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SEATTLE—Patients who undergo surgery for lung cancer may have a higher risk of developing venous thromboembolism (VTE) than we thought, according to a
new study.
About 12% of the patients studied developed deep vein thrombosis (DVT), pulmonary embolism (PE), or both, although they had received VTE prophylaxis until hospital discharge.
Only about 21% of these patients showed symptoms of VTE, and the clots conferred a higher risk of mortality at 30 days.
“This study shows that a significant proportion of lung cancer surgery patients are at risk of VTE and indicates a need for future research into minimizing the occurrence of DVT and PE,” said investigator Yaron Shargall, MD, of McMaster University in Hamilton, Ontario, Canada.
“It is possible that extended use of blood thinners beyond hospital discharge may reduce the number of patients who experience these life-threatening events and may help to reduce the rates of death after lung surgery.”
Dr Shargall presented this viewpoint at the 95th Annual Meeting of the American Association for Thoracic Surgery.
For their study, he and his colleagues evaluated 157 patients who underwent thoracic surgery for primary lung cancer (89.9%) or metastatic cancer (6.3%).
All patients received unfractionated heparin or low-molecular-weight heparin and graduated compression stockings as VTE prophylaxis from the time of surgery until leaving the hospital.
Two weeks later, these patients were evaluated for signs and symptoms of VTE. The investigators evaluated clinical outcomes at 30 ± 5 days post-operatively using CT pulmonary angiography and bilateral Doppler venous ultrasonography.
Patients who had developed symptoms suggestive of VTE within the 30 days after surgery underwent urgent CT-PE examination and had a repeat scan 30 days after surgery if the first scan was negative. Patients with VTE were monitored and treated.
In all, there were 19 VTEs, a 12.1% incidence rate. These included 14 PEs (8.9%), 3 DVTs (1.9%), and 1 combined PE/DVT. One patient developed a massive left atrial thrombus originating from a surgical stump and died.
For all 157 patients, the 30-day mortality rate was 0.64%. For those with VTE, it was 5.2%.
“This demonstrates the clinical importance and relative fatality of VTE following lung cancer surgery,” Dr Shargall said.
All of the patients who were diagnosed with a VTE had undergone anatomic resections (lobectomy or segmentectomy), and most had primary lung cancer. The clots tended to form on the same side as the lung surgery. The majority of patients developed lung clots without forming DVTs beforehand.
The investigators examined factors that might distinguish patients who developed VTEs from those who did not and could not find differences in patient age, lung function, hospital length of stay, comorbidities, lung cancer stage, smoking status, or Caprini Score.
Among patients diagnosed with a VTE, only 4 (21.1%) showed symptoms. All the events were diagnosed after the patient left the hospital and only because these patients were screened for VTEs as part of the study. 
Photo by Andre E.X. Brown
SEATTLE—Patients who undergo surgery for lung cancer may have a higher risk of developing venous thromboembolism (VTE) than we thought, according to a
new study.
About 12% of the patients studied developed deep vein thrombosis (DVT), pulmonary embolism (PE), or both, although they had received VTE prophylaxis until hospital discharge.
Only about 21% of these patients showed symptoms of VTE, and the clots conferred a higher risk of mortality at 30 days.
“This study shows that a significant proportion of lung cancer surgery patients are at risk of VTE and indicates a need for future research into minimizing the occurrence of DVT and PE,” said investigator Yaron Shargall, MD, of McMaster University in Hamilton, Ontario, Canada.
“It is possible that extended use of blood thinners beyond hospital discharge may reduce the number of patients who experience these life-threatening events and may help to reduce the rates of death after lung surgery.”
Dr Shargall presented this viewpoint at the 95th Annual Meeting of the American Association for Thoracic Surgery.
For their study, he and his colleagues evaluated 157 patients who underwent thoracic surgery for primary lung cancer (89.9%) or metastatic cancer (6.3%).
All patients received unfractionated heparin or low-molecular-weight heparin and graduated compression stockings as VTE prophylaxis from the time of surgery until leaving the hospital.
Two weeks later, these patients were evaluated for signs and symptoms of VTE. The investigators evaluated clinical outcomes at 30 ± 5 days post-operatively using CT pulmonary angiography and bilateral Doppler venous ultrasonography.
Patients who had developed symptoms suggestive of VTE within the 30 days after surgery underwent urgent CT-PE examination and had a repeat scan 30 days after surgery if the first scan was negative. Patients with VTE were monitored and treated.
In all, there were 19 VTEs, a 12.1% incidence rate. These included 14 PEs (8.9%), 3 DVTs (1.9%), and 1 combined PE/DVT. One patient developed a massive left atrial thrombus originating from a surgical stump and died.
For all 157 patients, the 30-day mortality rate was 0.64%. For those with VTE, it was 5.2%.
“This demonstrates the clinical importance and relative fatality of VTE following lung cancer surgery,” Dr Shargall said.
All of the patients who were diagnosed with a VTE had undergone anatomic resections (lobectomy or segmentectomy), and most had primary lung cancer. The clots tended to form on the same side as the lung surgery. The majority of patients developed lung clots without forming DVTs beforehand.
The investigators examined factors that might distinguish patients who developed VTEs from those who did not and could not find differences in patient age, lung function, hospital length of stay, comorbidities, lung cancer stage, smoking status, or Caprini Score.
Among patients diagnosed with a VTE, only 4 (21.1%) showed symptoms. All the events were diagnosed after the patient left the hospital and only because these patients were screened for VTEs as part of the study.
Photo by Andre E.X. Brown
SEATTLE—Patients who undergo surgery for lung cancer may have a higher risk of developing venous thromboembolism (VTE) than we thought, according to a
new study.
About 12% of the patients studied developed deep vein thrombosis (DVT), pulmonary embolism (PE), or both, although they had received VTE prophylaxis until hospital discharge.
Only about 21% of these patients showed symptoms of VTE, and the clots conferred a higher risk of mortality at 30 days.
“This study shows that a significant proportion of lung cancer surgery patients are at risk of VTE and indicates a need for future research into minimizing the occurrence of DVT and PE,” said investigator Yaron Shargall, MD, of McMaster University in Hamilton, Ontario, Canada.
“It is possible that extended use of blood thinners beyond hospital discharge may reduce the number of patients who experience these life-threatening events and may help to reduce the rates of death after lung surgery.”
Dr Shargall presented this viewpoint at the 95th Annual Meeting of the American Association for Thoracic Surgery.
For their study, he and his colleagues evaluated 157 patients who underwent thoracic surgery for primary lung cancer (89.9%) or metastatic cancer (6.3%).
All patients received unfractionated heparin or low-molecular-weight heparin and graduated compression stockings as VTE prophylaxis from the time of surgery until leaving the hospital.
Two weeks later, these patients were evaluated for signs and symptoms of VTE. The investigators evaluated clinical outcomes at 30 ± 5 days post-operatively using CT pulmonary angiography and bilateral Doppler venous ultrasonography.
Patients who had developed symptoms suggestive of VTE within the 30 days after surgery underwent urgent CT-PE examination and had a repeat scan 30 days after surgery if the first scan was negative. Patients with VTE were monitored and treated.
In all, there were 19 VTEs, a 12.1% incidence rate. These included 14 PEs (8.9%), 3 DVTs (1.9%), and 1 combined PE/DVT. One patient developed a massive left atrial thrombus originating from a surgical stump and died.
For all 157 patients, the 30-day mortality rate was 0.64%. For those with VTE, it was 5.2%.
“This demonstrates the clinical importance and relative fatality of VTE following lung cancer surgery,” Dr Shargall said.
All of the patients who were diagnosed with a VTE had undergone anatomic resections (lobectomy or segmentectomy), and most had primary lung cancer. The clots tended to form on the same side as the lung surgery. The majority of patients developed lung clots without forming DVTs beforehand.
The investigators examined factors that might distinguish patients who developed VTEs from those who did not and could not find differences in patient age, lung function, hospital length of stay, comorbidities, lung cancer stage, smoking status, or Caprini Score.
Among patients diagnosed with a VTE, only 4 (21.1%) showed symptoms. All the events were diagnosed after the patient left the hospital and only because these patients were screened for VTEs as part of the study.