Analysis of efficacy and safety of early administration of low molecular weight heparin inpreventing of venous thromboembolism after pancreatoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

Lü Zhiming , GUAN Fabin , Sulidankaza· Qiuman , GENG Cheng ,  HE Tieying

Department of Pancreas Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;

Corresponding?author：

HE Tieying, Email: tietie5309@163.com

Keywords：

venous thromboembolism; pancreaticoduodenectomy; preventive anticoagulation; low molecular weight heparin

DOI：

10.7507/1007-9424.202008074

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate efficacy and safety of early anticoagulation therapy with low molecular weight heparin (LMWH) in prevention of venous thromboembolism (VTE) after pancreatoduodenectomy (PD).Methods The patients who received PD in our hospital from January 2017 to December 2018 were collected retrospectively, then were divided into the anticoagulant group and the non-anticoagulant group. The operation time, intraoperative blood loss, tumor property, coagulation function indexes such as prothrombin time (PT), PT activity (PTA), fibrinogen (FIB), activated partial thromboplastin time (APTT), thrombin time (TT), and D-dimer (DD), platelet (PLT), VTE, bleeding related complications etc. were compared between the two groups.Results A total of 103 patients underwent PD were included in this study, including 52 patients in the anticoagulant group and 51 patients in the non-anticoagulant group. There were no significant differences in the baseline data such as the gender, age, and preoperative coagulation function indexes, etc. between the two groups (P>0.05). The incidence of VTE in the anticoagulant group was lower than that in the non-anticoagulant group (13.5% versus 47.1%, P<0.001). There was no significant difference in the incidence of bleeding between the anticoagulant group and the non-anticoagulant group (9.6% versus 7.8%, P>0.05). There were no statistically significant differences in the coagulation indexes between the two groups before operation and day 1 after operation (P>0.05). On day 8 after operation, the FIB and DD values of the anticoagulant group were significantly lower than those of the non-anticoagulant group (P values were 0.040 and 0.002, respectively). A comparison of different phases in the same group on coagulation indexes between day 8 and day 1 after surgery showed that there were statistically significant differences (P<0.05), the changes of all indexes were within the normal range.Conclusion The results of this study indicate that LMWH administered at 24 h after PD could decrease incidence of VTE and don’t increase risk of bleeding.

Citation： Lü Zhiming, GUAN Fabin, Sulidankaza· Qiuman, GENG Cheng, HE Tieying. Analysis of efficacy and safety of early administration of low molecular weight heparin inpreventing of venous thromboembolism after pancreatoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 636-640. doi: 10.7507/1007-9424.202008074 Copy

1.	Yhim HY, Jang MJ, Kwak JY, et al. The incidence, risk factors, and prognosis of recurrent venous thromboembolism (VTE) in patients with advanced solid cancers receiving anticoagulation therapy after the diagnosis of index VTE. Thromb Res, 2013, 131(4): e133-e140.
2.	復旦大學附屬中山醫院圍手術期處理多學科團隊. 接受抗凝藥物治療的普外科病人圍手術期處理—中山共識(1). 中國實用外科雜志, 2013, 33(1): 1-3.
3.	復旦大學附屬中山醫院圍手術期處理多學科團隊. 普外科病人圍手術期血栓預防—中山共識(2). 中國實用外科雜志, 2013, 33(11): 946-948.
4.	中華醫學會外科學分會. 中國普通外科圍手術期血栓預防與管理指南. 中國實用外科雜志, 2016, 36(5): 469-474.
5.	李瑤, 李紅斌. 低分子肝素鈉在腹部外科手術后預防下肢深靜脈血栓形成的效果觀察. 中國當代醫藥, 2014, 21(21): 52-53, 56.
6.	Sakon M, Maehara Y, Yoshikawa H, et al. Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan. J Thromb Haemost, 2006, 4(3): 581-586.
7.	Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e227S-e277S.
8.	Blom JW, Osanto S, Rosendaal FR. High risk of venous thrombosis in patients with pancreatic cancer: a cohort study of 202 patients. Eur J Cancer, 2006, 42(3): 410-414.
9.	De Martino RR, Goodney PP, Spangler EL, et al. Variation in thromboembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg, 2012, 55(4): 1035-1040.
10.	Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e278S-e325S.
11.	Hill J, Treasure T; National Clinical Guideline Centre for Acute and Chronic Conditions. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance. BMJ, 2010, 340: c95.
12.	中華醫學會外科學分會血管外科學組. 深靜脈血栓形成的診斷和治療指南(第三版). 中華血管外科雜志, 2017, 2(4): 201-208.
13.	中華醫學會呼吸病學分會肺栓塞與肺血管病學組, 中國醫師協會呼吸醫師分會肺栓塞與肺血管病工作委員會, 全國肺栓塞與肺血管病防治協作組. 肺血栓栓塞癥診治與預防指南. 中華醫學雜志, 2018, 98(14): 1060-1087.
14.	Beger HG, Gansauge F, Sehwarz M, et al. Pancreatic head resection: the risk for local and systemic complications in 1 315 patients—a monoinatitutional experience. Am J Surg, 2007, 194(4 Suppl): S16-S19.
15.	Rostas JW, Manley J, Gonzalez RP, et al. The safety of low molecular-weight heparin after blunt liver and spleen injuries. Am J Surg, 2015, 210(1): 31-34.
16.	秦新裕, 劉鳳林. 圍手術期靜脈血栓栓塞癥預防和管理幾個關鍵問題. 中國實用外科雜志, 2017, 37(2): 97-102.
17.	Nathens AB, McMurray MK, Cuschieri J, et al. The practice of venous thromboembolism prophylaxis in the major trauma patient. J Trauma, 2007, 62(3): 557-562.
18.	Kim JY, Khavanin N, Rambachan A, et al. Surgical duration and risk of venous thromboembolism. JAMA Surg, 2015, 150(2): 110-117.
19.	Qiu CS, Jordan SW, Dorfman RG, et al. Surgical duration impacts venous thromboembolism risk in microsurgical breast reconstruction. J Reconstr Microsurg, 2018, 34(1): 47-58.
20.	許小毛, 孫鐵英. 惡性腫瘤合并靜脈血栓栓塞癥的相關研究. 北京協和醫學院, 2014.
21.	Rasmussen MS, J?rgensen LN, Wille-J?rgensen P. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev, 2009, (1): CD004318.
22.	Agnelli G, George DJ, Kakkar AK, et al. Semuloparin for thromboprophylaxis in patients receiving chemotherapy for cancer. N Engl J Med, 2012, 366(7): 601-609.
23.	Agnelli G, Gussoni G, Bianchini C, et al. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study. Lancet Oncol, 2009, 10(10): 943-949.
24.	Haas SK, Freund M, Heigener D, et al. Low-molecular-weight heparin versus placebo for the prevention of venous thromboembolism in metastatic breast cancer or stage Ⅲ/Ⅳ lung cancer. Clin Appl Thromb Hemost, 2012, 18(2): 159-165.
25.	陳曉春, 賈樂生, 楊爽. 四肢骨折 D-二聚體的變化與血栓形成相關性及干預性治療. 中國現代醫生, 2009, 47(1): 11-12, 36.
26.	Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 2004, 126(3 Suppl): 338S-400S.
27.	龐德兵. 小劑量尿激酶聯合低分子肝素鈉治療下肢深靜脈血栓形成臨床觀察. 內科, 2013, 8(3): 242-243.
28.	中華醫學會腸外腸內營養學分會, 加速康復外科協作組. 結直腸手術應用加速康復外科中國專家共識(2015 版). 中華結直腸疾病電子雜志, 2015, 4(5): 456-459.

1. Yhim HY, Jang MJ, Kwak JY, et al. The incidence, risk factors, and prognosis of recurrent venous thromboembolism (VTE) in patients with advanced solid cancers receiving anticoagulation therapy after the diagnosis of index VTE. Thromb Res, 2013, 131(4): e133-e140.
2. 復旦大學附屬中山醫院圍手術期處理多學科團隊. 接受抗凝藥物治療的普外科病人圍手術期處理—中山共識(1). 中國實用外科雜志, 2013, 33(1): 1-3.
3. 復旦大學附屬中山醫院圍手術期處理多學科團隊. 普外科病人圍手術期血栓預防—中山共識(2). 中國實用外科雜志, 2013, 33(11): 946-948.
4. 中華醫學會外科學分會. 中國普通外科圍手術期血栓預防與管理指南. 中國實用外科雜志, 2016, 36(5): 469-474.
5. 李瑤, 李紅斌. 低分子肝素鈉在腹部外科手術后預防下肢深靜脈血栓形成的效果觀察. 中國當代醫藥, 2014, 21(21): 52-53, 56.
6. Sakon M, Maehara Y, Yoshikawa H, et al. Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan. J Thromb Haemost, 2006, 4(3): 581-586.
7. Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e227S-e277S.
8. Blom JW, Osanto S, Rosendaal FR. High risk of venous thrombosis in patients with pancreatic cancer: a cohort study of 202 patients. Eur J Cancer, 2006, 42(3): 410-414.
9. De Martino RR, Goodney PP, Spangler EL, et al. Variation in thromboembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg, 2012, 55(4): 1035-1040.
10. Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e278S-e325S.
11. Hill J, Treasure T; National Clinical Guideline Centre for Acute and Chronic Conditions. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance. BMJ, 2010, 340: c95.
12. 中華醫學會外科學分會血管外科學組. 深靜脈血栓形成的診斷和治療指南(第三版). 中華血管外科雜志, 2017, 2(4): 201-208.
13. 中華醫學會呼吸病學分會肺栓塞與肺血管病學組, 中國醫師協會呼吸醫師分會肺栓塞與肺血管病工作委員會, 全國肺栓塞與肺血管病防治協作組. 肺血栓栓塞癥診治與預防指南. 中華醫學雜志, 2018, 98(14): 1060-1087.
14. Beger HG, Gansauge F, Sehwarz M, et al. Pancreatic head resection: the risk for local and systemic complications in 1 315 patients—a monoinatitutional experience. Am J Surg, 2007, 194(4 Suppl): S16-S19.
15. Rostas JW, Manley J, Gonzalez RP, et al. The safety of low molecular-weight heparin after blunt liver and spleen injuries. Am J Surg, 2015, 210(1): 31-34.
16. 秦新裕, 劉鳳林. 圍手術期靜脈血栓栓塞癥預防和管理幾個關鍵問題. 中國實用外科雜志, 2017, 37(2): 97-102.
17. Nathens AB, McMurray MK, Cuschieri J, et al. The practice of venous thromboembolism prophylaxis in the major trauma patient. J Trauma, 2007, 62(3): 557-562.
18. Kim JY, Khavanin N, Rambachan A, et al. Surgical duration and risk of venous thromboembolism. JAMA Surg, 2015, 150(2): 110-117.
19. Qiu CS, Jordan SW, Dorfman RG, et al. Surgical duration impacts venous thromboembolism risk in microsurgical breast reconstruction. J Reconstr Microsurg, 2018, 34(1): 47-58.
20. 許小毛, 孫鐵英. 惡性腫瘤合并靜脈血栓栓塞癥的相關研究. 北京協和醫學院, 2014.
21. Rasmussen MS, J?rgensen LN, Wille-J?rgensen P. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev, 2009, (1): CD004318.
22. Agnelli G, George DJ, Kakkar AK, et al. Semuloparin for thromboprophylaxis in patients receiving chemotherapy for cancer. N Engl J Med, 2012, 366(7): 601-609.
23. Agnelli G, Gussoni G, Bianchini C, et al. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study. Lancet Oncol, 2009, 10(10): 943-949.
24. Haas SK, Freund M, Heigener D, et al. Low-molecular-weight heparin versus placebo for the prevention of venous thromboembolism in metastatic breast cancer or stage Ⅲ/Ⅳ lung cancer. Clin Appl Thromb Hemost, 2012, 18(2): 159-165.
25. 陳曉春, 賈樂生, 楊爽. 四肢骨折 D-二聚體的變化與血栓形成相關性及干預性治療. 中國現代醫生, 2009, 47(1): 11-12, 36.
26. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 2004, 126(3 Suppl): 338S-400S.
27. 龐德兵. 小劑量尿激酶聯合低分子肝素鈉治療下肢深靜脈血栓形成臨床觀察. 內科, 2013, 8(3): 242-243.
28. 中華醫學會腸外腸內營養學分會, 加速康復外科協作組. 結直腸手術應用加速康復外科中國專家共識(2015 版). 中華結直腸疾病電子雜志, 2015, 4(5): 456-459.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of efficacy and safety of early administration of low molecular weight heparin inpreventing of venous thromboembolism after pancreatoduodenectomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content