Effect of Extended-Duration Venous Thromboprophylaxis After Cancer Surgery.

BACKGROUND

Cancer patients undergoing surgery are at significantly increased risk of venous thromboembolism (VTE). Although extended thromboprophylaxis is recommended, the optimal anticoagulant type and duration remain unclear. This study aimed to evaluate the comparative efficacy and safety of different extended thromboprophylaxis in this population.

METHODS

A Bayesian network meta-analysis of randomized controlled trials (RCTs) was performed to evaluate various thromboprophylaxis strategies for patients undergoing cancer-related surgery. We conducted both three-node and five-node network analyses to evaluate extended-duration versus standard-duration thromboprophylaxis strategies. Outcomes included venous thromboembolism, major bleeding, and all-cause mortality. Net clinical benefit and risk-benefit assessments were additionally performed to determine the overall impact of prolonged anticoagulant therapy. Treatment effects were summarized as risk ratios (RRs) with corresponding 95% credible intervals (CrIs).

RESULTS

A total of 14 randomized controlled trials involving 4,331 participants were included. Compared with placebo, extended-duration prophylaxis with direct oral anticoagulants (DOACs) (RR 0.12, 95% CrI 0.05-0.27) and low-molecular-weight heparin (LMWH) (RR 0.17, 95% CrI 0.05-0.55) significantly reduced the incidence of venous thromboembolism without a corresponding increase in major bleeding. In net clinical benefit analyses, both prolonged DOAC therapy (RR 0.27, 95% CrI 0.14-0.49) and LMWH (RR 0.36, 95% CrI 0.17-0.76) demonstrated favorable overall outcomes. Risk-benefit evaluation suggested that prolonged DOACs provided a more advantageous balance than LMWH, with an NNH/NNT ratio of 4.17.

CONCLUSIONS

Extended thromboprophylaxis is effective and safe for cancer patients undergoing surgery. Besides, DOACs appears to be the optimal anticoagulant for extended thromboprophylaxis, providing the greatest net clinical benefit.