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International Angiology 2020 October;39(5):353-60

DOI: 10.23736/S0392-9590.20.04321-7


lingua: Inglese

Effect of thromboprophylaxis on the incidence of venous thromboembolism in surgical patients with colorectal cancer: a meta-analysis

Yu-Dong LI 1, Hai-Dong LI 2, Shu-Xin ZHANG 3

1 Department of Proctology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China; 2 Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; 3 Department of Proctology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China

INTRODUCTION: This study evaluates the role of thromboprophylaxis in venous thromboembolism (VTE) incidence in colorectal cancer (CRC) surgical patients.
EVIDENCE ACQUISITION: Literature search was conducted in electronic databases and studies (randomized controlled trials, or prospective/retrospective cohorts) were selected if they reported the incidence of VTE in CRC patients who underwent any type of open or laparoscopic surgery. Random-effects meta-analyses were performed to obtain pooled incidence estimates; or odds ratios (OR) of incidence between prophylaxis and no-prophylaxis groups; or between VTE and non-VTE patients to identify risk factors.
EVIDENCE SYNTHESIS: Twenty-four studies (804,003 patients) were included. Prophylaxis was performed mainly with low molecular weight heparins. Odds of VTE were significantly lower in prophylactic than in non-prophylactic patients (OR 0.42 [95% CI: 0.28, 0.63]; P<0.00001). Incidence of radiological and symptomatic VTE in patients with prophylaxis was 9.7% [95% CI: 8.6, 10.8] and 1.3% [95% CI: 0.7, 2.0] respectively. Odds of bleeding were higher in patients with prophylaxis (OR: 3.37 [95% CI: 1.05, 10.8]; P=0.04). Incidence of bleeding in patients with and without prophylaxis was 4.3% [95% CI: 3.2, 5.4] and 1.2% [95% CI: 0.02, 2.4] respectively. Operative time, anesthesia duration, and hospital stay were longer in patients with VTE. Obesity, disseminated cancer, chemotherapy, steroid use, emergency case status, advanced stage cancer, hypoalbuminemia, postoperative infection/sepsis, and history of VTE are identified as important risk factors for VTE incidence.
CONCLUSIONS: Thromboprophylaxis reduces the incidence of VTE in CRC surgical patients but may increase the chances of bleeding. Several risk factors can influence VTE incidence.

KEY WORDS: Thromboembolism; Colorectal neoplasms; Venous thrombosis; Surgery

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