 9:85–91.