Division of Gastrointestinal Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Jeollanam-do, Korea.
Ann Surg Oncol. 2010 Sep;17(9):2363-9. doi: 10.1245/s10434-010-1032-1. Epub 2010 Apr 1.
Low molecular weight heparin (LMWH) has been widely used to prevent venous thromboembolism in cancer surgical patients. However, relatively few studies have examined the safety aspects related to the use of LMWH after abdominal cancer surgery. This study was designed to investigate the relationship between bleeding complications and LMWH thromboprophylaxis after gastric cancer surgery.
From March to July in 2009, 179 consecutive patients who underwent gastric cancer surgery at our institution were administered LMWH (3200 U once daily from 2 to 6 h before surgery until discharge) perioperatively. A total of 182 patients consecutively treated before the introduction of LMWH prophylaxis were selected as controls.
There were 234 men and 127 women (mean age, 60 +/- 12 years). No significant intergroup differences were observed with respect to clinicopathological features and operative procedures. No patient in the LMWH or control group developed symptomatic venous thromboembolism postoperatively. However, the LMWH group had a significantly higher surgical complication rate (27.4 versus 15.4%, P = 0.005). Among the surgical complications, postoperative bleeding and wound complications were significantly higher in the LMWH group, whereas other complications were similar in the two study groups. Multivariate analysis showed that LMWH administration was an independent risk factor (odds ratio, 2.83; 95% confidence interval, 1.28-6.23, P = 0.009) of postoperative bleeding.
LMWH thromboprophylaxis was found to increase significantly the risk of bleeding complications after gastric cancer surgery. Optimal LMWH prophylaxis regimens, including the dosage and timing of treatment commencement, for gastric cancer surgery should be determined in further clinical trials.
低分子量肝素（LMWH）已广泛用于预防癌症手术患者的静脉血栓栓塞症。然而，很少有研究检查与腹部癌症手术后使用 LMWH 相关的安全性方面。本研究旨在调查胃癌手术后出血并发症与 LMWH 血栓预防之间的关系。
2009 年 3 月至 7 月，我院 179 例胃癌手术患者接受围手术期 LMWH（手术前 2 至 6 小时至出院时每天 3200U 一次）治疗。选择了 182 例在引入 LMWH 预防治疗前连续治疗的患者作为对照组。
共 234 例男性和 127 例女性（平均年龄 60±12 岁）。两组在临床病理特征和手术程序方面无显著差异。LMWH 组或对照组均无术后症状性静脉血栓栓塞发生。然而，LMWH 组的手术并发症发生率显著较高（27.4%比 15.4%，P=0.005）。在手术并发症中，LMWH 组术后出血和伤口并发症明显更高，而两组其他并发症相似。多因素分析显示，LMWH 给药是术后出血的独立危险因素（比值比，2.83；95%置信区间，1.28-6.23，P=0.009）。
LMWH 血栓预防被发现显著增加了胃癌手术后出血并发症的风险。在进一步的临床试验中，应确定用于胃癌手术的最佳 LMWH 预防方案，包括治疗开始的剂量和时间。
