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January 6, 2016
Preoperative Heparin Safe for Patients Undergoing Major Cancer Surgery

New York—The preoperative use of blood thinners such as heparin is safe for patients undergoing major cancer surgery, according to a new study.

Results suggest that the drugs do not increase rates of major bleeding or transfusions. The report was published online ahead of print in the Journal of the American College of Surgeons.

Background information in the article notes that administering blood thinners after surgical procedures is a common practice to prevent venous thromboembolism (VTE). No large studies, however, have investigated the safety and efficacy of giving a single preoperative dose of blood thinners, in addition to postoperative doses, to patients undergoing major cancer operations, according to study authors from Memorial Sloan Kettering Cancer Center (MSKCC) in New York.

Using National Surgical Quality Improvement Program (NSQIP) data, Sloan Kettering determined it had higher than expected rates of DVT and pulmonary embolism and sought to remedy that.

“We weren't sure if our VTE rate was due to the complexity of our operations, the fact that our patients had cancer, or that we weren't administering heparin, which could decrease the blood clots,” said coauthor Vivian Strong, MD, FACS.

“There was serious concern that administering preoperative VTE prophylaxis to our patients, who undergo extensive surgical resection, would increase the risk of bleeding. Knowing, from NSQIP, that we had a higher than expected VTE rate, the question was whether it was safe to expose our patients to the additional bleeding risk from VTE prophylaxis,” added lead author Luke V. Selby, MD, in an American College of Surgeons press release.

For the study, the researchers selected 2,058 patients undergoing major surgery for cancer to receive preoperative VTE prophylaxis of either low-molecular-weight heparin or unfractionated heparin. Bleeding, transfusion, and VTE rates from that cohort was then compared to a group of 4,960 cancer patients who had undergone a major surgical procedure a year earlier without VTE prophylaxis.

Results indicate that providing one dose of anticoagulant before surgery is safe and effective. Patients receiving VTE prophylaxis had lower transfusion rates (17% vs.14%) without raising their risk for major bleeding. Rates of deep venous thrombosis (1.3% vs. 0.2%) and pulmonary embolus (1.0% vs. 0.4%) also were significantly lower in the group receiving preoperative blood thinners.

“This research has been a practice-changing study for our institution,” Strong said. “Our study results demonstrate to other institutions that you can use preoperative VTE prophylaxis safely, so I think that it has very broad-reaching, practice-changing implications.”


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