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Lee, Park, Park, Kim, Choi, and Oh: The Prophylactic Impact of Low Molecular Weight Heparin on Occurrence of Venous Thromboembolism after Colorectal Cancer Resection
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(4): 253-260.

Published online: 31 October 2010

DOI: https://doi.org/10.4174/jkss.2010.79.4.253

The Prophylactic Impact of Low Molecular Weight Heparin on Occurrence of Venous Thromboembolism after Colorectal Cancer Resection

Seung Duk Lee, M.D., Ji Won Park, M.D.1, Sung Chan Park, M.D.1, Hak Jin Kim, M.D.2, Hyo Seong Choi, M.D., Ph.D.1, Jae Hwan Oh, M.D., Ph.D.1

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

1Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

2Cardiology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

Corresponding author (jayoh@ncc.re.kr)

Received 11 February 2010       Accepted 13 July 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

In western society, prophylaxis for venous thromboembolism (VTE) is the standard treatment under colorectal surgery for colorectal cancer. However, the incidence of VTE after colorectal surgery and the effect of prophylactic methods are not well known in Korea. The aim of this study is to evaluate the incidence of VTE and assess the efficacy and safety of low molecular weight heparin (enoxaparin) after major colorectal surgery in Korean patients with compression stockings.

Methods

From Jan. 2006 to Dec. 2008, 1,727 consecutive patients underwent major colorectal surgery. Thirty-six were excluded due to the therapeutic use of enoxaparin. A final number of 1,691 patients were included. Graduated compression stockings were used in all patients and 654 were perioperatively given enoxaparin. Only compression stocking group (group A) and compression stocking with enoxaparin group (group B) were compared in terms of VTE. The event of VTE within 6 months after surgery was counted by clinical symptoms, then imaging findings were used for confirmation.

Results

Total VTE developed in 10 patients (0.6%). Three with deep vein thrombosis had pulmonary embolism. Two had only pulmonary embolism. The rates of VTE were not different between group A and B (0.8% vs. 0.3%, P=0.333). Also, postoperative major bleeding was not significantly different. However, postoperative transfusion was higher in group B (P<0.001).

Conclusion

The incidence of VTE was very low after colorectal surgery in Korean patients with compression stockings. The additional use of enoxaparin for colorectal cancer patients with compression stockings seems to have little benefit for VTE prophylaxis.

Keywords: Colorectal cancer, Venous thromboembolism, Enoxaparin

Figures and Tables

Table 1
Demographic and clinical characteristics of the patients at baseline
jkss-79-253-i001

*P<0.05; †BMI = body mass index; ‡Missing values: n=9 in enoxaparin unuse patients and n=6 in enoxaparin use patients; §Obesity if BMI>25 kg/m2; ∥include cases with history of a operation. SD = standard deviation.

Table 2
Cancer and treatment characteristics of the patients
jkss-79-253-i002

*Preoperative chemotherapy done; †P<0.05.

Table 3
Venous thromboembolic events and safety outcomes
jkss-79-253-i003

*95% CI = 95% confidence interval; †VTE = venous thromboembolism; ‡DVT = deep vein thrombosis; §PE = pulmonary embolism; ∥Major bleeding includes re-operation for bleeding control or radiologic embolization; NS = not significant; **SD = standard deviation.

Table 4
Characteristics of the patients with a VTE*
jkss-79-253-i004

*VTE = venous thromboembolism; †CCRT = concurrent chemoradiation therapy; ‡Op = operation; §Duration when VTE was diagnosed after surgery; ∥DVT = deep vein thrombosis; DM = diabetes mellitus; **FOLFOX = leucovorin+fluorouracil+oxaliplatin; ††FOLFIRI = leucovorin+fluorouracil+irinotecan; ‡‡PE = pulmonary embolism; §§LAR = low anterior resection; ∥∥HTN = hypertension; ¶¶FL = fluorouracil+leucovorin; ***AR = anterior resection; †††Xeloda = capecitabine; ‡‡‡ULAR = ultralow anterior resection.

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