Scholarlink

Purpose <p>To report (1) efficacy and (2) safety outcomes comparing extended thromboprophylaxis (ETP) with low molecular weight heparin (LMWH) and direct oral anticoagulants (DOAC) versus no ETP after colorectal surgery.</p> Methods <p>A systematic review using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to March 2024. Randomised controlled trials and observational studies investigating ETP with LMWH or DOAC for at least 28&#xa0;days were included. (1) Efficacy outcome was venous thromboembolism (VTE) rate at 30-days postoperatively. (2) Safety outcomes included major bleeding events at 30–90-days. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using a Mantel–Haenszel fixed effects model.</p> Results <p>Five studies (2936 patients) investigating colorectal surgery for colorectal cancer (CRC) or inflammatory bowel disease (IBD) were included. Total VTE rates were significantly reduced in the LMWH ETP group compared with no ETP [0.56% (OR 0.18, 95% CI 0.07–0.50]. The DOAC ETP group was also compared with no ETP with lower total VTE rates [OR 0.22, 95% CI 0.08–0.67]. There was no difference in VTE rates between LMWH and DOAC ETP. There were no differences in major bleeding events in the LMWH ETP group at 90-days [OR 0.25, 95% CI 0.03–2.24], or the DOAC ETP at 30-days [OR 2.68, 95% CI 0.32–22.35]. There were no VTE-related mortalities at 90-days in either group.</p> Conclusion <p>ETP after colorectal surgery for CRC and IBD reduced the incidence of VTEs with no impact on major bleeding within 90-days. ETP for at least 28&#xa0;days should be considered particularly for those who have a high risk for postoperative VTE.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

The efficacy and safety of extended thromboprophylaxis after colorectal surgery: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年10月9日

查看全文
  • Joseph Do Woong Choi,
  • Nguyen Huynh,
  • Talia Shepherd,
  • Aswin Shanmugalingam,
  • Fiona Lee Gavegan,
  • Karen Shedden,
  • Amy Cao,
  • Nimalan Pathmanathan,
  • Toufic El-Khoury,
  • Kerry Hitos,
  • James Wei Tatt Toh

摘要

Purpose

To report (1) efficacy and (2) safety outcomes comparing extended thromboprophylaxis (ETP) with low molecular weight heparin (LMWH) and direct oral anticoagulants (DOAC) versus no ETP after colorectal surgery.

Methods

A systematic review using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to March 2024. Randomised controlled trials and observational studies investigating ETP with LMWH or DOAC for at least 28 days were included. (1) Efficacy outcome was venous thromboembolism (VTE) rate at 30-days postoperatively. (2) Safety outcomes included major bleeding events at 30–90-days. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using a Mantel–Haenszel fixed effects model.

Results

Five studies (2936 patients) investigating colorectal surgery for colorectal cancer (CRC) or inflammatory bowel disease (IBD) were included. Total VTE rates were significantly reduced in the LMWH ETP group compared with no ETP [0.56% (OR 0.18, 95% CI 0.07–0.50]. The DOAC ETP group was also compared with no ETP with lower total VTE rates [OR 0.22, 95% CI 0.08–0.67]. There was no difference in VTE rates between LMWH and DOAC ETP. There were no differences in major bleeding events in the LMWH ETP group at 90-days [OR 0.25, 95% CI 0.03–2.24], or the DOAC ETP at 30-days [OR 2.68, 95% CI 0.32–22.35]. There were no VTE-related mortalities at 90-days in either group.

Conclusion

ETP after colorectal surgery for CRC and IBD reduced the incidence of VTEs with no impact on major bleeding within 90-days. ETP for at least 28 days should be considered particularly for those who have a high risk for postoperative VTE.