M Farzan Rashid1, Terri L Jackson1, Jheanell A Morgan1, Franklin A Dwyer1, Beth A Schrope1, John A Chabot1, Michael D Kluger2. 1. Division of Gastrointestinal & Endocrine Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, 161 Fort Washington Ave - 8th Floor, New York, NY, 10032, USA. 2. Division of Gastrointestinal & Endocrine Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, 161 Fort Washington Ave - 8th Floor, New York, NY, 10032, USA. mk2462@cumc.columbia.edu.
Abstract
BACKGROUND: The American College of Chest Physicians and American Hepato-Pancreato-Biliary Association recommend using low-molecular-weight heparin for 28 days postoperatively for venous thromboembolism prophylaxis after cancer surgery. Dabigatran is a once daily oral anticoagulant that is FDA approved for venous thromboembolism prophylaxis after orthopedic surgery, uses fixed dosing, and has an antidote. METHODS: Patients undergoing surgery for malignant pancreatic tumors (neuroendocrine excluded) from January 2017 to January 2018 were converted to dabigatran 220 mg daily on discharge until postoperative day 28; patients with medical or insurance contraindications were converted to enoxaparin or another direct oral anticoagulant. The primary endpoint was bleeding complications through 90 days. RESULTS: A total of 134 patients were considered for this study (median age 67 ± 10; 58.9% male). Eighty-seven (82.9%) patients received dabigatran and 18 (17.1%) received another form of anticoagulation. There were 19 (4.2%) patients not prescribed dabigatran due to medical or inpatient contraindications. Four patients experienced bleeding complications after discharge while on dabigatran. Two (2%) were major bleeds (Clavien-Dindo IV and V), and 2 (2%) were minor (Clavien-Dindo I). Patient compliance was excellent, with 93% of prescribed patients fully completing their prophylaxis. There were 2 patients that developed symptomatic deep vein thrombosis. CONCLUSION: The use of a direct oral anticoagulant as extended venous thromboembolism prophylaxis after major gastrointestinal surgery has not been studied to date. These results show dabigatran to be a safe alternative to low-molecular-weight heparin for extended venous thromboembolism prophylaxis with regard to bleeding complications.
BACKGROUND: The American College of Chest Physicians and American Hepato-Pancreato-Biliary Association recommend using low-molecular-weight heparin for 28 days postoperatively for venous thromboembolism prophylaxis after cancer surgery. Dabigatran is a once daily oral anticoagulant that is FDA approved for venous thromboembolism prophylaxis after orthopedic surgery, uses fixed dosing, and has an antidote. METHODS:Patients undergoing surgery for malignant pancreatic tumors (neuroendocrine excluded) from January 2017 to January 2018 were converted to dabigatran 220 mg daily on discharge until postoperative day 28; patients with medical or insurance contraindications were converted to enoxaparin or another direct oral anticoagulant. The primary endpoint was bleeding complications through 90 days. RESULTS: A total of 134 patients were considered for this study (median age 67 ± 10; 58.9% male). Eighty-seven (82.9%) patients received dabigatran and 18 (17.1%) received another form of anticoagulation. There were 19 (4.2%) patients not prescribed dabigatran due to medical or inpatient contraindications. Four patients experienced bleeding complications after discharge while on dabigatran. Two (2%) were major bleeds (Clavien-Dindo IV and V), and 2 (2%) were minor (Clavien-Dindo I). Patient compliance was excellent, with 93% of prescribed patients fully completing their prophylaxis. There were 2 patients that developed symptomatic deep vein thrombosis. CONCLUSION: The use of a direct oral anticoagulant as extended venous thromboembolism prophylaxis after major gastrointestinal surgery has not been studied to date. These results show dabigatran to be a safe alternative to low-molecular-weight heparin for extended venous thromboembolism prophylaxis with regard to bleeding complications.
Authors: Giancarlo Agnelli; Giorgio Bolis; Lorenzo Capussotti; Roberto Mario Scarpa; Francesco Tonelli; Erminio Bonizzoni; Marco Moia; Fabio Parazzini; Romina Rossi; Francesco Sonaglia; Bettina Valarani; Carlo Bianchini; Gualberto Gussoni Journal: Ann Surg Date: 2006-01 Impact factor: 12.969
Authors: David Bergqvist; Giancarlo Agnelli; Alexander T Cohen; Amiram Eldor; Paul E Nilsson; Anne Le Moigne-Amrani; Flavia Dietrich-Neto Journal: N Engl J Med Date: 2002-03-28 Impact factor: 91.245
Authors: M S Rasmussen; L N Jorgensen; P Wille-Jørgensen; J D Nielsen; A Horn; A C Mohn; L Sømod; B Olsen Journal: J Thromb Haemost Date: 2006-08-01 Impact factor: 5.824
Authors: Christoph Kalka; David Spirk; Klaus-Arno Siebenrock; Urs Metzger; Philipp Tuor; Daniel Sterzing; Kurt Oehy; Daniela Wondberg; El Yazid Mouhsine; Emanuel Gautier; Nils Kucher Journal: Thromb Haemost Date: 2009-07 Impact factor: 5.249
Authors: William H Geerts; David Bergqvist; Graham F Pineo; John A Heit; Charles M Samama; Michael R Lassen; Clifford W Colwell Journal: Chest Date: 2008-06 Impact factor: 9.410
Authors: Paolo Prandoni; Anthonie W A Lensing; Andrea Piccioli; Enrico Bernardi; Paolo Simioni; Bruno Girolami; Antonio Marchiori; Paola Sabbion; Martin H Prins; Franco Noventa; Antonio Girolami Journal: Blood Date: 2002-07-12 Impact factor: 22.113