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Xiang L, Jin S, Yu Y, Wang D, Chen H. Risk of venous thromboembolism in patients undergoing gastric cancer surgery: a systematic review and meta-analysis. BMC Cancer 2023; 23:933. [PMID: 37789268 PMCID: PMC10546706 DOI: 10.1186/s12885-023-11424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common postoperative complication in patients undergoing surgery for gastric cancer (GC). Although VTE incidence may vary among cancers, guidelines rarely stratify preventive methods for postoperative VTE by cancer type. The risk of VTE in patients undergoing surgery for GC remains unclear. METHODS A systematic review and meta-analysis was undertaken to determine the risk of VTE after GC surgery and discuss the clinical value of pharmacological thromboprophylaxis in these cases. Medline, Embase, Web of Science, and Cochrane Library databases were searched for articles published from their inception to September 2022. RESULTS Overall, 13 studies (111,936 patients) were included. The overall 1-month incidence of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE) after GC surgery was 1.8% (95% CI, 0.8-3.1%; I²=98.5%), 1.2% (95% CI, 0.5-2.1%; I²=96.1%), and 0.4% (95% CI, 0.1-1.1%; I²=96.3%), respectively. The prevalence of postoperative VTE was comparable between Asian and Western populations (1.8% vs. 1.8%; P > 0.05). Compared with mechanical prophylaxis alone, mechanical plus pharmacological prophylaxis was associated with a significantly lower 1-month rate of postoperative VTE and DVT (0.6% vs. 2.9% and 0.6% vs. 2.8%, respectively; all P < 0.05), but not PE (P > 0.05). The 1-month postoperative incidence of VTE was not significantly different between laparoscopic and open surgery (1.8% vs. 4.3%, P > 0.05). CONCLUSION Patients undergoing GC surgery do not have a high risk of VTE. The incidence of VTE after GC surgery is not significantly different between Eastern and Western patients. Mechanical plus pharmacological prophylaxis is more effective than mechanical prophylaxis alone in postoperative VTE prevention. The VTE risk is comparable between open and laparoscopic surgery for GC.
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Affiliation(s)
- Lin Xiang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China.
- Department of Pathology, Lanzhou University Second Hospital, 82 Cuiying Gate, Lanzhou, 730030, China.
| | - Shuai Jin
- Department of Surgery, Qiaokou Hususu Clinic, Wuhan, China
| | - Yang Yu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Tumour Surgery, Lanzhou University Second Hospital, 82 Cuiying Gate, Lanzhou, 730030, China
| | - Dengfeng Wang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Hao Chen
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China.
- Department of Tumour Surgery, Lanzhou University Second Hospital, 82 Cuiying Gate, Lanzhou, 730030, China.
- The Key Laboratory of the Digestive System Tumours of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China.
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2
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Shin W, Lee S, Lim MC, Jung J, Kim HJ, Cho H. Incidence of venous thromboembolism after standard treatment in patients with epithelial ovarian cancer in Korea. Cancer Med 2021; 10:2045-2053. [PMID: 33638309 PMCID: PMC7957187 DOI: 10.1002/cam4.3797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/09/2020] [Accepted: 01/29/2021] [Indexed: 11/27/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a hospital‐associated severe complication that may adversely affect patient prognosis. In this study, we evaluated the incidence of VTE and its risk factors in patients with epithelial ovarian cancer (EOC). Methods We retrospectively analyzed the electronic health record data of 1268 patients with EOC who received primary treatment at the National Cancer Center, Korea between January 2007 and December 2017 to identify patients who developed VTE. Demographic, clinical, and surgical characteristics of these patients were ascertained. Competing risks analyses were performed to estimate the cumulative incidence of VTE according to the treatment type. The associations between putative risk factors and the incidence of VTE were evaluated using the Fine–Gray regression models accounting for competing risks of death. Results VTE was the most prevalent cardiovascular event, found in 9.6% (n = 122) of all patients. Of these VTE events, 115 (94.3%) occurred within 2 years of EOC diagnosis. Advanced cancer stage at diagnosis (distant vs. localized, hazards ratio [HR])= 14.49, p = 0.015) and extended hospital stay (≥15 days, HR =3.87, p = 0.004) were associated with the incidence of VTE. There was no significant difference in the cumulative incidence of VTE between primary cytoreductive surgery followed by adjuvant chemotherapy and neoadjuvant chemotherapy followed by interval cytoreductive surgery (HR =0.81, p = 0.390). Conclusions Approximately 10% of patients with EOC were diagnosed with VTE, which was the most common cardiovascular disease found in this study. The assessment of VTE risks in patients with advanced‐stage EOC with an extended hospital stay is needed to facilitate adequate prophylactic treatment.
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Affiliation(s)
- Wonkyo Shin
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.,Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sanghee Lee
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Myong Cheol Lim
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.,Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.,Division of Tumor Immunology, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.,Center for Clinical Trials, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Jipmin Jung
- Cancer Big Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Hak Jin Kim
- Branch of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Hyunsoon Cho
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.,Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Republic of Korea
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3
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Heijkoop B, Nadi S, Spernat D, Kiroff G. Extended versus inpatient thromboprophylaxis with heparins following major open abdominopelvic surgery for malignancy: a systematic review of efficacy and safety. Perioper Med (Lond) 2020; 9:7. [PMID: 32158540 PMCID: PMC7053065 DOI: 10.1186/s13741-020-0137-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background Patients undergoing open abdominopelvic procedures for malignancy are at high risk of postoperative venous thromboembolism (VTE). This risk can be mitigated with prophylaxis; however, optimum duration in this population remains unknown. Our objective was to conduct a systematic review of contemporary literature on the use of heparin thromboprophylaxis following major open pelvic surgery for malignancy, comparing the efficacy and safety of extended duration to inpatient treatment. Methods A study protocol describing search strategy and inclusion and exclusion criteria was developed and registered with PROSPERO. A literature review was conducted in accordance with the protocol. Results Literature review identified only 4 studies directly comparing extended and inpatient duration prophylaxis, with a combined population of 3198 and 3135 patients for VTE rate and bleeding events, respectively. Despite many studies reporting lower VTE rates in patients receiving extended prophylaxis, no statistically significant difference in rates of postoperative VTE (p = 0.18) or bleeding complications (p = 0.43) was identified between patients receiving extended duration prophylaxis and those receiving inpatient only prophylaxis. Conclusion On the review of contemporary literature, no significant difference was found in rates of postoperative VTE or bleeding complications between patients receiving extended duration heparin VTE prophylaxis and those receiving inpatient prophylaxis after open abdominopelvic surgery for malignancy. This raises the question of how extended duration prophylaxis has become common practice in this population, and whether this needs to be re-evaluated.
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Affiliation(s)
- B Heijkoop
- 1The Queen Elizabeth Hospital, Woodville, SA Australia.,2Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - S Nadi
- 2Discipline of Surgery, The University of Adelaide, Adelaide, Australia.,3Research and Evaluation, Incorporating ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, Australia
| | - D Spernat
- 1The Queen Elizabeth Hospital, Woodville, SA Australia.,2Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - G Kiroff
- 1The Queen Elizabeth Hospital, Woodville, SA Australia.,2Discipline of Surgery, The University of Adelaide, Adelaide, Australia
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4
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Jung YJ, Seo HS, Park CH, Jeon HM, Kim JI, Yim HW, Song KY. Venous Thromboembolism Incidence and Prophylaxis Use After Gastrectomy Among Korean Patients With Gastric Adenocarcinoma: The PROTECTOR Randomized Clinical Trial. JAMA Surg 2019; 153:939-946. [PMID: 30027281 DOI: 10.1001/jamasurg.2018.2081] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The guidelines by the National Comprehensive Cancer Network and the American Society for Clinical Oncology recommend the routine use of thromboprophylaxis for patients with gastric adenocarcinoma. However, many physicians in Asian countries use venous thromboembolism (VTE) prophylaxis much less often because of the perceived lower VTE incidence in this population. Objectives To evaluate the incidence of postgastrectomy VTE in Korean patients with gastric adenocarcinoma, and to identify the complications and evaluate the efficacy and safety of VTE prevention methods. Design, Setting, and Participants The Optimal Prophylactic Method for Venous Thromboembolism After Gastrectomy in Korean Patients (PROTECTOR) randomized clinical trial was conducted between August 1, 2011, and March 31, 2015. Patients with histologically confirmed gastric adenocarcinoma presenting to a single center (Seoul St Mary's Hospital in Seoul, South Korea) were enrolled. Patients were randomized to either an intermittent pneumatic compression (IPC)-only group or an IPC+low-molecular-weight (LMW) heparin sodium group. The data were analyzed on intention-to-treat and per protocol bases. Data analysis was performed from April 1, 2016, to October 30, 2017. Main Outcomes and Measures Venous thromboembolism incidence was the primary outcome. Postoperative complications, particularly those associated with VTE prophylaxis methods, were the secondary end point. Results Of the 682 patients enrolled and randomized, 447 (65.5%) were male and 245 (34.5%) were female, with a mean (SD) age of 57.67 (12.94) years. Among the 666 patients included in the analysis, the overall incidence of VTE was 2.1%. The incidence of VTE was statistically significantly higher in the IPC-only group compared with the IPC+LMW heparin group (3.6%; 95% CI, 2.05%-6.14% vs 0.6%; 95% CI, 0.17%-2.18%; P = .008). Among the 14 patients (2.1%) with VTE, 13 were asymptomatic and received a deep vein thrombosis diagnosis, whereas 1 patient received a symptomatic pulmonary thromboembolism diagnosis. The overall incidence of bleeding complications was 5.1%. The incidence of bleeding complications was significantly higher in the IPC+LMW heparin group compared with the IPC-only group (9.1% vs 1.2%; P < .001). No cases of VTE-associated mortality were noted. Conclusions and Relevance Use of IPC alone is inferior to the use of IPC+LMW heparin in preventing postoperative VTE. Because LMW heparin is associated with a high bleeding risk, further study is needed to stratify the patients at high risk for perioperative development of VTE. Trial Registration ClinicalTrials.gov Identifier: NCT01448746.
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Affiliation(s)
- Yoon Ju Jung
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cho Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Myung Jeon
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Il Kim
- Division of Vascular and Transplantation Surgery, Department of Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon Woo Yim
- Clinical Research Coordinating Center of Catholic Medical Center, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Liu Y, Li B, Hu TL, Li T, Zhang Y, Zhang C, Yu M, Wang C, Hou L, Dong Z, Hu TS, Novakovic VA, Shi J. Increased Phosphatidylserine on Blood Cells in Oral Squamous Cell Carcinoma. J Dent Res 2019; 98:763-771. [PMID: 30979345 DOI: 10.1177/0022034519843106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The specific function of phosphatidylserine (PS) in the context of the development of a hypercoagulable state among individuals with oral squamous cell carcinoma (OSCC) is uncertain. The goal of this study was therefore to assess the exposure of PS on microparticles (MPs) as well as on endothelial and blood cells and to assess procoagulant activity (PCA) as a function of the stage of OSCC progression. We recruited patients with OSCC (n = 63) as well as healthy controls (n = 26) to participate in this study. PS exposure was then assessed via confocal microscopy and flow cytometry, revealing that patients with stage III/IV OSCC exhibited higher frequencies of PS-exposing blood cells, MPs, and serum-cultured endothelial cells (ECs) than did patients with stage I/II OSCC or healthy controls. When we conducted functional coagulation assays, we discovered that PS+ blood cells, MPs, and serum-cultured ECs from patients with stage III/IV OSCC mediated more rapid coagulation and more substantial production of FXa, thrombin, and fibrin as compared with controls. When samples were treated with the PS antagonist lactadherin, this resulted in an 80% disruption of PCA. Strikingly, when pre- and postoperative samples were compared from patients with stage III/IV OSCC undergoing resective surgery, PCA was significantly reduced in the postoperative samples. After stimulating ECs with inflammatory cytokines, we found by confocal microscopy that they expose PS on their cell membranes, thus generating FVa and FXa binding sites and mediating the formation of fibrin. Together our findings provide evidence that PS+ blood cells and MPs are important mediators of the development of a hypercoagulable and prothrombotic state among individuals afflicted by advanced-stage OSCC. As such, a PS blockade may be a viable therapeutic strategy for treating such patients.
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Affiliation(s)
- Y Liu
- 1 Department of Stomatology, First Hospital, Harbin Medical University, Harbin, China
| | - B Li
- 1 Department of Stomatology, First Hospital, Harbin Medical University, Harbin, China
| | - T L Hu
- 1 Department of Stomatology, First Hospital, Harbin Medical University, Harbin, China.,2 Department of Oral Anatomy and Physiology, Stomatology School, Harbin Medical University, Harbin, China
| | - T Li
- 3 Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Y Zhang
- 3 Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - C Zhang
- 3 Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - M Yu
- 3 Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - C Wang
- 3 Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - L Hou
- 3 Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - Z Dong
- 4 Department of Cardiology, First Hospital, Harbin Medical University, Harbin, China
| | - T S Hu
- 3 Department of Hematology, First Hospital, Harbin Medical University, Harbin, China
| | - V A Novakovic
- 5 Departments of Research and Surgery, VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Shi
- 3 Department of Hematology, First Hospital, Harbin Medical University, Harbin, China.,5 Departments of Research and Surgery, VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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6
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Jung YJ, Song KY. Quantifying the Added Value of Low-Molecular-Weight Heparin to Intermittent Pneumatic Compression for Preventing Venous Thromboembolic Events Under the Risk-Benefit Perspective-Reply. JAMA Surg 2019; 154:271-272. [PMID: 30484831 DOI: 10.1001/jamasurg.2018.4306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yoon Ju Jung
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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7
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Li M, Guo Q, Hu W. Incidence, risk factors, and outcomes of venous thromboembolism after oncologic surgery: A systematic review and meta-analysis. Thromb Res 2018; 173:48-56. [PMID: 30471508 DOI: 10.1016/j.thromres.2018.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/06/2018] [Accepted: 11/14/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The risk and prognosis of VTE associated with oncologic surgery need to be quantified to guide patient management. We aimed to examine the availability of data and to report the incidence of venous thromboembolism (VTE) in cancer patients after surgery, as well as the clinical outcomes of VTE following oncologic surgery. METHODS We searched multiple databases for terms related to VTE after oncologic surgery from inception to November 1, 2017. A random-effects meta-analysis was done to calculate the pooled incidence of VTE. RESULTS Of the 8611 citations identified, 136 studies including 1,481,659 patients met the eligibility criteria. The overall incidence of VTE was estimated to be 2.3% (95% CI 2.1-2.5). Bone and soft tissue cancer (10.6%, 95% CI 2.9-18.2) and lung cancer (8.1%, 95% CI 3.7-12.6) were associated with the highest and second highest risk of postoperative VTE, respectively. Age (standardized mean difference [SMD] = 0.46, 95% CI 0.40-0.53; I2 = 93.8%), radiation (OR 1.29, 95% CI 1.03-1.62; I2 = 34.6%), transfusion (OR 1.96, 95% CI 1.48-2.59; I2 = 57.0%), and operative time (SMD = 1.12, 95% CI 1.07-1.16; I2 = 100%) were possible risk factors for postoperative VTE. Patients with VTE versus those without had increased odds of all-cause fatal events (11.15, 95% CI 4.07-30.56; I2 = 92.0%). CONCLUSIONS The risk of VTE after oncologic surgery remains high, and this risk varied according to the cancer type, study region, surgical location, and thromboprophylactic strategy. VTE is associated with increased mortality at the early stage of cancer surgery.
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Affiliation(s)
- Mao Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiang Guo
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Weiming Hu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
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8
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Pak J, Ikeda M, Uemura M, Miyake M, Nishikawa K, Miyamoto A, Miyazaki M, Hirao M, Nakamori S, Sekimoto M. Risk factors for bleeding in patients receiving fondaparinux after colorectal cancer surgery. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 1:131-135. [PMID: 31583313 PMCID: PMC6768684 DOI: 10.23922/jarc.2017-022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/20/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to identify risk factors for bleeding complications in patients who receive Venous thromboembolism (VTE) prophylaxis with fondaparinux (FPX) after colorectal cancer surgery. METHODS Records of 546 patients who underwent VTE prophylaxis with intermittent pneumatic compression and FPX after colorectal cancer surgery between January 2009 and May 2014 were reviewed. Patient characteristics, surgical procedures, and patient laboratory data were examined to identify risk factors for bleeding complications using univariate and multivariate logistic regression. RESULTS We reviewed the records of 324 males and 222 females. Median age and BMI were 68.5 years and 22.7 kg/m2, respectively. The number of laparoscopic surgeries was 366. Median operative time and blood loss were 188.5 min and 20 ml, respectively. The incidence (%) of bleeding events was 5.3%. In univariate analysis, age ≥80 years, BMI ≥25.0 kg/m2, hypertension, and antithrombotic therapy were associated with a significantly higher incidence of bleeding events. Multivariate analysis identified age ≥80 years (odds ratio 5.814; 95% confidence interval 2.502-13.278) as an independent risk factor. CONCLUSION Age ≥80 is a risk factor for bleeding in patients who receive FPX for VTE prophylaxis after colorectal cancer surgery.
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Affiliation(s)
- Jongsung Pak
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Masataka Ikeda
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Mamoru Uemura
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Kazuhiro Nishikawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Michihiko Miyazaki
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Shoji Nakamori
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
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Jung MR, Ryu SY, Park YK, Jeong O. Compliance with an Enhanced Recovery After a Surgery Program for Patients Undergoing Gastrectomy for Gastric Carcinoma: A Phase 2 Study. Ann Surg Oncol 2018; 25:2366-2373. [PMID: 29789971 DOI: 10.1245/s10434-018-6524-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs have gained widespread acceptance in different fields of major surgery. However, most elements of perioperative care in ERAS are based on practices that originated from colorectal surgery. This study investigated compliance with the main elements of ERAS for patients undergoing gastrectomy for gastric carcinoma. METHODS This phase 2 study enrolled 168 patients undergoing elective gastrectomy for gastric carcinoma. An ERAS program consisting of 18 main elements was implemented, and compliance with each element was evaluated (ClinicalTrials.gov, NCT01653496). RESULTS Distal gastrectomy was performed for 142 patients (84.5%) and total gastrectomy for 26 patients (10.1%). Laparoscopic surgery was performed for 141 patients (86%). The postoperative morbidity rate was 9.5%, and the mortality rate was 0%. The rates of compliance with the 18 main elements of ERAS ranged from 88.1 to 100%. The lowest compliance rate was observed in the restriction of intravenous fluid element (88.1%). Overall, all ERAS elements were successfully applied for 122 patients (72.6%). In the multivariate analysis, the significant factors that adversely affected compliance with ERAS were surgery during the early study period [odds ratio (OR) 0.39; p = 0.038], open surgery (OR 0.15; p <0.001), and postoperative morbidity (OR 0.16; p = 0.003). CONCLUSIONS Most elements of ERAS can be successfully applied for patients undergoing gastrectomy for gastric carcinoma. Multimodal collaboration between providers is essential to achieve proper application of ERAS.
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Affiliation(s)
- Mi Ran Jung
- Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea.,Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea
| | - Seong Yeob Ryu
- Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea.,Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea
| | - Young Kyu Park
- Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea.,Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea
| | - Oh Jeong
- Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea. .,Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea.
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10
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Risk and incidence of perioperative deep vein thrombosis in patients undergoing gastric cancer surgery. Surg Today 2017; 48:525-533. [PMID: 29234961 DOI: 10.1007/s00595-017-1617-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Venous thromboembolism (VTE) is a potentially fatal perioperative complication. Understanding the risk factors for deep vein thrombosis (DVT) and initiating appropriate prophylaxis is pivotal for reducing the risk of VTE. The purpose of this study was to clarify the perioperative risk factors for DVT in patients undergoing surgery for gastric cancer. METHODS We reviewed the findings of lower limb ultrasonography performed in 160 patients who underwent gastrectomy for gastric cancer. RESULTS The preoperative and postoperative incidence of DVT was 4.4% (7/160) and 7.2% (11/153), respectively. All postoperative DVTs were of the distal type, whereas preoperative DVTs were of the proximal (n = 3) and distal type (n = 4). None of the patients suffered symptomatic VTE. Multivariate analysis indicated that depth of invasion and D-dimer concentration were independent risk factors for preoperative DVT and that gender and performance status were risk factors for postoperative DVT. Receiver operating characteristic analysis revealed that the optimal cut-off D-dimer concentration was 1.4 μg/mL. CONCLUSIONS The incidence of perioperative DVT was low for patients undergoing gastric cancer surgery. Therefore, the risk-stratified application of perioperative pharmacologic thromboprophylaxis is thought to be more appropriate than routine pharmacologic thromboprophylaxis for Japanese patients undergoing surgery for gastric cancer.
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11
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Tanizawa Y, Bando E, Kawamura T, Tokunaga M, Makuuchi R, Iida K, Nanri K, Yoneyama M, Terashima M. Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients. Gastric Cancer 2017; 20:878-886. [PMID: 27987041 DOI: 10.1007/s10120-016-0677-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of deep venous thrombosis (DVT) in patients with gastric cancer before surgery is unknown. This study aimed to clarify the risk factors for DVT of the lower extremities in patients with gastric cancer before surgery and to evaluate the usefulness of ultrasonographic screening for prevention of postoperative pulmonary thromboembolism (PTE). METHODS Patients who had undergone lower-extremity venous ultrasonography before surgery for gastric cancer were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to identify the predictors of DVT before surgery. Perioperative management of patients with DVTs and the incidence of postoperative PTE were investigated. RESULTS Of the total 1140 patients, 86 had DVT preoperatively. On univariate analysis, the incidence of DVT was significantly higher with: female sex; age ≥80 years; PS ≥ 1 (vs. PS = 0); stage IV (vs. stages I-III); history of preoperative chemotherapy; and the presence of a central venous catheter (CVC). Multivariate logistic regression analysis demonstrated that sex, age ≥80 years, PS ≥ 1, history of preoperative chemotherapy, and the presence of CVC were significantly correlated with DVT before surgery. Postoperative PTE occurred in 2 patients with proximal DVT. No patients in whom DVT was not detected developed PTE. CONCLUSIONS Female sex, older age, worse PS, the presence of CVC, and a history of preoperative chemotherapy were the independent risk factors for DVT. Routine lower-extremity venous ultrasonographic screening is useful for prevention of PTE because it can identify patients at high or low risk for PTE.
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Affiliation(s)
- Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Taiichi Kawamura
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masanori Tokunaga
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Rie Makuuchi
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kei Iida
- Division of Cardiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazuhide Nanri
- Division of Physiological Examination, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masashi Yoneyama
- Division of Physiological Examination, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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Yanagita T, Kusanagi H. Safety and Effectiveness of Enoxaparin as Venous Thromboembolism Prophylaxis after Gastric Cancer Surgery in Japanese Patients. Am Surg 2016. [DOI: 10.1177/000313481608201232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Routine prophylaxis for venous thromboembolism (VTE) has been recommended after surgery not only in the West but also in Asia recently. The primary objective of this study was to investigate the safety and effectiveness of enoxaparin as a prophylaxis in patients undergoing distal, proximal, or total gastrectomy (TG) for gastric cancers. A total of 565 patients who underwent gastrectomy for gastric cancer were reviewed retrospectively. About 256 patients received postoperative prophylaxis with enoxaparin (2000 international unit twice daily for at least six days) and compression stockings; these patients were assigned to the enoxaparin group. About 257 patients comprised a historical control group, who used only compression stockings as a thromboprophylaxis. All patients underwent the same rehabilitation programs during the perioperative period. None of the patients developed symptomatic venous thromboembolism in either the enoxaparin group or the control group. The complication rate of bleeding was not significantly different between the two groups. Only one patient who used three antiplatelet agents concomitantly with enoxaparin required reoperation for anastomotic site bleeding. The usage of enoxaparin for venous thromboembolism prophylaxis is safe for Japanese patients after gastrectomy. But, cautious application is still needed especially when used concomitantly with other antiplatelet agents.
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Affiliation(s)
- Takeshi Yanagita
- From the Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
| | - Hiroshi Kusanagi
- From the Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
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Bilgi K, Muthusamy A, Subair M, Srinivasan S, Kumar A, Ravi R, Kumar R, Sureshkumar S, Mahalakshmy T, Kundra P, Kate V. Assessing the risk for development of Venous Thromboembolism (VTE) in surgical patients using Adapted Caprini scoring system. Int J Surg 2016; 30:68-73. [PMID: 27109201 DOI: 10.1016/j.ijsu.2016.04.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/14/2016] [Accepted: 04/16/2016] [Indexed: 11/19/2022]
Abstract
AIM To determine the incidence, morbidity and mortality due to Venous Thromboembolism (VTE) in surgical patients, and to assess the validity and reliability of Adapted Caprini scoring in risk stratification for VTE prophylaxis. METHODOLOGY This was a prospective observational study in a tertiary care hospital of South India on patients who underwent both elective and emergency surgeries over a period of 9 months. An Adapted Caprini score was devised which included only the clinical criteria. The patients were scored by two persons independently at admission and followed up till the 30th post-operative day and primary and secondary end points were statistically analyzed. RESULTS Three hundred and one patients were included and the overall incidence of VTE at 30 days was 7.3%. The risk of developing VTE was found to be significantly higher among the >8 score group as compared to 3-4 group (OR = 153.5, p < 0.001), or the 5-6 group (OR = 52.9, p < 0.001) or the 7-8 group (OR = 2.3, p = 0.002). Patients with a score of 7-8 were more likely to develop VTE as compared to 3-4 group (OR = 67.5, p < 0.001) or the 5-6 group (OR = 23.2, p < 0.001). CONCLUSION The risk of developing VTE is less significant in the 5-6 score group compared to 7-8 or more score group. Further stratification of the highest risk groups is recommended to provide appropriate prophylaxis only to the patients with high scores, thereby reducing complications due to VTE prophylaxis.
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Affiliation(s)
- Kanchan Bilgi
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Anitha Muthusamy
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Mohsina Subair
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Sanjeev Srinivasan
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Arun Kumar
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Ramya Ravi
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Ranjith Kumar
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Sathasivam Sureshkumar
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - T Mahalakshmy
- Department of Social and Preventive Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
| | - Vikram Kate
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India.
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Contributions of phosphatidylserine-positive platelets and leukocytes and microparticles to hypercoagulable state in gastric cancer patients. Tumour Biol 2015; 37:7881-91. [DOI: 10.1007/s13277-015-4667-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/16/2015] [Indexed: 12/16/2022] Open
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Yasui M, Ikeda M, Miyake M, Ide Y, Okuyama M, Shingai T, Kitani K, Ikenaga M, Hasegawa J, Akamatsu H, Murata K, Takemasa I, Mizushima T, Yamamoto H, Sekimoto M, Nezu R, Doki Y, Mori M. Comparison of bleeding risks related to venous thromboembolism prophylaxis in laparoscopic vs open colorectal cancer surgery: a multicenter study in Japanese patients. Am J Surg 2015; 213:43-49. [PMID: 26772140 DOI: 10.1016/j.amjsurg.2015.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/19/2015] [Accepted: 10/12/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Venous thromboembolism is the most common preventable cause of hospital death. The objective of this study was to clarify risk factors for postoperative bleeding related to thromboprophylaxis after laparoscopic colorectal cancer surgery. METHODS The study was conducted at 23 Japanese institutions and included patients with colorectal cancer who underwent laparoscopic or open surgery followed by fondaparinux treatment. We performed a retrospective analysis from a prospectively maintained database. We used multivariate analyses to evaluate clinical risk factors for prophylaxis-related bleeding events. RESULTS After multivariate analysis, male gender, intraoperative blood loss of less than 25 mL, and a preoperative platelet count below 15 × 104/μL were found to be independent risk factors in the laparoscopic surgery group. Only the preoperative platelet count was an independent risk factor in the open surgery group. CONCLUSIONS Different prophylactic treatments for postoperative venous thromboembolism may be necessary in laparoscopic vs open surgery for colorectal cancer.
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Affiliation(s)
- Masayoshi Yasui
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-Ku, Osaka City, Osaka 537-8511, Japan.
| | - Masataka Ikeda
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka City, Osaka, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka City, Osaka, Japan
| | - Yoshihito Ide
- Department of Surgery, Yao Municipal Hospital, Yao City, Osaka, Japan
| | - Masaki Okuyama
- Department of Surgery, Higashiosaka City General Hospital, Higashiosaka City, Osaka, Japan
| | - Tatsushi Shingai
- Department of Surgery, Saiseikai Senri Hospital, Suita City, Osaka, Japan
| | - Kotaro Kitani
- Department of Surgery, Nara Hospital Kinki University Faculty of Medicine, Ikoma City, Nara, Japan
| | - Masakazu Ikenaga
- Department of Surgery, Osaka Rosai Hospital, Sakai City, Osaka, Japan
| | - Junichi Hasegawa
- Department of Surgery, Osaka Rosai Hospital, Sakai City, Osaka, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Osaka Police Hospital, Osaka City, Osaka, Japan
| | - Kohei Murata
- Department of Surgery, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Ichiro Takemasa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Hirofumi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka City, Osaka, Japan
| | - Riichiro Nezu
- Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya City, Hyogo, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
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Mita K, Ito H, Takahashi K, Hashimoto M, Nagayasu K, Murabayashi R, Asakawa H, Koizumi K, Hayashi T, Fujino K. Postpancreatectomy Hemorrhage After Pancreatic Surgery in Patients Receiving Anticoagulation or Antiplatelet Agents. Surg Innov 2015; 23:284-90. [PMID: 26611788 DOI: 10.1177/1553350615618288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Postpancreatectomy hemorrhage (PPH) is a serious complication after pancreatic surgery. In this study, we evaluated PPH and thromboembolic complications after pancreatic surgery in patients with perioperative antithrombotic treatment. Methods Medical records of patients undergoing pancreatic surgery were reviewed retrospectively. Patients receiving thromboprophylaxis were given either bridging therapy with unfractionated heparin or continued on aspirin as perioperative antithrombotic treatment according to clinical indications and published recommendations. The International Study Group of Pancreatic Surgery definition of PPH was used. Risk factors associated with PPH were assessed by multivariate analysis. Results Thirty-four of 158 patients received perioperative antithrombotic treatment; this group had a significantly higher PPH rate (29.4% vs 6.5%, P = .001) and mortality (11.8% vs 2.4%, P = .039) than patients not receiving thromboprophylaxis. Multivariate analysis revealed that perioperative antithrombotic treatment was the only independent risk factor for PPH after pancreatic surgery (odds ratio 4.77; 95% CI 1.61-14.15; P = .005). Conclusions Perioperative antithrombotic treatment is an independent risk factor for PPH in patients undergoing pancreatic surgery, although this treatment effectively prevents postoperative thromboembolic events.
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Yeo DXW, Junnarkar S, Balasubramaniam S, Tan YP, Low JK, Woon W, Pang TCY. Incidence of venous thromboembolism and its pharmacological prophylaxis in Asian general surgery patients: a systematic review. World J Surg 2015; 39:150-7. [PMID: 25189450 DOI: 10.1007/s00268-014-2763-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a condition that has always been perceived to be rare in Asia. The aim of this systematic review was to gather the current available evidence on the incidence of VTE in this population. A secondary aim was to assess the efficacy of pharmacological prophylaxis, and hence determine its role, in the Asian population. METHODS A comprehensive literature search was performed using MEDLINE, Embase, and the Cochrane Database of Systematic Reviews in June 2014. Articles found using search terms related to venous thromboembolism (VTE), Asian countries and general surgery procedures and pathologies were screened using the following inclusion criteria: (1) either the population studied was primarily Asian or the study was conducted in an Asian country, (2) the subjects studied underwent a major gastrointestinal or other general surgery procedure, (3) the primary outcome was the incidence of deep vein thrombosis (DVT) or pulmonary embolus (PE), and (4) secondary outcomes assessed included mortality and complications due to the VTE or prophylaxis against VTE. RESULTS Fourteen publications with a total of 11,218 patients were analyzed. Nine of the fourteen were observational studies, with half being prospective in nature. There were five interventional studies of which two were randomized controlled trials. Among the observational studies, the median (range) incidence of above-knee DVT was 0.08 % (0-2.9 %), while the median (range) incidence of PE was 0.18 % (0-0.58 %). The rates of DVT in the control groups were reported to be between 0 and 7.4 %, while the incidence of PE in the control groups ranged from 0 to 1.9 %. Analysis of the comparative studies revealed that the incidence of bleeding-related complications varied from 0 to 18.1 % in the low-molecular-weight heparin (LMWH) group compared to 0-7.5 % in the control group. The difference in minor bleeding complications between the LMWH group and the control group was found to be statistically significant. CONCLUSION Data from this systematic review suggest that the risk of VTE in Asian general surgery patients is low, even in the context of risk factors typically regarded as high risk.
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Affiliation(s)
- Danson X W Yeo
- Hepatic, Pancreatic and Biliary (HPB) Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore,
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Song KY, Yoo HM, Kim EY, Kim JI, Yim HW, Jeon HM, Park CH. Optimal Prophylactic Method of Venous Thromboembolism for Gastrectomy in Korean Patients: An Interim Analysis of Prospective Randomized Trial. Ann Surg Oncol 2014; 21:4232-4238. [DOI: 10.1245/s10434-014-3893-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Yhim HY, Jang MJ, Bang SM, Kim KH, Kim YK, Nam SH, Bae SH, Kim SH, Mun YC, Kim I, Jung CW, Oh D. Incidence of venous thromboembolism following major surgery in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2014; 12:1035-43. [PMID: 24837640 DOI: 10.1111/jth.12611] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on the incidence of venous thromboembolism (VTE) following major surgery in Asian populations are limited. METHODS Using the Korean Health Insurance Review and Assessment Service database, we performed a nationwide population-based epidemiologic study to estimate the incidence of VTE after major orthopedic, cancer, and benign surgeries. VTE cases were identified from all patients undergoing major surgery between 2007 and 2011 using both diagnostic and drug codes as treatment evidence of VTE within 5 weeks of surgery. We also calculated the relative risk of VTE in major orthopedic and cancer surgery compared to benign surgery. RESULTS The overall rates of postoperative VTE were 1.24%, 0.67%, and 0.05% for major orthopedic, cancer, and benign surgeries, respectively. Hip fracture (1.60%) and colorectal cancer surgeries (1.67%) were associated with the highest rates of VTE, and the rates steadily increased during the study period. Advanced age, female sex, and general anesthesia were independent risk factors for VTE. Patients undergoing surgery for colorectal, pancreatic, ovarian, and esophageal cancer, and major orthopedic surgery had a > 20-fold higher risk of VTE than those undergoing benign surgery. CONCLUSIONS This is the largest epidemiologic study to investigate the incidence of VTE after major surgery in Asia, demonstrating that the rates of postoperative VTE are lower than in Caucasian populations. This study contributes to a better understanding of the differences in postoperative VTE development between Korean and Caucasian populations; the data also suggest that perioperative prophylactic strategies in Asians should be based on studies of such populations.
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Affiliation(s)
- H-Y Yhim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea; Research Institute of Clinical Medicine, Chonbuk National University-Chonbuk National University Hospital, Jeonju, Korea
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Choi SH, Shim JH, Park CH, Song KY. Low molecular-weight heparin for thromboprophylaxis in patients undergoing gastric cancer surgery: an experience from one Korean institute. Ann Surg Treat Res 2014; 86:22-7. [PMID: 24761403 PMCID: PMC3994607 DOI: 10.4174/astr.2014.86.1.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/13/2013] [Accepted: 10/24/2013] [Indexed: 02/02/2023] Open
Abstract
Purpose This study evaluated the efficacy for preventing venous thromboembolism (VTE) and adverse effects of low-molecular-weight heparin (LMWH) in order to launch a prospective clinical trial in Korea. Methods We reviewed the medical records of 108 consecutive patients who underwent gastric cancer surgery. These patients were divided into 2 groups according to the type of thromboprophylaxis: group A, LMWH combined with intermittent pneumatic compression (IPC); group B, IPC alone. The postoperative outcomes of the two groups were compared. Results Symptomatic VTE was observed in only 1 patient (0.9%) from group B. Postoperative bleeding was more common in group A than in group B (10.9% vs. 7.5%), although the difference was not significant (P = 0.055). Most bleeding episodes were minor and managed conservatively without intervention. Only a high body mass index was associated with a significantly increased risk of postoperative bleeding (odds ratio, 1.45; 95% confidence interval, 1.12-2.43; P = 0.051). Conclusion A 40 mg of enoxaparin sodium is a safe and feasible dose for prevention of VTE. With the results of this study, we are planning a prospective randomized clinical trial to investigate the clinical efficacy of LMWH thromboprophylaxis in gastric cancer patients in Korea.
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Affiliation(s)
- Sung Ho Choi
- Division of Gastrointestinal Surgery, Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Jung Ho Shim
- Division of Gastrointestinal Surgery, Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Cho Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea
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Malafaia O, Montagnini AL, Luchese A, Accetta AC, Zilberstein B, Malheiros CA, Jacob CE, Quireze-Junior C, Bresciani CJC, Kruel CDP, Cecconello I, Sad EF, Ohana JAL, Aguilar-Nascimento JED, Manso JEF, Ribas-Filho JM, Santo MA, Andreollo NA, Torres OJM, Herman P, Cuenca RM, Sallum RAA, Bernardo WM. Thromboembolism prevention in surgery of digestive cancer. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 25:216-23. [PMID: 23411918 DOI: 10.1590/s0102-67202012000400002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/10/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND The venous thromboembolism is a common complication after surgical treatment in general and, in particular, on the therapeutic management on cancer. Surgery of the digestive tract has been reported to induce this complication. Patients with digestive cancer have substantial increased risk of initial or recurrent thromboembolism. AIM To provide to surgeons working in digestive surgery and general surgery guidance on how to make safe thromboprophylaxis for patients requiring operations in the treatment of their gastrointestinal malignancies. METHODS The guideline was based on 15 relevant clinical issues and related to the risk factors, treatment and prognosis of the patient undergoing surgical treatment of cancer on digestive tract. They focused thromboembolic events associated with operations and thromboprophylaxis. The questions were structured using the PICO (Patient, Intervention or Indicator, Comparison and Outcome), allowing strategies to generate evidence on the main primary bases of scientific information (Medline / Pubmed, Embase, Lilacs / Scielo, Cochrane Library, PreMedline via OVID). Evidence manual search was also conducted (BDTD and IBICT). The evidence was recovered from the selected critical evaluation using discriminatory instruments (scores) according to the category of the question: risk, prognosis and therapy (JADAD Randomized Clinical Trials and New Castle Ottawa Scale for studies not randomized). After defining potential studies to support the recommendations, they were selected by the strength of evidence and grade of recommendation according to the classification of Oxford, including the available evidence of greater strength. RESULTS A total of 53,555 papers by title and / or abstract related to issue were found. Of this total were selected (1st selection) 478 studies that were evaluated as full-text. From them to support the recommendations were included in the consensus 132 papers. The 15 questions could be answered with evidence grade of articles with 31 A, 130 B, 1 C and 0 D. CONCLUSION It was possible to prepare safe recommendations as guidance for thromboembolism prophylaxis in operations on the digestive tract malignancies, addressing the most frequent topics of everyday work of digestive and general surgeons.
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Affiliation(s)
- Osvaldo Malafaia
- Colégio Brasileiro de Cirurgia Digestiva, São Paulo, SP, Brazil.
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A prospective study on the incidence of postoperative venous thromboembolism in Korean gastric cancer patients: an inquiry into the application of Western guidelines to Asian cancer patients. PLoS One 2013; 8:e61968. [PMID: 23613988 PMCID: PMC3629116 DOI: 10.1371/journal.pone.0061968] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 03/15/2013] [Indexed: 11/22/2022] Open
Abstract
Several Western guidelines recommend the routine use of pharmacologic thromboprophylaxis for cancer surgery patients to prevent venous thromboembolism (VTE). However, the necessity of routine pharmacologic perioperative thromboprophylaxis in Asian gastric cancer (GC) patients has not been clearly determined. To determine the necessity of routine perioperative pharmacologic thromboprophylaxis in Korean gastric cancer patients, the incidence of postoperative VTE was prospectively evaluated in gastric cancer patients receiving surgery. Among 610 GC patients who had received surgery, 375 patents underwent routine duplex Doppler ultrasonography (DUS) on days 5–12 following surgery to detect VTE and then VTE-related symptoms and signs were checked at 4 weeks after surgery (cohort A). The 235 patients that declined DUS were registered to cohort B and the occurrence of postoperative VTE was retrospectively analyzed. In cohort A, symptomatic or asymptomatic VTE until 4 weeks after surgery was detected in 9 patients [2.4%; 95% confidence interval (CI); 0.9–3.9]. Tumor stage was a significant factor related to VTE development [stage I, 1.4%; stage II/III, 2.4%; stage IV, 9.7% (P = 0.008)]. In multivariate analysis, patients with stage IV had a higher postoperative VTE development [odds ratio, 8.18 (95% CI, 1.54–43.42)] than those with stage I. In cohort B, a low incidence of postoperative VTE was reaffirmed; only one postoperative VTE case (0.4%) was observed. In conclusion, the incidence of postoperative VTE in Korean GC patients was only 2.4%. Risk-stratified applications of perioperative pharmacologic thromboprophylaxis are thought to be more appropriate than the routine pharmacologic thromboprophylaxis in Korean GC patients receiving surgery.
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Dikken JL, Stiekema J, van de Velde CJH, Verheij M, Cats A, Wouters MWJM, van Sandick JW. Quality of care indicators for the surgical treatment of gastric cancer: a systematic review. Ann Surg Oncol 2012; 20:381-98. [PMID: 23054104 DOI: 10.1245/s10434-012-2574-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Quality assurance is increasingly acknowledged as a crucial factor for the (surgical) treatment of gastric cancer. The purpose of the current study was to define a minimum set of evidence-based quality of care indicators for the surgical treatment of locally advanced gastric cancer. METHODS A systematic review of the literature published between January 1990 and May 2011 was performed, using search terms on gastric cancer, treatment, and quality of care. Studies were selected based on predefined selection criteria. Potential quality of care indicators were assessed based on their level of evidence and were grouped into structure, process, and outcome indicators. RESULTS A total of 173 articles were included in the current study. For structural measures, evidence was found for the inverse relationship between hospital volume and postoperative mortality as well as overall survival. Regarding process measures, the most common indicators concerned surgical technique, perioperative care, and multimodality treatment. The only outcome indicator with supporting evidence was a microscopically radical resection. CONCLUSIONS Although specific literature on quality of care indicators for the surgical treatment of locally advanced gastric cancer is limited, several quality of care indicators could be identified. These indicators can be used in clinical audits and other quality assurance programs.
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Affiliation(s)
- Johan L Dikken
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Mita K, Ito H, Murabayashi R, Sueyoshi K, Asakawa H, Nabetani M, Kamasako A, Koizumi K, Hayashi T. Postoperative bleeding complications after gastric cancer surgery in patients receiving anticoagulation and/or antiplatelet agents. Ann Surg Oncol 2012; 19:3745-52. [PMID: 22805868 DOI: 10.1245/s10434-012-2500-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Perioperative antithrombotic treatment for gastric cancer patients receiving chronic anticoagulation and/or antiplatelet agents requires an understanding of potential bleeding and thromboembolic risks. However, no study has examined the safety aspects of perioperative antithrombotic treatment during radical gastrectomy. This study sought to evaluate postoperative bleeding and thromboembolic complications after radical gastrectomy in patients undergoing perioperative antithrombotic treatment. METHODS The medical records of patient treated by radical gastrectomy from January 2006 to December 2010 were retrospectively reviewed. Those in the thromboprophylaxis group had received one of three regimens of perioperative antithrombotic treatment according to the clinical indications of chronic anticoagulation and/or antiplatelet agents and several published evidence-based recommendations: (1) bridging therapy with unfractionated heparin; (2) continuation of aspirin; or (3) both 1 and 2. multivariate analysis was used to identify risk factors for postoperative bleeding complications after radical gastrectomy. RESULTS During the study period, 340 patients underwent radical gastrectomy. Of these, 62 patients received perioperative antithrombotic treatment; this thromboprophylaxis group had a significantly higher postoperative bleeding rate (8.1 vs. 0.7 %, P = 0.003). However, other complications, including thromboembolic events, were similar in the two study groups. Multivariate analysis revealed that perioperative antithrombotic treatment was the only independent risk factor of postoperative bleeding complications after radical gastrectomy (odds ratio, 8.53; 95 % confidence interval, 1.47-49.39; P = 0.017). CONCLUSIONS Perioperative antithrombotic treatment is an independent risk factor of postoperative bleeding complications in patients with gastric cancer undergoing radical gastrectomy, although such treatment was effective in preventing postoperative thromboembolic events.
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Affiliation(s)
- Kazuhito Mita
- Department of Surgery, New-Tokyo Hospital, Matudo, Chiba, Japan.
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26
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Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e227S-e277S. [PMID: 22315263 PMCID: PMC3278061 DOI: 10.1378/chest.11-2297] [Citation(s) in RCA: 1366] [Impact Index Per Article: 113.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND VTE is a common cause of preventable death in surgical patients. METHODS We developed recommendations for thromboprophylaxis in nonorthopedic surgical patients by using systematic methods as described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. RESULTS We describe several alternatives for stratifying the risk of VTE in general and abdominal-pelvic surgical patients. When the risk for VTE is very low (< 0.5%), we recommend that no specific pharmacologic (Grade 1B) or mechanical (Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE (∼1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE (∼3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE (∼6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava filter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. CONCLUSIONS Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients.
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Affiliation(s)
- Michael K Gould
- Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - David A Garcia
- University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Paul J Karanicolas
- Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - John A Heit
- College of Medicine, Mayo Clinic, Rochester, MN
| | - Charles M Samama
- Department of Anaesthesiology and Intensive Care, Hotel-Dieu University Hospital, Paris, France
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Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer 2012; 15:34-41. [PMID: 21573918 DOI: 10.1007/s10120-011-0057-x] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/18/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radical gastrectomy for gastric cancer is among the most invasive procedures in gastrointestinal surgery. Several studies have found that an enhanced recovery after surgery (ERAS) protocol is useful in patients who undergo colorectal surgery, but its value in gastric surgery remains uncertain. The aim of this study was to assess the usefulness of an ERAS protocol for gastric surgery. METHODS We studied the clinical characteristics, oncological factors, surgical factors, and outcomes in patients who underwent elective radical gastrectomy for gastric cancer before and after the introduction of an ERAS protocol. RESULTS The first days of oral intake, oral intake recovery, flatus, and defecation were significantly earlier in the ERAS group (n = 91) than in the conventional care (CONV) group (n = 100). Maximum pain evaluated on a visual analog scale and the number of additional analgesics on demand were significantly less in the ERAS group than in the CONV group. The ratio of the postoperative body weight at 1 week to the preoperative body weight was significantly higher in the ERAS group than in the CONV group (0.95 vs. 0.94, respectively, P = 0.01). CONCLUSION Our results suggest that the ERAS protocol is useful in patients who undergo elective radical gastrectomy.
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Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement. Oncol Rev 2011. [DOI: 10.1007/s12156-011-0079-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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