Prescribing Patterns of Extended Venous Thromboembolism Prophylaxis and VTE Incidence After Colorectal Cancer Resection: Insights From a Single Institution.

INTRODUCTION

Patients undergoing colorectal cancer surgery are at increased risk for postoperative venous thromboembolism (VTE). Several societies recommend extended duration pharmacologic prophylaxis after discharge for selected high-risk patients, but real-world use is inconsistent, and the absolute benefit in the era of minimally invasive surgery and enhanced recovery remains uncertain.

METHODS

We performed a retrospective cohort study of adults undergoing colon or rectal resection for cancer at a single academic center between 2020 and 2023. Patients receiving therapeutic anticoagulation, those with recent VTE or nonmalignant indications for surgery were excluded. Demographic, operative, and oncologic variables were collected along with inpatient and postdischarge VTE prophylaxis practices. Primary outcomes were (1) prescription of extended pharmacologic prophylaxis at discharge and (2) 90-d symptomatic VTE incidence.

RESULTS

A total of 177 patients met the inclusion criteria. Most operations were minimally invasive and performed within an Enhanced Recovery After Surgery pathway. Despite the presence of traditional VTE risk factors, only a minority of patients were discharged on extended pharmacologic prophylaxis. Within 90 d, two patients developed symptomatic lower extremity deep vein thrombosis (1.1%); no pulmonary emboli or VTE events were identified. Both patients had high-risk features, including advanced age and emergent surgery. Routine screening imaging was not performed, and all events were clinically detected.

CONCLUSIONS

In this enhanced recovery after surgery-based colorectal cancer cohort, extended postdischarge VTE prophylaxis was rarely prescribed; yet, the symptomatic VTE rate was low and limited to two high-risk individuals. These findings support a risk-stratified rather than universal approach to extended prophylaxis after colorectal surgery.