PB1472 - One-week versus extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer: an individual patient meta-analysis

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

CB

Cecilia Becattini, PhD

Professor
University of Perugia
Perugia, Umbria, Italy

Co-Author(s)

FR

Fabio Rondelli

MD
Department of General Surgery, University of Perugia, Terni
Terni, Umbria, Italy
UP

Ugo Pace

MD
Colorectal Surgical Oncology, Istituto Nazionale per lo studio e la cura dei tumori, “Fondazione Giovanni Pascale IRCCS-Italia”
Naples, Campania, Italy
FP

Felice Pirozzi

MD
Laparoscopic and Robotic surgery, Department of General Surgery, Santa Maria delle Grazie Hospital
Pozzuoli, Campania, Italy
Giuseppe Camporese, MD

Vascular Physician
Department of Internal Medicine, Padua University Hospital
Padua, Veneto, Italy
MB

Michela Boncompagni

MD
Department of General Surgery, S. Maria della Misericordia Hospital
Perugia, Umbria, Italy
DC

Damiano Chiari

MD
Department of Biomedical Sciences, Humanitas University
Milan, Lombardia, Italy
AD

Annibale Donini

MD
Department of Oncology Surgery, University of Perugia
Perugia, Umbria, Italy
AV

Adriana Visonà

Head
UOC Angiologia - Dipartimento di Medicina Clinica - Azienda ULSS 2 Marca Trevigiana - Ospedale San Giacomo Apostolo
Castelfranco Veneto, Veneto, Italy
RD

Raffaele De Luca

MD
Department of Surgical Oncology IRCCS Istituto Tumori " Giovanni Paolo II
Bari, Puglia, Italy
FG

Francesco Guerra

MD
Department of General Surgery, Ospedali Riuniti Marche Nord
Pesaro, Marche, Italy
AM

Andrea Muratore

MD
Department of General Surgery, E. Agnelli Hospital
Pinerolo, Piemonte, Italy
GP

Giuseppe Portale

MD
Department of General Surgery, Cittadella Hospital, AULSS 6 Euganea
CIttadella, Veneto, Italy
AB

Alberto Bartoli

MD
Department of General Surgey, San Matteo degli Infermi Hospital
Spoleto, Umbria, Italy
Marc Righini, MD

MD
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
Geneve, Geneve, Switzerland
SF

Stefania Frasson

MD
Research Department, FADOI Foundation
Milan, Lombardia, Italy
FD

Francesco Dentali

MD
Department of Emergencies and Medical Center, ASST “Sette Laghi”, Insubria University
Varese, Lombardia, Italy
PD

Paolo Delrio

MD
Colorectal Surgical Oncology, Istituto Nazionale per lo studio e la cura dei tumori, “Fondazione Giovanni Pascale IRCCS-Italia”
Naples, Campania, Italy
Giancarlo Agnelli, MD

Professor
University of Perugia
Perugia, Umbria, Italy
Maria Cristina Vedovati, MD

Professor
Vascular and Emergency Medicine, University of Perugia
Perugia, Umbria, Italy

Background: The clinical benefit of extended antithrombotic prophylaxis for venous thromboembolism (VTE) and the risk factors for post-operative VTE after laparoscopic surgery for cancer are unclear.

Aims: We aimed at assessing risk factors for post-operative VTE after laparoscopic surgery for colorectal cancer in patients randomized to receive extended 4-week or short 1-week prophylaxis.

Methods: An individual patient data meta-analysis (IPDMA) of randomized, controlled studies assessing the clinical benefit of extended versus short antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer was performed. The primary study outcome was the composite of symptomatic objectively confirmed VTE, asymptomatic ultrasonography-detected deep vein thrombosis or VTE-related death at 90 days after surgery. The primary safety outcome was major bleeding.

Results: Two randomized, controlled studies were selected for this meta-analysis. Individual data of 794 patients from the two studies were pooled for the analysis. A primary study outcome event occurred in 5 out of 399 patients randomized to extended compared with 22 out of 395 randomized to short prophylaxis (1.3 vs 5.6%; hazard ratio, 0.22; 95% confidence interval, 0.08 to 0.58; p=0.002). Major bleeding occurred in two patients randomized to extended compared with one patient randomized to short prophylaxis. The complete analysis of risk factors for post-operative VTE in patients randomized to extended or short-term prophylaxis after laparoscopic surgery for colorectal cancer will be prepared to be presented at the ISTH 2023 Congress.

Conclusion(s): Extended antithrombotic prophylaxis reduces the risk for post-operative VTE after laparoscopic surgery for colorectal cancer, without increasing the risk for major bleeding.