Thomas D Christensen1, Henrik Vad2, Søren Pedersen3, Anne-Mette Hvas4, Robin Wotton5, Babu Naidu6, Torben B Larsen7. 1. Department of Cardiothoracic and Vascular Surgery and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark. Electronic address: tdc@ki.au.dk. 2. Department of Cardiothoracic and Vascular Surgery and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark. 3. Department of Anesthesiology and Intensive Care and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark. 4. Department of Clinical Biochemistry and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark. 5. Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom. 6. Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom; University of Birmingham, Birmingham, United Kingdom. 7. Department of Cardiology, Aalborg University, Aalborg, Denmark; Aalborg Thrombosis Research Centre, Aalborg University, Aalborg, Denmark.
Abstract
BACKGROUND: The risk of venous thromboembolism is perceived to be high in patients with lung cancer. However, existing studies in patients undergoing operations for lung cancer draw inconsistent conclusions and recommendations in terms of thromboprophylaxis. The aim of this study was to perform a systematic review of the risk of perioperative and postoperative venous thromboembolism for patients undergoing potential curative surgical procedures for primary lung cancer METHODS: This was a systematic review including studies of patients with primary lung cancer undergoing operations with curative intent. RESULTS: We included 19 studies with a total of 10,660 patients. All studies, except 1, were observational in design. Marked heterogeneity was found between the studies in terms of methodologic aspects, patient characteristics, and findings. The mean risk of venous thromboembolism (VTE) was estimated at 2.0% (range, 0.2%-19%), with a mean observation period of 16 months (range, 0.1-22), and the risk was nearly identical in studies with 1 month of follow-up and studies with a longer follow-up. CONCLUSIONS: The evidence for using thromboprophylaxis after lung cancer operations is relatively sparse, and the use is based predominantly on clinical consensus. However, the risk of VTE seems to occur predominantly within the initial postoperative period, and subsequently the risk falls. Future research should focus on identifying patients and surgical procedures that increase the risk of VTE. This could be accomplished by large observational studies in addition to randomized controlled trials evaluating different thromboprophylaxis strategies.
BACKGROUND: The risk of venous thromboembolism is perceived to be high in patients with lung cancer. However, existing studies in patients undergoing operations for lung cancer draw inconsistent conclusions and recommendations in terms of thromboprophylaxis. The aim of this study was to perform a systematic review of the risk of perioperative and postoperative venous thromboembolism for patients undergoing potential curative surgical procedures for primary lung cancer METHODS: This was a systematic review including studies of patients with primary lung cancer undergoing operations with curative intent. RESULTS: We included 19 studies with a total of 10,660 patients. All studies, except 1, were observational in design. Marked heterogeneity was found between the studies in terms of methodologic aspects, patient characteristics, and findings. The mean risk of venous thromboembolism (VTE) was estimated at 2.0% (range, 0.2%-19%), with a mean observation period of 16 months (range, 0.1-22), and the risk was nearly identical in studies with 1 month of follow-up and studies with a longer follow-up. CONCLUSIONS: The evidence for using thromboprophylaxis after lung cancer operations is relatively sparse, and the use is based predominantly on clinical consensus. However, the risk of VTE seems to occur predominantly within the initial postoperative period, and subsequently the risk falls. Future research should focus on identifying patients and surgical procedures that increase the risk of VTE. This could be accomplished by large observational studies in addition to randomized controlled trials evaluating different thromboprophylaxis strategies.
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