Extended Venothromboembolism Prophylaxis in Patients with Pancreas Adenocarcinoma Undergoing Abdominal Surgery: Is it Really Beneficial?

INTRODUCTION: Current practice guidelines recommend extended venothromboembolism prophylaxis (EVP) for patients with cancer undergoing abdominal surgery.Patients with pancreatic adenocarcinoma (PCA) are especially prone to venothromboembolism (VTE) development.We aim to investigate the relationship between extended VTE prophylaxis in PCA patients and symptomatic VTE development.Methods: We retrospectively reviewed patients with pathology proven pancreatic ductal adenocarcinoma undergoing abdominal surgery in a high volume HPB surgical program from 2013 to 2016.Implementation of EVP was decided by surgeon preference during this time period.Patients receiving EVP were compared to those receiving standard in-hospital VTE prophylaxis.Outcomes were occurrence of symptomatic VTE within 90 days postoperatively and bleeding complications requiring transfusion.Standard statistical analysis was employed (p<0.05).Results: 124 patients were included, 54 (44%) of whom received EVP, while 70 (56%) received no VTE prophylaxis after hospital discharge.Both the EVP and control groups displayed similar patient and tumour characteristics (age at operation, percentage of male patients, and ASA at operation) (p>0.05).There was no significant difference in the rate of symptomatic VTE between the EVP and control group (0% vs. 2.9% respectively, p=0.21).The overall 90-day VTE rate for all PCA patients was 2 out of 124 patients (1.6%).One patient suffered a pulmonary embolus while the other had right subclavian vein thrombosis.Both patients were systemically anticoagulated and neither event resulted in mortality.Furthermore, there were no bleeding complications postoperatively in either group.Conclusion: In this cohort, EVP was associated with a similar rate of postoperative VTE in patients with PCA undergoing abdominal surgery, when compared to standard in-house VTE prophylaxis.Neither cohort had any bleeding complications.Furthermore, the rate of symptomatic VTE in all patients was only 1.6%.Given the significant financial cost of EVP, coupled with the uncommon occurrence of VTE observed in this patient cohort, prospective analysis with randomized controlled trials is imperative.Tu1402