Martins Russell Seth, Christophel Elizabeth, Poulikidis Kostantinos, Razi Syed Shahzad, Latif M Jawad, Luo Jeffrey, Bhora Faiz Y
Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian Health Network, Hackensack, New Jersey.
Hackensack Meridian School of Medicine, Hackensack Meridian Health Network, Hackensack, New Jersey.
Ann Thorac Surg Short Rep. 2024 May 6;2(3):422-426. doi: 10.1016/j.atssr.2024.04.014. eCollection 2024 Sep.
In 2022, the American Association for Thoracic Surgery (AATS) and the European Society of Thoracic Surgeons (ESTS) published joint guidelines regarding the timing, duration, and choice of agent for perioperative venous thromboembolism prophylaxis for thoracic cancer patients. Now, 1 year after their release, we looked to assess practices and general adherence to these recommendations.
We conducted a survey among board-certified/board-eligible thoracic surgeons in the United States, between July and October 2023.
A total of 103 board-certified thoracic surgeons responded to the survey. Over half of the surgeons reported using preoperative chemical thromboprophylaxis routinely for lobectomy/sublobar resections (56.3%), pneumonectomy/extended lung resections (64.1%), and esophagectomy (67%). Over two thirds of thoracic surgeons limited the duration of postoperative chemical thromboprophylaxis to the patient's length of hospital stay and never administered chemoprophylaxis post-discharge. Among surgeons who always continued chemical thromboprophylaxis post-discharge, low-molecular-weight heparin (LMWH) was the most commonly used agent (>70%), followed by direct oral anticoagulants (13.8%-16.7%). Only 33.3% of surgeons prescribing post-discharge chemical thromboprophylaxis after lobectomy/sublobar resections continued prophylaxis up to 4 weeks postoperatively.
Contrary to the 2022 joint AATS/ESTS guidelines, the majority of surveyed thoracic surgeons in the United States do not routinely prescribe postoperative thromboprophylaxis after lung and esophageal cancer resections. The dogma of routine extended thromboprophylaxis must be reevaluated as modern minimally invasive thoracic surgery allows for very earlier ambulation and enhanced recovery. There is a need for randomized controlled trials exploring the utility of extended thromboprophylaxis and newer agents such as direct oral anticoagulants.
2022年，美国胸外科医师协会（AATS）和欧洲胸外科医师协会（ESTS）发布了关于胸段癌患者围手术期静脉血栓栓塞症预防的时机、持续时间和药物选择的联合指南。如今，在指南发布1年后，我们旨在评估这些建议的实施情况和总体遵循情况。
2023年7月至10月期间，我们对美国具备委员会认证资格/符合委员会认证条件的胸外科医生进行了一项调查。
共有103名获得委员会认证的胸外科医生回复了调查。超过半数的外科医生报告称，在肺叶切除术/肺段以下切除术（56.3%）、全肺切除术/扩大肺切除术（64.1%）和食管切除术（67%）中常规使用术前化学血栓预防措施。超过三分之二的胸外科医生将术后化学血栓预防的持续时间限制在患者住院期间，出院后从不进行化学预防。在出院后一直继续进行化学血栓预防的外科医生中，低分子肝素（LMWH）是最常用的药物（>70%），其次是直接口服抗凝剂（13.8%-16.7%）。在肺叶切除术/肺段以下切除术后开具出院后化学血栓预防药物的外科医生中，只有33.3%的人在术后持续预防长达4周。
与2022年AATS/ESTS联合指南相反，美国大多数接受调查的胸外科医生在肺癌和食管癌切除术后不常规开具术后血栓预防药物。由于现代微创胸外科手术允许患者更早活动并加快康复，常规延长血栓预防的教条必须重新评估。需要进行随机对照试验，以探索延长血栓预防和新型药物（如直接口服抗凝剂）的效用。
