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Extended duration chemoprophylaxis for venous thromboembolism following abdominopelvic oncologic surgery

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Abstract

Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is the most common cause of 30-day morbidity in oncology patients following surgery due to their hypercoagulable state. To combat this, VTE prophylaxis with anticoagulation extending beyond hospital discharge, termed extended duration chemoprophylaxis (EDCP), has been proposed, with the most recent guidelines recommending 28 post-operative days of EDCP. However, the literature has demonstrated poor compliance to these recommendations. We extended the duration of EDCP to 28 days post hospital discharge, effectively creating a standard discharge prescription for all surgical oncology patients. Our aim is to assess our EDCP protocol on patient compliance and VTE rate following major oncologic resection. We performed a retrospective, single institution, cohort study that involved chart review and telephone survey on patients who underwent major open abdominopelvic oncologic resection. A total of 130 patients were included; 60 received EDCP and 68 did not. VTE rate for the EDCP cohort was 0% and 7.4% for the non-EDCP cohort (p = 0.04). 85% of patients were fully compliant with EDCP. No bleeding related complications with EDCP were identified. Our data is consistent with prior literature in demonstrating a lower VTE rate with EDCP without an increase in bleeding related complications and we have demonstrated that it is possible to achieve a high rate of patient compliance with EDCP.

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Acknowledgements

We would like to thank Karen Hagglund, MS, for her contributions with the statistical analysis of the data.

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Authors and Affiliations

  1. Department of Surgery, Ascension St. John Hospital and Medical Center, 22151 Moross Rd, Suite 212, Detroit, MI, 48236, USA

    John Kanitra, John Holtrop, Ali Jawad & Richard Berri

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  1. John Kanitra
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  2. John Holtrop
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  3. Ali Jawad
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  4. Richard Berri
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JK, JH and AJ. The first draft of the manuscript was written by JK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Richard Berri.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ascension St. John Hospital institutional review board; 1340191-1) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the telephone survey.

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Kanitra, J., Holtrop, J., Jawad, A. et al. Extended duration chemoprophylaxis for venous thromboembolism following abdominopelvic oncologic surgery. J Thromb Thrombolysis 50, 190–194 (2020). https://doi.org/10.1007/s11239-019-02002-9

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  • DOI: https://doi.org/10.1007/s11239-019-02002-9

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