Prolonged duration of pharmacological thromboprophylaxis following oncologic surgery: A systematic review and meta-analysis of RCTs.

BACKGROUND

Venous thromboembolism (VTE) is the leading cause of 30-day postoperative mortality, with current guidelines recommending extended-duration thromboprophylaxis despite limited evidence on its impact on clinically meaningful benefits.

OBJECTIVE

To evaluate the efficacy and safety of prolonged anticoagulant prophylaxis versus in-hospital only prophylaxis in cancer surgery patients using a meta-analysis of randomized controlled trials (RCTs).

METHODS

We conducted a systematic review and meta-analysis of 10 RCTs. The primary outcomes included overall VTE, symptomatic VTE, pulmonary embolism (PE), major bleeding, and all-cause mortality. Results were summarized using relative ratios (RR) and 95 % confidence intervals (CIs).

RESULTS

Prolonged prophylaxis significantly reduced the 30-day incidence of overall VTE (4.0 % vs. 10.0 %; RR 0.40, 95 %CI 0.22-0.76). No significant differences were observed in the 30-day incidence of symptomatic VTE (0.7 % vs. 1.1 %; RR 0.66, 95 %CI 0.29-1.48), PE (0.5 % vs. 0.5 %), or 90-day mortality (1.4 % vs. 1.6 %). A non-significant increase in major bleeding occurred (0.9 % vs. 0.2 %; RR 2.37, 95 %CI 0.79-7.11). Subgroup analyses indicated heterogeneity in primary outcomes based on surgical site (abdominopelvic vs. thoracic surgery).

CONCLUSION

While prolonged duration of pharmacological thromboprophylaxis reduces the incidence of overall VTE, it does not demonstrate clinically meaningful benefits for symptomatic events or survival. Current risk-stratification tools may overestimate thrombotic risk in cancer surgery patients receiving standard in-hospital prophylaxis. Our findings support a selective, rather than universal, approach to prolonged prophylaxis, emphasizing individualized risk assessment.