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Post-hospital prophylaxis could reduce risk for venous thromboembolism, death after lung resection
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The incidence of post-operative venous thromboembolism following oncologic lung resections and after discharge is significant, despite guidelines directing prophylaxis take place only inside the hospital, according to researchers in Canada.
No specific risk factors were associated with the development of venous thromboembolism (VTE) post-discharge in a study of patients who had thoracic surgery for primary lung cancer or metastatic cancer, and a majority of patients did not have symptoms suggesting the condition.
“This study shows that a significant proportion of lung cancer surgery patients are at risk of VTE, and indicates a need for future research into minimizing the occurrence of [deep vein thrombosis] and [pulmonary embolism],” Yaron Shargall, MD, head of thoracic surgery at McMaster University in Hamilton, Ontario, said in a press release.
Yaron Shargall
Shargall, with colleagues from the institution and the University of Toronto, prospectively analyzed VTE occurrence among 157 patients (mean age 67 years; 55% female) who underwent anatomical or non-anatomical resections for either primary lung cancer (89.9%) or metastatic cancer (6.3%).
Patients received blood thinners, either unfractionated heparin or low molecular weight heparin, and mechanical prophylaxis with graduated compression stockings peri-operatively and until hospital discharge.
CT pulmonary angiography and bilateral Doppler venous ultrasound were performed after surgery (30±5 days). The investigators also recorded patient demographics, pre-operative comorbidities, histology, staging, peri-operative complications and VTE-related outcomes for up to 3 months after surgery.
The incidence rate among patients at high risk for VTE due to type of lung cancer was 12.1%, or 19 VTE events; 14 were pulmonary embolisms (8.9%), three were cases of deep vein thrombosis (1.9%), one was a combination of pulmonary embolism and DVT, and one death occurred due to a left atrial thrombus. The 30-day mortality rate was 0.64% overall and 5.2% with VTE.
“This demonstrates the clinical importance and relative fatality of VTE following lung cancer surgery,” Shargall said.
All patients diagnosed with VTE had lobectomy or segmentectomy, and most had primary lung cancer, according to the release. The clots generally formed on the same lung side as the procedure, and most patients developed lung clots without forming DVT first; only 4 (21.1%) patients showed symptoms of VTE.
Age, lung function, hospital length of stay, comorbidities, lung cancer stage, smoking status or Caprini Score (correlating to patient risk for developing VTE post-operatively) did not appear to distinguish patients who developed clots from those who did not.
“It is possible that extended use of blood thinners beyond hospital discharge may reduce the number of patients who experience these life-threatening events and may help to reduce the rates of death after lung surgery,” Shargall said.
Reference:
Shargall Y. et al. Abstract P33. Presented at: The American Association for Thoracic Surgery Annual Meeting; April 25-29; Seattle.
Disclosure: Shargall reports no relevant financial disclosures.