Heijkoop B, Nadi S, Spernat D, Kiroff G
1The Queen Elizabeth Hospital, Woodville, SA Australia.
2Discipline of Surgery, The University of Adelaide, Adelaide, Australia.
Perioper Med (Lond). 2020 Mar 3;9:7. doi: 10.1186/s13741-020-0137-8. eCollection 2020.
Patients undergoing open abdominopelvic procedures for malignancy are at high risk of postoperative venous thromboembolism (VTE). This risk can be mitigated with prophylaxis; however, optimum duration in this population remains unknown. Our objective was to conduct a systematic review of contemporary literature on the use of heparin thromboprophylaxis following major open pelvic surgery for malignancy, comparing the efficacy and safety of extended duration to inpatient treatment.
A study protocol describing search strategy and inclusion and exclusion criteria was developed and registered with PROSPERO. A literature review was conducted in accordance with the protocol.
Literature review identified only 4 studies directly comparing extended and inpatient duration prophylaxis, with a combined population of 3198 and 3135 patients for VTE rate and bleeding events, respectively. Despite many studies reporting lower VTE rates in patients receiving extended prophylaxis, no statistically significant difference in rates of postoperative VTE ( = 0.18) or bleeding complications ( = 0.43) was identified between patients receiving extended duration prophylaxis and those receiving inpatient only prophylaxis.
On the review of contemporary literature, no significant difference was found in rates of postoperative VTE or bleeding complications between patients receiving extended duration heparin VTE prophylaxis and those receiving inpatient prophylaxis after open abdominopelvic surgery for malignancy.This raises the question of how extended duration prophylaxis has become common practice in this population, and whether this needs to be re-evaluated.
因恶性肿瘤接受开放性腹部盆腔手术的患者术后发生静脉血栓栓塞（VTE）的风险很高。这种风险可通过预防措施减轻；然而，该人群的最佳预防持续时间仍不清楚。我们的目的是对当代有关恶性肿瘤大型开放性盆腔手术后使用肝素进行血栓预防的文献进行系统综述，比较延长预防时间与住院治疗的疗效和安全性。
制定了一项描述搜索策略以及纳入和排除标准的研究方案，并在国际前瞻性系统评价注册库（PROSPERO）进行了注册。按照该方案进行了文献综述。
文献综述仅发现4项直接比较延长预防时间和住院期间预防的研究，分别有3198例和3135例患者纳入VTE发生率和出血事件的合并人群。尽管许多研究报告接受延长预防的患者VTE发生率较低，但接受延长预防的患者与仅接受住院期间预防的患者之间，术后VTE发生率（P = 0.18）或出血并发症发生率（P = 0.43）未发现统计学上的显著差异。
通过对当代文献的综述发现，对于因恶性肿瘤接受开放性腹部盆腔手术后的患者，接受延长肝素VTE预防的患者与接受住院期间预防的患者相比，术后VTE发生率或出血并发症发生率没有显著差异。这就引发了一个问题，即延长预防时间如何在该人群中成为普遍做法，以及是否需要重新评估。
