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Preoperative anticoagulant therapy is safe and effective for cancer patients, a single-center study suggests.
Among patients undergoing major cancer operations, the preoperative use of anticoagulants did not increase rates of major bleeding or transfusion.
And the treatment proved effective, decreasing the risk of venous thromboembolism (VTE).
Researchers reported these results in the Journal of the American College of Surgeons.
The team conducted this study after discovering that their institution, Memorial Sloan Kettering Cancer Center in New York, New York, had higher-than-expected rates of deep vein thrombosis (DVT) and pulmonary embolism (PE).
This was according to the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP®) database, a nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals.
So the researchers set out to identify the reason for their high VTE rate and lower it.
“We weren’t sure if our VTE rate was due to the complexity of our operations, the fact that our patients had cancer, or that we weren’t administering heparin, which could decrease the blood clots,” said study author Vivian Strong, MD.
“There was serious concern that administering preoperative VTE prophylaxis to our patients, who undergo extensive surgical resection, would increase the risk of bleeding,” said Luke V. Selby, MD.
“Knowing, from NSQIP, that we had a higher-than-expected VTE rate, the question was whether it was safe to expose our patients to the additional bleeding risk from VTE prophylaxis.”
To find out, the researchers selected 2058 patients undergoing major operations for cancer to receive preoperative VTE prophylaxis with low-molecular-weight heparin or unfractionated heparin.
The team compared these patients—called the “post-intervention cohort”—with a group of 4960 cancer patients who had already undergone a major surgical procedure a year earlier but, for the most part, did not receive preoperative VTE prophylaxis—the “pre-intervention cohort.” Forty patients in this group did receive VTE prophylaxis.
There was no significant difference in the rate of major bleeding between the pre- and post-intervention cohorts. The major bleeding rates were 0.8% and 0.5%, respectively (P=0.2).
The rate of any documented bleeding was actually higher in the pre-intervention group—4.2% vs 2.5% (P=0.001)—as was the rate of transfusion—17% vs 14% (P=0.0003).
As expected, rates of DVT and PE were significantly lower in the post-intervention group. The rate of DVT was 1.3% in the pre-intervention group and 0.2% in the post-intervention group (P<0.0001). The rates of PE were 1.0% and 0.4%, respectively (P=0.017).
Because of these findings, Memorial Sloan Kettering Cancer Center has adopted a routine anticoagulation approach for patients who meet certain selection criteria.
“This research has been a practice-changing study for our institution,” Dr Strong said. “Our study results demonstrate to other institutions that you can use preoperative VTE prophylaxis safely, so I think that it has very broad-reaching, practice-changing implications.” 
Preoperative anticoagulant therapy is safe and effective for cancer patients, a single-center study suggests.
Among patients undergoing major cancer operations, the preoperative use of anticoagulants did not increase rates of major bleeding or transfusion.
And the treatment proved effective, decreasing the risk of venous thromboembolism (VTE).
Researchers reported these results in the Journal of the American College of Surgeons.
The team conducted this study after discovering that their institution, Memorial Sloan Kettering Cancer Center in New York, New York, had higher-than-expected rates of deep vein thrombosis (DVT) and pulmonary embolism (PE).
This was according to the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP®) database, a nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals.
So the researchers set out to identify the reason for their high VTE rate and lower it.
“We weren’t sure if our VTE rate was due to the complexity of our operations, the fact that our patients had cancer, or that we weren’t administering heparin, which could decrease the blood clots,” said study author Vivian Strong, MD.
“There was serious concern that administering preoperative VTE prophylaxis to our patients, who undergo extensive surgical resection, would increase the risk of bleeding,” said Luke V. Selby, MD.
“Knowing, from NSQIP, that we had a higher-than-expected VTE rate, the question was whether it was safe to expose our patients to the additional bleeding risk from VTE prophylaxis.”
To find out, the researchers selected 2058 patients undergoing major operations for cancer to receive preoperative VTE prophylaxis with low-molecular-weight heparin or unfractionated heparin.
The team compared these patients—called the “post-intervention cohort”—with a group of 4960 cancer patients who had already undergone a major surgical procedure a year earlier but, for the most part, did not receive preoperative VTE prophylaxis—the “pre-intervention cohort.” Forty patients in this group did receive VTE prophylaxis.
There was no significant difference in the rate of major bleeding between the pre- and post-intervention cohorts. The major bleeding rates were 0.8% and 0.5%, respectively (P=0.2).
The rate of any documented bleeding was actually higher in the pre-intervention group—4.2% vs 2.5% (P=0.001)—as was the rate of transfusion—17% vs 14% (P=0.0003).
As expected, rates of DVT and PE were significantly lower in the post-intervention group. The rate of DVT was 1.3% in the pre-intervention group and 0.2% in the post-intervention group (P<0.0001). The rates of PE were 1.0% and 0.4%, respectively (P=0.017).
Because of these findings, Memorial Sloan Kettering Cancer Center has adopted a routine anticoagulation approach for patients who meet certain selection criteria.
“This research has been a practice-changing study for our institution,” Dr Strong said. “Our study results demonstrate to other institutions that you can use preoperative VTE prophylaxis safely, so I think that it has very broad-reaching, practice-changing implications.”
Preoperative anticoagulant therapy is safe and effective for cancer patients, a single-center study suggests.
Among patients undergoing major cancer operations, the preoperative use of anticoagulants did not increase rates of major bleeding or transfusion.
And the treatment proved effective, decreasing the risk of venous thromboembolism (VTE).
Researchers reported these results in the Journal of the American College of Surgeons.
The team conducted this study after discovering that their institution, Memorial Sloan Kettering Cancer Center in New York, New York, had higher-than-expected rates of deep vein thrombosis (DVT) and pulmonary embolism (PE).
This was according to the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP®) database, a nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals.
So the researchers set out to identify the reason for their high VTE rate and lower it.
“We weren’t sure if our VTE rate was due to the complexity of our operations, the fact that our patients had cancer, or that we weren’t administering heparin, which could decrease the blood clots,” said study author Vivian Strong, MD.
“There was serious concern that administering preoperative VTE prophylaxis to our patients, who undergo extensive surgical resection, would increase the risk of bleeding,” said Luke V. Selby, MD.
“Knowing, from NSQIP, that we had a higher-than-expected VTE rate, the question was whether it was safe to expose our patients to the additional bleeding risk from VTE prophylaxis.”
To find out, the researchers selected 2058 patients undergoing major operations for cancer to receive preoperative VTE prophylaxis with low-molecular-weight heparin or unfractionated heparin.
The team compared these patients—called the “post-intervention cohort”—with a group of 4960 cancer patients who had already undergone a major surgical procedure a year earlier but, for the most part, did not receive preoperative VTE prophylaxis—the “pre-intervention cohort.” Forty patients in this group did receive VTE prophylaxis.
There was no significant difference in the rate of major bleeding between the pre- and post-intervention cohorts. The major bleeding rates were 0.8% and 0.5%, respectively (P=0.2).
The rate of any documented bleeding was actually higher in the pre-intervention group—4.2% vs 2.5% (P=0.001)—as was the rate of transfusion—17% vs 14% (P=0.0003).
As expected, rates of DVT and PE were significantly lower in the post-intervention group. The rate of DVT was 1.3% in the pre-intervention group and 0.2% in the post-intervention group (P<0.0001). The rates of PE were 1.0% and 0.4%, respectively (P=0.017).
Because of these findings, Memorial Sloan Kettering Cancer Center has adopted a routine anticoagulation approach for patients who meet certain selection criteria.
“This research has been a practice-changing study for our institution,” Dr Strong said. “Our study results demonstrate to other institutions that you can use preoperative VTE prophylaxis safely, so I think that it has very broad-reaching, practice-changing implications.”