542 Prolonged VTE Prophylaxis Post Abdominal Cancer Surgery: Is It Necessary?
E J O'Malley, Y Lima de Mendonca, A Smith, K Kirby, R Bethune- Surgery
Abstract
Aim
NICE guidance currently recommends extending venous thromboembolism (VTE) prophylaxis to 28 days for patients who have undergone major cancer surgery in the abdomen. Literature highlights controversy around the efficacy of prolonged treatment preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) and potential areas for improvement.
Method
Retrospective study of urology and colorectal cancer patients undergoing surgery between October 2020 and September 2022. Electronic patient notes were used to determine adherence to guideline and prevalence of PE and/or DVT in post-operative patients. Comparison was made between both cohorts.
Results
Patient cohort n = 802, colorectal n = 345 and urology n = 457. Average age 66.6±10.4. M:F ratio = 543:258. Colorectal cohort 20.9%(n = 71) received extended prophylaxis, 79.1%(n = 269) did not, of which 19.7%(n = 53) prophylaxis was contraindicated. 5 excluded as died or an inpatient. Urology cohort 53.4%(n = 244) received extended prophylaxis, 46.6%(n = 213) did not, of which 28.2%(n = 60) prophylaxis was contraindicated. Overall, 39.5%(n = 315) received extended prophylaxis vs 60.5%(n = 482) did not. n = 4 developed PE/DVT. Of which, n = 1 on extended prophylaxis and n = 3 not, Chi-squared 0.35, P value = 0.55.
Conclusions
Very few patients developed symptomatic PE and/or DVT despite a significant proportion of patients not receiving extended prophylaxis. No significant difference in symptomatic PE or DVT in patients with extended prophylaxis vs patients without. Prolonged administration of low molecular weight heparin as anticoagulation has repercussions such as cost and patients’ ability to self-administer which may subsequently require community support or a longer hospital stay. Therefore, a more targeted approach to extended VTE should be explored.