Safety profile of preoperative administration of low-molecular-weight heparin on minimally invasive lung cancer surgery: a randomized controlled trial

Gu-Ha A-Lai,Xu Shen,Yi-Dan Lin,Zhi-Jie Xu,Tie-Niu Song,Peng Yao,Ze-Guo Zhuo,Gang Li

doi:10.1186/s12893-021-01244-w

Abstract

BackgroundVenous thromboembolism remains a common but preventable complication for cancerous lung surgical patients. Current guidelines recommend thromboprophylaxis for lung patients at high risk of thrombosis, while a consensus about specific administration time is not reached. This study was designed to investigate the safety profile of preoperative administration of low-molecular-weight-heparin (LMWH) for lung cancer patients.MethodsFrom July 2017 to June 2018, patients prepared to undergo lung cancer surgery were randomly divided into the preoperative LMWH-administration group (PRL) for 4000 IU per day and the postoperative LMWH-administration group (POL) with same dosage, all the patients received thromboprophylaxis until discharge. Baseline characteristics including demographics and preoperative coagulation parameters were analyzed, while the endpoints included postoperative coagulation parameters, postoperative drainage data, hematologic data, intraoperative bleeding volume and reoperation rate.ResultsA total of 246 patients were collected in this RCT, 34 patients were excluded according to exclusion criterion, 101 patients were assigned to PRL group and 111 patients belonged to POL group for analysis finally. The baseline characteristic and preoperative coagulation parameters were all comparable except the PRL group cost more operation time (p = 0.008) and preoperative administration duration was significantly longer (p < 0.001). The endpoints including postoperative day 1 coagulation parameters, mean and total drainage volume, drainage duration, intraoperative bleeding volume and reoperation rate were all similar between the two groups. Moreover, coagulation parameters for postoperative day 3 between the two groups demonstrated no difference.ConclusionPreoperative administration of low-molecular-weight-heparin demonstrated safety and feasibility for lung cancer patients intended to receive minimally invasive surgery.Trial registration: ChiCTR2000040547 (www.chictr.org.cn), 2020/12/1, retrospectively registered.

Highlights

Venous thromboembolism remains a common but preventable complication for cancerous lung surgi‐ cal patients
A total of 246 patients were recruited in this study From July 2017 to June 2018, 16 patients were excluded according to the exclusion criterions of rejection, abnormal coagulation function, perioperative menstruation et al a population of 230 were randomly divided into two groups with 108 in preoperative LMWH-administration group (PRL) group and 122 in postoperative LMWH-administra‐ tion group (POL) group respectively
Seven patients were excluded for analysis because some data of hematologic test were missing. 1 patient from POL group suffered intraoperative artery rupture resulting in bleeding of more than 500 ml and it was excluded for analysis in this study

Summary

Introduction

Venous thromboembolism remains a common but preventable complication for cancerous lung surgi‐ cal patients. Current guidelines recommend thromboprophylaxis for lung patients at high risk of thrombosis, while a consensus about specific administration time is not reached. A survey containing 1150 thoracic surgeons of current status thromboprophylaxis for thoracic surgery in China demonstrated that 66.96% surgeons suggested thromboprophylaxis should be administrated at first day after lung cancer resection and extended the prophylaxis after discharge, and half of the surgeons acknowledged they made the decision of prophylaxis method and duration based on their clinical experience [12]. While American College of Chest Physicians Evidence-Based Clinical Practice Guidelines suggested low-molecular-weight-heparin or heparin for high risk VTE patients undergoing thoracic surgery, the start timing and duration were still lack of consensus while the recommendation for orthopedic surgery was 12 h or more preoperatively [14, 15]. We innovatively designed this study to testify whether preoperative administration of LMWH for lung cancer patients was safe and feasible

Methods

Results

Discussion

Conclusion