Type of Pharmacological Thromboprophylaxis and Disease Stage as Risk Factors for Bleeding in Patients After Colorectal Cancer Surgery
Japanese authors of a study published last year in the World Journal of Surgical Oncology attempted to answer the question of whether the incidence of postoperative bleeding in patients undergoing elective surgery for colorectal cancer is associated with the type of pharmacological prophylaxis or the disease stage.
Introduction
Pharmacological prophylaxis for operations on patients with colorectal cancer (CRC) is recommended by several international guidelines as prevention for venous thromboembolic disease. It has been clearly demonstrated that surgical procedures in the abdominal area are associated with an increased risk of thromboembolism. Additionally, there is growing evidence that even colorectal cancer is associated with increased activation of the coagulation system.
Analyzed Data
The authors retrospectively analyzed risk factors associated with postoperative bleeding after elective procedures in patients with primary CRC who were perioperatively administered thromboprophylaxis with either enoxaparin or fondaparinux and had their perioperative D-dimer levels measured. They also focused on the TNM classification of the disease stage. Data were obtained from 266 consecutive patients with CRC, of whom 218 receiving thromboprophylaxis were included in the final analysis.
Results
In the entire cohort, 1 symptomatic deep vein thrombosis (VTE; 0.46%) and 11 cases (5%) of postoperative bleeding were recorded. These bleedings (minor and significant) occurred in 10.4% of patients prophylactically treated with fondaparinux and in 2.6% of patients receiving enoxaparin.
In the univariate analysis, fondaparinux and early-stage disease were associated with an increased risk of bleeding in the postoperative period. The multivariate analysis then identified thromboprophylaxis with fondaparinux as an independent risk factor for postoperative bleeding.
Other interesting findings were also noted. Preoperative D-dimer levels were significantly higher in patients with stage IV disease compared to other stages. Higher D-dimer levels were also recorded in patients in stage II compared to stage I CRC and collectively in stages II, III, and IV compared to stage I.
Conclusion
In patients with colorectal cancer, thromboprophylaxis with fondaparinux is associated with a higher risk of postoperative bleeding compared to prophylaxis with enoxaparin. Another risk factor for bleeding may also be a lower stage of CRC.
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Source: Ohta H., Miyake T., Shimizu T. et al. The impact of pharmacological thromboprophylaxis and disease-stage on postoperative bleeding following colorectal cancer surgery. World J Surg Oncol 2019 Jun 27; 17 (1): 110, doi: 10.1186/s12957-019-1653-1.
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