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

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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.	复旦大学附属中山医院围手术期处理多学科团队. 接受抗凝药物治疗的普外科病人围手术期处理—中山共识(1). 中国实用外科杂志, 2013, 33(1): 1-3.
3.	复旦大学附属中山医院围手术期处理多学科团队. 普外科病人围手术期血栓预防—中山共识(2). 中国实用外科杂志, 2013, 33(11): 946-948.
4.	中华医学会外科学分会. 中国普通外科围手术期血栓预防与管理指南. 中国实用外科杂志, 2016, 36(5): 469-474.
5.	李瑶, 李红斌. 低分子肝素钠在腹部外科手术后预防下肢深静脉血栓形成的效果观察. 中国当代医药, 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.	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版). 中华血管外科杂志, 2017, 2(4): 201-208.
13.	中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南. 中华医学杂志, 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, 刘凤林. 围手术期静脉血栓栓塞症预防和管理几个关键问题. 中国实用外科杂志, 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.	许小毛, 孙铁英. 恶性肿瘤合并静脉血栓栓塞症的相关研究. 北京协和医学院, 2014.
21.	Rasmussen MS, Jørgensen LN, Wille-Jørgensen 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.	陈晓春, 贾乐生, 杨爽. 四肢骨折 D-二聚体的变化与血栓形成相关性及干预性治疗. 中国现代医生, 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.	庞德兵. 小剂量尿激酶联合低分子肝素钠治疗下肢深静脉血栓形成临床观察. 内科, 2013, 8(3): 242-243.
28.	中华医学会肠外肠内营养学分会, 加速康复外科协作组. 结直肠手术应用加速康复外科中国专家共识(2015 版). 中华结直肠疾病电子杂志, 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. 复旦大学附属中山医院围手术期处理多学科团队. 接受抗凝药物治疗的普外科病人围手术期处理—中山共识(1). 中国实用外科杂志, 2013, 33(1): 1-3.
3. 复旦大学附属中山医院围手术期处理多学科团队. 普外科病人围手术期血栓预防—中山共识(2). 中国实用外科杂志, 2013, 33(11): 946-948.
4. 中华医学会外科学分会. 中国普通外科围手术期血栓预防与管理指南. 中国实用外科杂志, 2016, 36(5): 469-474.
5. 李瑶, 李红斌. 低分子肝素钠在腹部外科手术后预防下肢深静脉血栓形成的效果观察. 中国当代医药, 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. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版). 中华血管外科杂志, 2017, 2(4): 201-208.
13. 中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南. 中华医学杂志, 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, 刘凤林. 围手术期静脉血栓栓塞症预防和管理几个关键问题. 中国实用外科杂志, 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. 许小毛, 孙铁英. 恶性肿瘤合并静脉血栓栓塞症的相关研究. 北京协和医学院, 2014.
21. Rasmussen MS, Jørgensen LN, Wille-Jørgensen 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. 陈晓春, 贾乐生, 杨爽. 四肢骨折 D-二聚体的变化与血栓形成相关性及干预性治疗. 中国现代医生, 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. 庞德兵. 小剂量尿激酶联合低分子肝素钠治疗下肢深静脉血栓形成临床观察. 内科, 2013, 8(3): 242-243.
28. 中华医学会肠外肠内营养学分会, 加速康复外科协作组. 结直肠手术应用加速康复外科中国专家共识(2015 版). 中华结直肠疾病电子杂志, 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

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