Ottawa Hospital Research Institute, Ottawa Hospital - General Campus, 501 Smyth Road, Box 201a, Ottawa, Ontario, K1H 8L6, Canada.
University of Manitoba, CancerCare Manitoba, Health Sciences Center, 810 Sherbrooke St., Rs406, Winnipeg, Manitoba, R3A-1R9, Canada.
Am J Surg. 2019 Sep;218(3):537-550. doi: 10.1016/j.amjsurg.2018.11.046. Epub 2018 Dec 16.
Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Certain abdominopelvic cancer surgeries are associated with a six to 14-fold increased risk of DVT versus surgeries for benign disease, and extended thromboprophylaxis using perioperative LMWHs may further reduce VTE rates over standard duration administration. This review assesses the value of extended low molecular weight heparin (LMWH) thromboprophylaxis as a recommended strategy after abdominopelvic cancer surgery.
Six eligible randomized controlled trials (RCTs), seven meta-analyses (MAs), and five non-randomized cohort studies were identified evaluating extended versus standard thromboprophylaxis following abdominopelvic cancer surgery.
Available evidence showed significantly reduced rates of VTE for extended versus standard LMWH thromboprophylaxis following abdominopelvic cancer surgery, with some studies showing trends toward reduced rates of symptomatic VTE events. Many of these studies showed significantly reduced rates of proximal DVT and some showed trends toward reduced PE, suggesting potentially important clinical benefits.
静脉血栓栓塞症（VTE）包括深静脉血栓形成（DVT）和肺栓塞（PE）。某些腹盆腔癌症手术与良性疾病手术相比，DVT 的风险增加 6 至 14 倍，使用围手术期低分子肝素（LMWH）进行延长血栓预防可能会进一步降低标准持续给药的 VTE 发生率。本综述评估了延长低分子肝素（LMWH）血栓预防在腹盆腔癌症手术后作为推荐策略的价值。
共确定了 6 项合格的随机对照试验（RCT）、7 项荟萃分析（MA）和 5 项非随机队列研究，评估了腹盆腔癌症手术后延长与标准血栓预防的效果。
可用证据表明，与标准 LMWH 血栓预防相比，腹盆腔癌症手术后延长 LMWH 血栓预防可显著降低 VTE 发生率，一些研究显示症状性 VTE 事件发生率有降低趋势。这些研究中有许多显示近端 DVT 发生率显著降低，有些研究显示 PE 发生率有降低趋势，这表明可能具有重要的临床获益。
