Clinical outcomes of extended venous thromboembolism prophylaxis after oncologic colorectal surgery

Current guidelines recommend extended venous thromboembolism (VTE) prophylaxis after colorectal surgery for cancer. However, adherence to these guidelines has been low. Moreover, the effectiveness of extended VTE prophylaxis has not been evaluated using real-world data.

This study retrospectively analyzed a random 25% sample of the 2009-2022 IQVIA PharMetrics Plus for Academics database, an administrative claims database representative of the commercially insured population of the United States. Patients with cancer who underwent oncologic colorectal surgery were included. The primary outcomes were 90-day postdischarge VTE and bleeding events. The association between preoperative and intraoperative variables and the outcomes was assessed using univariate and multivariate main-effect logistic regression models.

A total of 13,117 surgical procedures were analyzed (35.0% laparoscopic colectomy, 33.4% open colectomy, 17.3% laparoscopic rectal resection, and 14.2% open rectal resection). The median age was 59 years, and 52% of patients were female. Extended VTE prophylaxis prescriptions were filled for 676 patients (5.2% of eligible patients), primarily with enoxaparin (95.5%), and increased over time (1.7% in 2010 to 12.0% in 2021). After risk adjustment, extended VTE prophylaxis was not associated with 90-day postdischarge VTE (odds ratio [OR], 1.15 [95% CI, 0.68-1.83]) or bleeding (OR, 0.93 [95% CI, 0.63-1.33]). The only factors independently associated with postdischarge VTE were the Elixhauser comorbidity score and surgery type.

Most patients who underwent colorectal surgery for cancer did not receive extended VTE prophylaxis. This did not seem to affect the risk of postoperative VTE or bleeding. Further research should focus on patients most likely to benefit from extended VTE prophylaxis.