Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan.
World J Surg Oncol. 2019 Jun 27;17(1):110. doi: 10.1186/s12957-019-1653-1.
Pharmacological thromboprophylaxis after colorectal cancer (CRC) surgery is internationally recommended for venous thromboembolism (VTE) prevention. The aim of this retrospective study was to evaluate the risk factors of postoperative bleeding after elective surgery for patients with primary CRC receiving pharmacological thromboprophylaxis of fondaparinux or enoxaparin.
We experienced consecutive 266 patients who underwent elective surgery for CRC during the study period. Finally, the medical records of 218 patients with CRC administrated fondaparinux or enoxaparin following surgery were retrospectively reviewed to evaluate symptomatic VTE until 28 days and postoperative bleeding comparing perioperative D-dimer levels.
The significant differences in TNM classification staging and type of thromboprophylaxis were observed between postoperative bleeding-negative and bleeding-positive group. There was no statistical significance among other backgrounds of patients between the two groups. One case (0.46%) of symptomatic VTE and total 11 cases (5%) of postoperative bleeding were observed. In the univariate analysis, fondaparinux thromboprophylaxis and early disease-stage CRC (stages 0 and I) were associated with risk for postoperative bleeding. Multivariate analysis revealed that fondaparinux thromboprophylaxis was identified as an independent risk factor of postoperative bleeding. Moreover, preoperative levels of D-dimer in patients with stage IV CRC were significantly higher than those with the other stages. The significant elevation in preoperative D-dimer was also observed in patients with stage II CRC compared to those with stage I CRC. Perioperative levels of D-dimer in patients with advanced disease-stage CRC (stages II, III, and IV) were significantly higher than those in patients with early disease-stage CRC.
Fondaparinux administration and early disease-stage CRC appeared to be risk factors for postoperative bleeding in patients with pharmacological thromboprophylaxis undergoing surgical treatment for CRC. Patients' hypercoagulative condition depending on disease progression of CRC might be related to the occurrence of postoperative bleeding following CRC surgery.
结直肠癌（CRC）手术后的药理学血栓预防在国际上被推荐用于预防静脉血栓栓塞症（VTE）。本回顾性研究的目的是评估接受法安明或依诺肝素进行药理学血栓预防的原发性 CRC 患者接受选择性手术治疗后发生术后出血的危险因素。
我们连续观察了 266 例接受 CRC 择期手术的患者。最后，回顾性分析了 218 例接受手术后法安明或依诺肝素治疗的 CRC 患者的病历，评估症状性 VTE 直至 28 天，并比较围手术期 D-二聚体水平的术后出血情况。
术后出血阴性组和出血阳性组在 TNM 分期和血栓预防类型方面存在显著差异。两组患者的其他背景无统计学意义。观察到 1 例（0.46%）有症状性 VTE 和 11 例（5%）术后出血。单因素分析显示，法安明预防性抗凝和早期疾病分期 CRC（0 期和 I 期）与术后出血风险相关。多因素分析显示，法安明预防性抗凝是术后出血的独立危险因素。此外，IV 期 CRC 患者的术前 D-二聚体水平明显高于其他分期患者。与 I 期 CRC 患者相比，II 期 CRC 患者的术前 D-二聚体水平也明显升高。晚期疾病分期 CRC（II、III 和 IV 期）患者的围手术期 D-二聚体水平明显高于早期疾病分期 CRC 患者。
法安明给药和早期疾病分期 CRC 似乎是接受 CRC 手术治疗并接受药理学血栓预防的患者术后出血的危险因素。CRC 疾病进展导致的患者高凝状态可能与 CRC 手术后出血的发生有关。
