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14.06.2018 | original article

The impact of hereditary thrombophilia on the incidence of postoperative venous thromboembolism in colorectal cancer patients: a prospective cohort study

Hereditary thrombophilia and VTE in colorectal cancer surgery

Zeitschrift:
European Surgery
Autoren:
Jan Ulrych, MD, PhD Assoc. Prof. Tomas Kvasnicka, Vladimir Fryba, Martin Komarc, Ivana Malikova, Radka Brzezkova, Jan Kvasnicka Jr, Zdenek Krska, Jan Briza, Jan Kvasnicka

Summary

Background

Hereditary thrombophilia may play an important role in the rate of postoperative venous thromboembolism (VTE). We focused on the impact of hereditary thrombophilia on VTE incidence in colorectal cancer surgery patients within a 1-year postoperative period.

Methods

Preoperatively, identifying of colorectal cancer patients with thrombotic mutations (PTM+) and without thrombotic mutations (PTM−) was performed by screening of factor V Leiden (FVL) and prothrombin G20210A mutation. Within prophylactic period (0–28 days postoperatively), coagulation markers (platelets, fibrinogen, D‑dimer) were measured and symptomatic VTE was observed. Within post-prophylactic period (2–12 months after surgery), symptomatic VTE was observed.

Results

In all, 202 patients were assessed and hereditary thrombophilia was detected in 9.9% (FVL 8.4%; prothrombin G20210A mutation 1.5%). In the prophylactic period, VTE incidence in PTM+ and PTM− was 0.0% and 1.6%, respectively (p = 0.730). Levels of coagulation markers were comparable in both patient cohorts within 28 days postoperatively. In the post-prophylactic period, VTE incidence in PTM+ and PTM− was 15.0% and 5.5%, respectively (p = 0.125), and detailed incidence of deep vein thrombosis (DVT) in PTM+ and PTM− was 15.0% and 3.3%, respectively (p = 0.048). We observed significantly increased incidence of lower extremity DVT in such patients with FVL (17.6%).

Conclusion

The standard regimen of extended-duration VTE prophylaxis is adequate for colorectal cancer patients with thrombotic mutations and more intensified VTE prophylaxis within the 28-day postoperative period is not justified. However, the ongoing postoperative pharmacologic prophylaxis (>28 days) should be considered in patients with hereditary thrombophilia, especially with FVL.

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