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Extended thromboprophylaxis in enhanced recovery after surgery for colorectal cancer: a multicentre retrospective
S T Glazemakers1, S H J Ketelaers2, H B Cornelisse3
1Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW, Faculty of Health, Medicine, and Life Science, Maastricht University, the Netherlands.
Introduction:
The value of continuing thromboprophylaxis after hospital discharge (extended prophylaxis) following colorectal cancer surgery is uncertain in modern surgical practices.
Methods:
A multicentre, retrospective cohort study was conducted across 6 ERAS-adherent centres in the Netherlands, including 2409 patients who underwent elective colorectal cancer surgery between January 2018 and August 2023. Patients were categorized based on their hospital's thromboprophylaxis regimen: thromboprophylaxis until discharge or extended prophylaxis continued after discharge. The primary outcome was 90-day cumulative incidence of symptomatic VTE, with log-rank tests for group comparisons. Secondary outcomes included major bleeding complications (Clavien-Dindo grade ≥ III), and factors associated with occurence of postoperative VTE or major bleeding complications.
Results:
The median duration of thromboprophylaxis was 4 (IQR 2-6) days in the until-discharge group (n = 1260) and 28 (IQR 18-28) days in the extended-prophylaxis group (n = 1149). The overall incidence of symptomatic VTE was 0.2 %, with no significant difference observed between the two groups (0.2 % vs. 0.2 %; p = 0.925). Major bleeding complications occurred more frequently in the extended-prophylaxis group (1.0 % vs. 2.0 %; p = 0.049). Multivariate analysis demonstrated that extended thromboprophylaxis was independently associated with major bleeding complications (OR2.002, 95 %CI 1.007-3.980), but not with VTE incidence.
Conclusion:
The overall incidence of symptomatic VTE following elective colorectal cancer surgery within ERAS protocols was low. Thromboprophylaxis regimens continued after discharge were not associated with lower incidence of postoperative VTE, but were associated with a higher frequency of postoperative major bleeding complications. These findings suggest that routine extended thromboprophylaxis may be reconsidered in modern colorectal cancer surgery.
Clinical Trial Registration:
registration number W22.176.
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