International journal of colorectal disease · 2025
The efficacy and safety of extended thromboprophylaxis after colorectal surgery: a systematic review and meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Choi Joseph Do Woong, Huynh Nguyen, Shepherd Talia, Shanmugalingam Aswin, Gavegan Fiona Lee, Shedden Karen, Cao Amy, Pathmanathan Nimalan, El-Khoury Toufic, Hitos Kerry, Toh James Wei Tatt
Аннотация
PURPOSE: To report (1) efficacy and (2) safety outcomes comparing extended thromboprophylaxis (ETP) with low molecular weight heparin (LMWH) and direct oral anticoagulants (DOAC) versus no ETP after colorectal surgery.
METHODS: A systematic review using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to March 2024. Randomised controlled trials and observational studies investigating ETP with LMWH or DOAC for at least 28 days were included. (1) Efficacy outcome was venous thromboembolism (VTE) rate at 30-days postoperatively. (2) Safety outcomes included major bleeding events at 30-90-days. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using a Mantel-Haenszel fixed effects model.
RESULTS: Five studies (2936 patients) investigating colorectal surgery for colorectal cancer (CRC) or inflammatory bowel disease (IBD) were included. Total VTE rates were significantly reduced in the LMWH ETP group compared with no ETP [0.56% (OR 0.18, 95% CI 0.07-0.50]. The DOAC ETP group was also compared with no ETP with lower total VTE rates [OR 0.22, 95% CI 0.08-0.67]. There was no difference in VTE rates between LMWH and DOAC ETP. There were no differences in major bleeding events in the LMWH ETP group at 90-days [OR 0.25, 95% CI 0.03-2.24], or the DOAC ETP at 30-days [OR 2.68, 95% CI 0.32-22.35]. There were no VTE-related mortalities at 90-days in either group.
CONCLUSION: ETP after colorectal surgery for CRC and IBD reduced the incidence of VTEs with no impact on major bleeding within 90-days. ETP for at least 28 days should be considered particularly for those who have a high risk for postoperative VTE.
METHODS: A systematic review using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to March 2024. Randomised controlled trials and observational studies investigating ETP with LMWH or DOAC for at least 28 days were included. (1) Efficacy outcome was venous thromboembolism (VTE) rate at 30-days postoperatively. (2) Safety outcomes included major bleeding events at 30-90-days. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using a Mantel-Haenszel fixed effects model.
RESULTS: Five studies (2936 patients) investigating colorectal surgery for colorectal cancer (CRC) or inflammatory bowel disease (IBD) were included. Total VTE rates were significantly reduced in the LMWH ETP group compared with no ETP [0.56% (OR 0.18, 95% CI 0.07-0.50]. The DOAC ETP group was also compared with no ETP with lower total VTE rates [OR 0.22, 95% CI 0.08-0.67]. There was no difference in VTE rates between LMWH and DOAC ETP. There were no differences in major bleeding events in the LMWH ETP group at 90-days [OR 0.25, 95% CI 0.03-2.24], or the DOAC ETP at 30-days [OR 2.68, 95% CI 0.32-22.35]. There were no VTE-related mortalities at 90-days in either group.
CONCLUSION: ETP after colorectal surgery for CRC and IBD reduced the incidence of VTEs with no impact on major bleeding within 90-days. ETP for at least 28 days should be considered particularly for those who have a high risk for postoperative VTE.