The Prevention of Venous Thromboembolism After Surgery for Cancer

Abstract

Patients undergoing surgery for cancer are at high risk for developing venous thromboembolism (VTE) in the postoperative period, in spite of receiving traditional regimens of pharmacological prophylaxis. Anticoagulant thromboprophylaxis with low-molecular-weight-heparin (LMWH), given once daily, and unfractionated heparin (UFH), given usually thrice daily, has reduced the incidence of VTE by approximately 50% in placebo-controlled trials. Studies have shown no differences in efficacy or bleeding risks between these agents, although the overall incidence of heparin-induced thrombocytopenia (HIT) is lower with LMWH. Clinical trials have also shown that extended prophylaxis for up to 4 weeks significantly reduces the incidence of out-of-hospital VTE in cancer patients following major abdominal surgery. Mechanical methods should be considered for patients with absolute contraindications to pharmacologic prophylaxis, although the risk-benefit profile of low-dose anticoagulant prophylaxis appears to be favorable in many surgical cancer patients, even those undergoing neurosurgery. Novel oral anticoagulants have the potential to improve periprocedural prophylaxis utilization in this patient group.