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.

Keun Wook Lee,Jee Hyun Kim,Sang Il Choi,Yu Jung Kim,Eun Ju Chun,Do Joong Park,Jong-Seok Lee,Jin Won Kim,Jeong-Ok Lee,Soo-Mee Bang,Hyung-Ho Kim

doi:10.1200/jco.2013.31.15_suppl.e15129

Abstract

e15129 Background: Several Western guidelines recommend the routine use of pharmacologic thromboprophylaxis for cancer surgery patients to prevent venous thromboembolism (VTE). However, the necessity of routine pharmacologic perioperative thromboprophylaxis in Asian gastric cancer (GC) patients has not been clearly determined. Methods: To determine the necessity of routine perioperative pharmacologic thromboprophylaxis in Korean gastric cancer patients, the incidence of postoperative VTE was prospectively evaluated in gastric cancer patients receiving surgery. Among 610 GC patients who had received surgery, 375 patents prospectively underwent routine duplex Doppler ultrasonography (DUS) on days 5-12 following surgery to detect VTE and then VTE-related symptoms and signs were checked at 4 weeks after surgery (cohort A). The 235 patients that declined DUS were registered to cohort B and the occurrence of postoperative VTE was retrospectively analyzed. Results: In cohort A, symptomatic or asymptomatic VTE until 4 weeks after surgery was detected in 9 patients [2.4%; 95% confidence interval (CI); 0.9-3.9]. Tumor stage was a significant factor related to VTE development [stage I, 1.4%; stage II/III, 2.4%; stage IV, 9.7% (P = 0.008)]. In multivariate analysis, patients with stage IV had a higher postoperative VTE development [odds ratio, 8.18 (95% CI, 1.54-43.42)] than those with stage I. In cohort B, a low incidence of postoperative VTE was reaffirmed; only one postoperative VTE case (0.4%) was observed. Conclusions: The incidence of postoperative VTE in Korean GC patients was only 2.4%. Risk-stratified applications of perioperative pharmacologic thromboprophylaxis are thought to be more appropriate than the routine pharmacologic thromboprophylaxis in Korean GC patients receiving surgery.

Highlights

Venous thromboembolism (VTE), including extremity deep vein thrombosis (DVT) and pulmonary embolism (PE), is attributed to several risk factors including old age, immobilization, surgery and others [1]
This is the largest prospective study on the incidence of postoperative VTE in Gastric cancer (GC) patients. It demonstrated that postoperative VTE is very rare (2.4%; 95% confidence interval (CI), 0.9–3.9) in Korean GC patients
As routine pharmacologic prophylaxis is generally considered when the incidence of postoperative VTE is $ 10% [10], our study shows that risk-stratified applications of perioperative pharmacologic thromboprophylaxis is more appropriate than the routine pharmacologic thromboprophylaxis in Asian GC patients receiving surgery

Summary

Introduction

Venous thromboembolism (VTE), including extremity deep vein thrombosis (DVT) and pulmonary embolism (PE), is attributed to several risk factors including old age, immobilization, surgery and others [1]. Several Western guidelines recommend the routine use of pharmacologic thromboprophylaxis for cancer surgery patients to prevent VTE [3,4,5,6,7]. There is no firm evidence from prospective studies, many Asian cancer surgeons believe that the incidence of postoperative VTE is not so high as they must follow Western guidelines. Since most previous studies insisting on a low incidence of VTE in Asian patients have been retrospectively conducted [8,11], the necessity of routine pharmacologic perioperative thromboprophylaxis in Asian cancer patients has not been clearly determined. As GC is prevalent in Asia, large prospective studies on the incidence of postoperative VTE in Asian GC patients are required to justify risk-stratified application of perioperative pharmacologic thromboprophylaxis

Materials and Methods

Results

Discussion