Prospective Study on the Incidence of Postoperative Venous Thromboembolism in Korean Patients with Colorectal Cancer.
Prospective Study on the Incidence of Postoperative Venous Thromboembolism in Korean Patients with Colorectal Cancer.
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DOI：
10.4143/crt.2015.311
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发表时间：
2016-07
影响因子：
4.6
通讯作者：
Lee KW
中科院分区：
文献类型：
--
作者：
Lee E;Kang SB;Choi SI;Chun EJ;Kim MJ;Kim DW;Oh HK;Ihn MH;Kim JW;Bang SM;Lee JO;Kim YJ;Kim JH;Lee JS;Lee KW
为了预防静脉血栓栓塞症(VTE)，西方癌症患者接受大手术后，通常建议采用药物血栓预防措施。然而，在所有亚洲外科癌症患者中是否有必要常规给予药物血栓预防仍是不确定的。这项前瞻性研究旨在研究韩国结直肠癌(CRC)患者接受腹部大手术后发生VTE的发生率和危险因素。这项研究包括两个队列，没有患者接受围手术期药物血栓预防。在队列A(n=400)中，患者在术后第5-14天常规使用下肢多普勒超声(DUS)筛查静脉血栓栓塞症。B组(n=148)不行常规DUS检查，仅在有可疑VTE症状或体征时行影像检查。A组术后4周的VTE发生率为3.0%(n=12)。12例患者中，8例出现小腿静脉远端血栓，1例有症状性血栓形成。年龄≥70岁(优势比OR 5.6 1)、≥2合并症(OR 13.42)、白细胞计数<10 0 0/μL(OR 17.43)是术后VTE的独立危险因素(P<；0.0 5)。在队列B中，发生VTE 1例(0.7%)。在没有接受药物血栓预防的韩国结直肠癌患者中，术后VTE的发生率为3.0%，其中包括无症状病例。亚洲结直肠癌患者应在风险分层的基础上进行围手术期药物血栓预防。
Pharmacologic thromboprophylaxis is routinely recommended for Western cancer patients undergoing major surgery for prevention of venous thromboembolism (VTE). However, it is uncertainwhetherroutine administration of pharmacologic thromboprophylaxis is necessary in all Asian surgical cancer patients. This prospective study was conducted to examine the incidence of and risk factors for postoperative VTE in Korean colorectal cancer (CRC) patients undergoing major abdominal surgery. This study comprised two cohorts, and none of patients received perioperative pharmacologic thromboprophylaxis. In cohort A (n=400), patients were routinely screened for VTE using lower-extremity Doppler ultrasonography (DUS) on postoperative days 5-14. In cohort B (n=148), routine DUS was not performed, and imaging was only performed when there were symptoms or signs that were suspicious for VTE. The primary endpoint was the VTE incidence at 4 weeks postoperatively in cohort A. The postoperative incidence of VTE was 3.0% (n=12) in cohort A. Among the 12 patients, eight had distal calf vein thromboses and one had symptomatic thrombosis. Age ≥ 70 years (odds ratio [OR], 5.61), ≥ 2 comorbidities (OR, 13.42), and white blood cell counts of > 10,000/μL (OR, 17.43) were independent risk factors for postoperative VTE (p < 0.05). In cohort B, there was one case of VTE (0.7%). The postoperative incidence of VTE, which included asymptomatic cases, was 3.0% in Korean CRC patients who did not receive pharmacologic thromboprophylaxis. Perioperative pharmacologic thromboprophylaxis should be administered to Asian CRC patients on a risk-stratified basis.