Postoperative Deep Vein Thrombosis in Patients Undergoing Surgery With Curative Intent for Colorectal Cancer: A Prospective Cohort Study

TL;DR

This study found that in-hospital thromboprophylaxis with compression stockings was sufficient to prevent DVT in colorectal cancer surgery patients in India.

Contribution

Demonstrates that in-hospital thromboprophylaxis may be sufficient for DVT prevention in this patient group in the Indian context.

Findings

No symptomatic or asymptomatic DVT was detected during follow-up in 42 patients.

In-hospital thromboprophylaxis with GCS and LMWH was effective in preventing DVT.

Patients with follow-up Doppler had greater exposure to neoadjuvant/adjuvant therapy.

Abstract

Background

Deep vein thrombosis (DVT) is a known postoperative complication associated with morbidity and mortality. Colorectal cancer patients have a higher risk of developing postoperative DVT, considering the long duration of surgery, positioning during surgery, pelvic dissection, and neoadjuvant chemoradiotherapy. For them, current guidelines recommend a protocol of 28-day postoperative pharmacological thromboprophylaxis with low-molecular-weight heparin (LMWH), unfractionated heparin, or fondaparinux, along with mechanical thromboprophylaxis like graduated compression stockings (GCS). However, most patients receive only in-hospital thromboprophylaxis. The aim of this study was to estimate the frequency of DVT in patients undergoing curative intent surgery for colorectal cancer, followed by postoperative thromboprophylaxis with GCS during their in-hospital stay in the Indian population.

Methods

Patients undergoing curative intent surgery for colorectal cancer were screened for occult pre-operative DVT including a duplex ultrasound. All patients received in-hospital thromboprophylaxis with LMWH and GCS and were followed up for 28 days to six months after surgery to screen for symptomatic and asymptomatic DVT during their follow-up.

Results

Of the 42 patients recruited to the study, 13 were followed up with Doppler ultrasonography and 29 were followed for symptoms of DVT telephonically. No asymptomatic DVT or symptomatic DVT was detected during the follow-up. There was no significant difference in the risk factors between those who underwent follow-up Doppler ultrasonography and those who did not, except that those who did have follow-up Doppler ultrasonography had a greater exposure to neoadjuvant and/or adjuvant therapy.

Conclusions

Our study suggests that thromboprophylaxis during the in-hospital postoperative period along with GCS was sufficient for preventing symptomatic or asymptomatic postoperative DVT in patients undergoing curative-intent surgery for colorectal cancer. However, a study with a larger sample size is required to recommend this for thromboprophylaxis in patients undergoing surgery for colorectal cancer in India.