Justification of Choice of Thromboprophylaxis Method in Patients with High-Risk Surgical Profile: A Literature Review

Abstract

INTRODUCTION: Venous thromboembolic complications (VTEC) such as deep and subcutaneous vein thrombosis and pulmonary embolism are the most important clinical problems in many specialties. High-risk factors for thrombus formation include surgical interventions leading to the activation of the hemostatic system. Despite the existing international and Russian clinical recommendations on the treatment and prophylaxis of VTEC containing a detailed description of the methods and algorithms of prophylaxis in patients with different nosologies including patients with polymorbidities, the incidence of VTEC remains high. In the scientific community, there is a continuing discussion of the effectiveness of various approaches to VTEC prophylaxis in different clinical groups of patients. Algorithms available prescribe anticoagulants at standard doses and combinations. However, in patients with comorbidities, isolated conservative anticoagulant therapy may be insufficient for effective VTEC prophylaxis.

CONCLUSION: Currently, there is a need to improve the algorithms of VTEC prophylaxis in patients with comorbid pathologies to elaborate clear indications for the use of both pharmacological and mechanical prevention methods and their combinations.

Keywords

deep vein thrombosis / pulmonary embolism / anticoagulant therapy / thromboprophylaxis

References

[1] Vatutin NT, Taradin GG, Iofe EI, et al. Diagnosis and management of acute deep vein thrombosis. The review of 2018 joint consensus document from the European society of cardiology. Bulletin of Urgent and Recovery Surgery. 2019;4(4):38–52. (In Russ).

[2] Ватутин Н.Т., Тарадин Г.Г., Иофе Е.И., и др. Диагностика и лечение острого тромбоза глубоких вен. Обзор совместного согласительного документа Европейского общества кардиологов 2018 г. // Вестник неотложной и восстановительной хирургии. 2019. Т. 4, № 4. С. 38–52.

[3] Somonova OV, Elizarova AL, Blindar VN, et al. Low molecular weight heparin enixum in the prevention and treatment of thrombosis in oncology clinic. Pacific Medical Journal. 2019;(1):56–60. (In Russ). doi: 10.17238/PmJ1609-1175.2019.1.56-60

[4] Сомонова О.В., Елизарова А.Л., Блиндарь В.Н., и др. Низкомолекулярный гепарин «Эниксум» в профилактике и лечении тромбозов в онкологической клинике // Тихоокеанский медицинский журнал. 2019. № 1 (75). С. 56–60. doi: 10.17238/PmJ1609-1175.2019.1.56-60

[5] Ptushkin VV. Prevention of thrombothic complications in cancer patients in high-risk groups. Meditsinskiy Sovet. 2017;(6):88–92. (In Russ). doi: 10.21518/2079-701X-2017-6-88-92

[6] Птушкин В.В. Профилактика тромботических осложнений у онкологических больных в группах высокого риска // Медицинский совет. 2017. № 6. С. 88–92. doi: 10.21518/2079-701X-2017-6-88-92

[7] Somonova OV, Teodorovich SL, Elizarova AL, et al. Thrombotic complications in patients with kidney cancer and their prevention. Tekhnologii Zhivykh Sistem. 2019;16(4):5–15. (In Russ). doi: 10.18127/j20700997-201904-01

[8] Сомонова О.В., Теодорович С.Л., Елизарова А.Л., и др. Тромботические осложнения у больных раком почки и их профилактика // Технологии живых систем. 2019. Т. 16, № 4. С. 5–15. doi: 10.18127/j20700997-201904-01

[9] Fedotkina YuA, Panchenko EP. Prophylaxis of venous thromboembolic complications in patients with active oncological disease, receiving medical anti-cancer chemotherapy in outpatient conditions. Role of apixaban. Aterotromboz. 2019;(2):46–54. (In Russ). doi: 10.21518/2307-1109-2019-2-46-54

[10] Федоткина Ю.А., Панченко Е.П. Профилактика венозных тромбоэмболических осложнений у пациентов с активным онкологическим заболеванием, получающих медикаментозную противораковую химиотерапию в амбулаторных условиях. Роль апиксабана // Атеротромбоз. 2019. № 2. С. 46–54. doi: 10.21518/2307-1109-2019-2-46-54

[11] Agnelli G, Becattini C, Meyer G, et al.; Caravaggio Investigators. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. The New England Journal of Medicine. 2020;382(17):1599–607. doi: 10.1056/NEJMoa1915103

[12] Agnelli G., Becattini C., Meyer G., et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer // The New England Journal of Medicine. 2020. Vol. 382, № 17. P. 1599–1607. doi: 10.1056/NEJMoa1915103

[13] Faraoni D, Comes RF, Geerts W, et al. European guidelines on perioperative venous thromboembolism prophylaxis: Neurosurgery. European Journal of Anaesthesiology. 2018;35(2):90–5. doi: 10.1097/EJA.0000000000000710

[14] Faraoni D., Comes R.F., Geerts W., et al. European guidelines on perioperative venous thromboembolism prophylaxis: Neurosurgery // European Journal of Anaesthesiology. 2018. Vol. 35, № 2. P. 90–95. doi: 10.1097/EJA.0000000000000710

[15] Fokin AA, Bagaev KV. Venous thromboembolic complications in oncological patients: present-day possibilities of effective and safe anticoagulant therapy. Angiology and Vascular Surgery. 2019;25(1):19–23. (In Russ). doi: 10.33529/angio2019102

[16] Фокин А.А., Багаев К.В. Венозные тромбоэмболические осложнения у онкологических больных — современные возможности эффективной и безопасной антикоагулянтной терапии // Ангиология и сосудистая хирургия. 2019. Т. 25, № 1. С. 19–23. doi: 10.33529/angio2019102

[17] Felder S, Rasmussen MS, King R, et al. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. The Cochrane Database System Reviews. 2019;8(8):CD004318. doi: 10.1002/14651858.CD004318.pub5

[18] Felder S., Rasmussen M.S., King R., et al. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery // The Cochrane Database System Reviews. 2019. Vol. 8, № 8. P. CD004318. doi: 10.1002/14651858.CD004318.pub5

[19] Chi G, Goldhaber SZ, Kittelson JM, et al. Effect of extended — duration thromboprophylaxis on venous thromboembolism and major bleeding among acutely ill hospitalized medical patients: a bivariate analysis. Journal of Thrombosis and Haemostasis. 2017;15(10):1913–22. doi: 10.1111/jth.13783

[20] Chi G., Goldhaber S.Z., Kittelson J.M., et al. Effect of extended-duration thromboprophylaxis on venous thromboembolism and major bleeding among acutely ill hospitalized medical patients: a bivariate analysis // Journal of Thrombosis and Haemostasis. 2017. Vol. 15, № 10. P. 1913–1922. doi: 10.1111/jth.13783

[21] Somonova OV, Madzhuga AV, Elizarova AL, et al. Fraksiparin v profilaktike tromboticheskikh oslozhneniy u onkoginekologicheskikh bol'nykh. Sovremennaya Onkologiya. 2008;10(1):53–7. (In Russ).

[22] Сомонова О.В., Маджуга А.В., Елизарова А.Л., и др. Фраксипарин в профилактике тромботических осложнений у онкогинекологических больных // Современная онкология. 2008. Т. 10, № 1. С. 53–57.

[23] Wang Y, Wang M, Ni Y, et al. Direct oral anticoagulants for thromboprophylaxis in ambulatory patients with cancer. Hematology. 2020;25(1):63–70. doi: 10.1080/16078454.2020.1719726

[24] Wang Y., Wang M., Ni Y., et al. Direct oral anticoagulants for thromboprophylaxis in ambulatory patients with cancer // Hematology. 2020. Vol. 25, № 1. P. 63–70. doi: 10.1080/16078454.2020.1719726

[25] Felder S, Rasmussen MS, King R, et al. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. The Cochrane Database System Reviews. 2019;3(3):CD004318. doi: 10.1002/14651858.CD004318.pub4

[26] Felder S., Rasmussen M.S., King R., et al. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery // The Cochrane Database System Reviews. 2019. Vol. 3, № 3. P. CD004318. doi: 10.1002/14651858.CD004318.pub4

[27] Felder S, Rasmussen MS, King R, et al. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. The Cochrane Database System Reviews. 2018;11(11):CD004318. doi: 10.1002/14651858.CD004318.pub3

[28] Felder S., Rasmussen M.S., King R., et al. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery // The Cochrane Database System Reviews. 2018. Vol. 11, № 11. P. CD004318. doi: 10.1002/14651858.CD004318.pub3

[29] Ferreira D, de Sousa JA, Felicíssimo P, et al. Venous thromboembolism risk and prophylaxis in the Portuguese hospital care setting: The ARTE study. Revista Portuguesa de Cardiologia. 2017;36(11):823–30. doi: 10.1016/j.repc.2017.01.009

[30] Ferreira D., de Sousa J.A., Felicíssimo P., et al. Venous thromboembolism risk and prophylaxis in the Portuguese hospital care setting: The ARTE study // Revista Portuguesa de Cardiologia. 2017. Vol. 36, № 11. P. 823–830. doi: 10.1016/j.repc.2017.01.009

[31] Franco Moreno AI, Gutiérrez LC, Navarro MJG. Direct oral anticoagulants for the treatment of venous thromboembolism in patients with cancer. Medicina Clinica. 2019;153(3):122–5. doi: 10.1016/j.medcli.2019.01.002

[32] Franco-Moreno A.I., Cabezón-Gutiérrez L., Garcia-Navarro M.J. Direct oral anticoagulants for the treatment of venous thromboembolism in patients with cancer // Medicina Clinica. 2019. Vol. 153, № 3. P. 122–125. doi: 10.1016/j.medcli.2019.01.002

[33] Franco-Moreno A, Cabezón-Gutiérrez L, Palka-Kotlowsa M, et al. Evaluation of direct oral anticoagulants for the treatment of cancer — associated thrombosis: an update. Journal of Thrombosis and Thrombolysis. 2019;47(3):409–19. doi: 10.1007/s11239-018-1783-2

[34] Franco-Moreno A., Cabezón-Gutiérrez L., Palka-Kotlowsa M., et al. Evaluation of direct oral anticoagulants for the treatment of cancer-associated thrombosis: an update // Journal of Thrombosis and Thrombolysis. 2019. Vol. 47, № 3. P. 409–419. doi: 10.1007/s11239-018-1783-2

[35] Guéroult AM, Machin M, Lawton R, et al. What does the future hold for mechanical thromboprophylaxis? Phlebology. 2021;36(4):257–9. doi: 10.1177/0268355520975599

[36] Guéroult A.M., Machin M., Lawton R., et al. What does the future hold for mechanical thromboprophylaxis? // Phlebology. 2021. Vol. 36, № 4. P. 257–259. doi: 10.1177/0268355520975599

[37] Gulizia Chairperson MM, Parrini Co-Chairperson I, Colivicchi Co-Chairperson F, et al. HCF-ANMCO/AICPR/GIEC/ITAHFA/SICOA/SICP/ SIMG/SIT Cardiological Societies Council Consensus document: Anticoagulant therapy in venous thromboembolism and atrial fibrillation of the patient with cancer. Current knowledge and new evidence. Giornale Italiano di Cardiologia. 2020;21(9):687–738. doi: 10.1714/3413.33967

[38] Gulizia Chairperson M.M., Parrini Co-Chairperson I., Colivicchi Co-Chairperson F., et al. HCF-ANMCO/AICPR/GIEC/ITAHFA/SICOA/SICP/ SIMG/SIT Cardiological Societies Council Consensus document: Anticoagulant therapy in venous thromboembolism and atrial fibrillation of the patient with cancer. Current knowledge and new evidence // Giornale Italiano di Cardiologia. 2020. Vol. 21, № 9. P. 687–738. doi: 10.1714/3413.33967

[39] Guo Q, Huang B, Zhao J, et al. Perioperative Pharmacological Thromboprophylaxis in Patients With Cancer: A Systematic Review and Meta-analysis. Annals of Surgery. 2017;265(6):1087–93. doi: 10.1097/SLA.0000000000002074

[40] Guo Q., Huang B., Zhao J., et al. Perioperative Pharmacological Thromboprophylaxis in Patients With Cancer: A Systematic Review and Meta-analysis // Annals of Surgery. 2017. Vol. 265, № 6. P. 1087–1093. doi: 10.1097/SLA.0000000000002074

[41] Hirmerová J. Anticoagulation therapy in cancer associated thromboembolism — new studies, new guidelines. Vnitrni Lekarstvi. 2020;66(4):225–31.

[42] Hirmerová J. Anticoagulation therapy in cancer associated thromboembolism — new studies, new guidelines // Vnitrni Lekarstvi. 2020. Vol. 66, № 4. P. 225–231.

[43] Jimenez-Fonseca P, Carmona-Bayonas A, Calderon C, et al. FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence. Clinical & Translational Oncology. 2017;19(8):997–1009. doi: 10.1007/s12094-017-1632-3

[44] Jimenez-Fonseca P., Carmona-Bayonas A., Calderon C., et al. FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer — associated thrombosis in areas of uncertainty and low quality of evidence // Clinical & Translational Oncology. 2017. Vol. 19, № 8. P. 997–1009. doi: 10.1007/s12094-017-1632-3

[45] Jung YJ, Seo HS, Park CH, et al. Venous Thromboembolism Incidence and Prophylaxis Use After Gastrectomy Among Korean Patients With Gastric Adenocarcinoma: The PROTECTOR Randomized Clinical Trial. JAMA Surgery. 2018;153(10):939–46. doi: 10.1001/jamasurg.2018.2081

[46] Jung Y.J., Seo H.S., Park C.H., et al. Venous Thromboembolism Incidence and Prophylaxis Use After Gastrectomy Among Korean Patients With Gastric Adenocarcinoma: The PROTECTOR Randomized Clinical Trial // JAMA Surgery. 2018. Vol. 153, № 10. P. 939–946. doi: 10.1001/jamasurg.2018.2081

[47] Kanitra J, Holtrop J, Jawad A, et al. Extended duration chemoprophylaxis for venous thromboembolism following abdominopelvic oncologic surgery. Journal of Thrombosis and Thrombolysis. 2020;50(1): 190–4. doi: 10.1007/s11239-019-02002-9

[48] Kanitra J., Holtrop J., Jawad A., et al. Extended duration chemoprophylaxis for venous thromboembolism following abdominopelvic oncologic surgery // Journal of Thrombosis and Thrombolysis. 2020. Vol. 50, № 1. P. 190–194. doi: 10.1007/s11239-019-02002-9

[49] Kim BJ, Day RW, Davis CH, et al. Extended pharmacologic thromboprophylaxis in oncologic liver surgery is safe and effective. Journal of Thrombosis and Haemostasis. 2017;15(11):2158–64. doi: 10.1111/jth.13814

[50] Kim B.J., Day R.W., Davis C.H., et al. Extended pharmacologic thromboprophylaxis in oncologic liver surgery is safe and effective // Journal of Thrombosis and Haemostasis. 2017. Vol. 15, № 11. P. 2158–2164. doi: 10.1111/jth.13814

[51] Kramer V, Klein M, Cevallos F, et al. Caracterización de pacientes hospitalizados con neoplasia activa y diagnóstico de enfermedad tromboembólica venosa mediante la puntuación de Khorana en el Instituto Nacional del Cáncer. Revista Medica de Chile. 2016;144(5):593–7. (In Spanish). doi: 10.4067/S0034-98872016000500006

[52] Kramer V., Klein M., Cevallos F., et al. Caracterización de pacientes hospitalizados con neoplasia activa y diagnóstico de enfermedad tromboembólica venosa mediante la puntuación de Khorana en el Instituto Nacional del Cáncer // Revista Medica de Chile. 2016. Vol. 144, № 5. P. 593–597. (In Spanish). doi: 10.4067/S0034-98872016000500006

[53] Lewis TC, Cortes J, Altshuler D, et al. Venous Thromboembolism Prophylaxis: A Narrative Review With a Focus on the High-Risk Critically Ill Patient. Journal of Intensive Care Medicine. 2019;34(11–12):877–88. doi: 10.1177/0885066618796486

[54] Lewis T.C., Cortes J., Altshuler D., et al. Venous Thromboembolism Prophylaxis: A Narrative Review With a Focus on the High-Risk Critically Ill Patient // Journal of Intensive Care Medicine. 2019. Vol. 34, № 11–12. P. 877–888. doi: 10.1177/0885066618796486

[55] Mukkamala A, Montgomery JR, De Roo AC, et al. Population-Based Analysis of Adherence to Postdischarge Extended Venous Thromboembolism Prophylaxis After Colorectal Resection. Diseases of the Colon and Rectum. 2020;63(7):911–7. doi: 10.1097/DCR.0000000000001650

[56] Mukkamala A., Montgomery J.R., De Roo A.C., et al. Population-Based Analysis of Adherence to Postdischarge Extended Venous Thromboembolism Prophylaxis After Colorectal Resection // Diseases of the Colon and Rectum. 2020. Vol. 63, № 7. P. 911–917. doi: 10.1097/DCR.0000000000001650

[57] Nozawa H, Shinagawa T, Kawai K, et al. Laparoscopic surgery in colon cancer patients treated with chronic anti-thrombotic therapy. Surgical Endoscopy. 2018;32(8):3509–16. doi: 10.1007/s00464-018-6071-x

[58] Nozawa H., Shinagawa T., Kawai K., et al. Laparoscopic surgery in colon cancer patients treated with chronic anti-thrombotic therapy // Surgical Endoscopy. 2018. Vol. 32, № 8. P. 3509–3516. doi: 10.1007/s00464-018-6071-x

[59] Rausa E, Kelly ME, Asti E, et al. Extended versus conventional thromboprophylaxis after major abdominal and pelvic surgery: Systematic review and meta-analysis of randomized clinical trials. Surgery. 2018;164(6):1234–40. doi: 10.1016/j.surg.2018.05.028

[60] Rausa E, Kelly ME, Asti E, et al. Extended versus conventional thromboprophylaxis after major abdominal and pelvic surgery: Systematic review and meta-analysis of randomized clinical trials // Surgery. 2018. Vol. 164, № 6. P. 1234–1240. doi: 10.1016/j.surg.2018.05.028

[61] Pfliegler G. A vénás tromboembólia (VTE) korszerû diagnosztikája és kezelése — különös tekintettel az onkológiai betegekre. Magyar Onkológia. 2017;61(3):267–74. (In Hungarian).

[62] Pfliegler G. A vénás tromboembólia (VTE) korszerû diagnosztikája és kezelése — különös tekintettel az onkológiai betegekre // Magyar Onkológia. 2017. Vol. 61, № 3. P. 267–274. (In Hungarian).

[63] Wang Y, Wang M, Ni Y, et al. Direct oral anticoagulants for thromboprophylaxis in ambulatory patients with cancer. Hematology. 2020;25(1):63–70. doi: 10.1080/16078454.2020.1719726

[64] Wang Y., Wang M., Ni Y., et al. Direct oral anticoagulants for thromboprophylaxis in ambulatory patients with cancer // Hematology. 2020. Vol. 25, № 1. P. 63–70. doi: 10.1080/16078454.2020.1719726

[65] Rashid MF, Jackson TL, Morgan JA, et al. Dabigatran (Pradaxa) Is Safe for Extended Venous Thromboembolism Prophylaxis After Surgery for Pancreatic Cancer. Journal of Gastrointestinal Surgery. 2019;23(6):1166–71. doi: 10.1007/s11605-018-3936-1

[66] Rashid M.F., Jackson T.L., Morgan J.A., et al. Dabigatran (Pradaxa) Is Safe for Extended Venous Thromboembolism Prophylaxis After Surgery for Pancreatic Cancer // Journal of Gastrointestinal Surgery. 2019. Vol. 23, № 6. P. 1166–1171. doi: 10.1007/s11605-018-3936-1

[67] Skertich NJ, Gerard J, Poirier J, et al. Do All Abdominal Neuroendocrine Tumors Require Extended Postoperative VTE Prophylaxis? A NSQIP Analysis. Journal of Gastrointestinal Surgery. 2019;23(4):788–93. doi: 10.1007/s11605-018-04075-y

[68] Skertich N.J., Gerard J., Poirier J., et al. Do All Abdominal Neuroendocrine Tumors Require Extended Postoperative VTE Prophylaxis? A NSQIP Analysis // Journal of Gastrointestinal Surgery. 2019. Vol. 23, № 4. P. 788–793. doi: 10.1007/s11605-018-04075-y

[69] Tanaka Y, Yamada A, Hirata S, et al. Efficacy and Safety of Enoxaparin for Prophylaxis of Postoperative Venous Thromboembolism After Esophagectomy: A Single-center Prospective Randomized Controlled Phase II Study. Anticancer Research. 2019;39(5):2615–25. doi: 10.21873/anticanres.13385

[70] Tanaka Y., Yamada A., Hirata S., et al. Efficacy and Safety of Enoxaparin for Prophylaxis of Postoperative Venous Thromboembolism After Esophagectomy: A Single-center Prospective Randomized Controlled Phase II Study // Anticancer Research. 2019. Vol. 39, № 5. P. 2615-2625. doi: 10.21873/anticanres.13385

[71] Trepanier M, Alhassan N, Sabapathy CA, et al. Cost-Effectiveness of Extended Thromboprophylaxis in Patients Undergoing Colorectal Surgery from a Canadian Health Care System Perspective. Diseases of the Colon and Rectum. 2019;62(11):1381–9. doi: 10.1097/DCR. 0000000000001438

[72] Trepanier M., Alhassan N., Sabapathy C.A., et al. Cost-Effectiveness of Extended Thromboprophylaxis in Patients Undergoing Colorectal Surgery from a Canadian Health Care System Perspective // Diseases of the Colon and Rectum. 2019. Vol. 62, № 11. P. 1381–1389. doi: 10.1097/DCR.0000000000001438

[73] Venclauskas L, Llau JV, Jenny JY, et al. European guidelines on perioperative venous thromboembolism prophylaxis: Day surgery and fast-track surgery. European Journal of Anaesthesiology. 2018;35(2):134–8. doi: 10.1097/EJA.0000000000000706

[74] Venclauskas L., Llau J.V., Jenny J.Y., et al. European guidelines on perioperative venous thromboembolism prophylaxis: Day surgery and fast-track surgery // European Journal of Anaesthesiology. 2018. Vol. 35, № 2. P. 134–138. doi: 10.1097/EJA.0000000000000706

[75] Portillo Sánchez J. Prophylaxis of venous thromboembolism disease in patients with cancer. Revista Clinica Española. 2020;220(Suppl 1):17–24. doi: 10.1016/j.rce.2020.04.018

[76] Portillo Sánchez J. Prophylaxis of venous thromboembolism disease in patients with cancer // Revista Clinica Española. 2020. Vol. 220, Suppl. 1. P. 17–24. doi: 10.1016/j.rce.2020.04.018

RIGHTS & PERMISSIONS

Katel’nitskiy I.I., Nemirovich M.V., Prostov I.I., Livadnyaya E.S.