SCI

3 August 2022

Should All Patients Receive Extended Thromboprophylaxis After Resection of Primary Lung Cancer?

(JTCVS, IF: 6.439)

• Kho J, Mitchell J, Curry N, Di Chiara F, Stavroulias D, Belcher E, Should AllPatients Receive Extended Thromboprophylaxis After Resection of Primary Lung Cancer?, The Journalof Thoracic and Cardiovascular Surgery (2022), doi: https://doi.org/10.1016/j.jtcvs.2022.06.016.

Objective 目的

The optimal duration of thromboprophylaxis in patients undergoing resection of primary lung cancer is not known. We investigated the incidence of pulmonary emboli  and venous thromboembolism in patients undergoing early-stage lung cancer resection and the impact of change from short duration to extended thromboprophylaxis.

在接受原发性肺癌切除术的患者中，预防血栓形成的最佳时间尚不清楚。我们调查了接受早期肺癌切除术的患者肺栓塞和静脉血栓栓塞的发生率，以及从短时间预防到延长预防血栓的影响。

Methods 方法

We reviewed the outcomes of consecutive patients who underwent resection  of early-stage primary lung cancer following a change in protocol from inpatient only to extended thromboprophylaxis to 28 days. Propensity-score matching of control  (routine inpatient pharmacological thromboprophylaxis) and treatment group (extended pharmacological thromboprophylaxis) was performed. Adjustment for covariates based  on the Caprini Risk Assessment Model was undertaken. Thromboembolic outcomes were compared between the two groups.

我们回顾了连续接受早期原发性肺癌切除术的患者的治疗结果，这些患者的治疗方案从单纯住院改为延长血栓预防治疗至28天。对照组（常规住院药物预防血栓形成）和治疗组（延长药物预防血栓形成）进行倾向评分匹配。根据卡普里尼风险评估模型进行协变量调整。比较两组的血栓栓塞结果。

Results 结果

Seven hundred and fifty consecutive patients underwent resection of primary lung cancer at Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018. Six hundred patients were included for analysis and propensity-score matching resulted in 253 matched pairs. Extended prophylaxis was  associated with a significant reduction in pulmonary emboli (PE) (10 of 253 patients (4%) vs. 1 of 253 patients (0.4%), p=0.01). One patient (0.4%) developed a bleeding complication within the treatment cohort. Multivariable logistic regression model demonstrated that extended thromboprophylaxis was independently associated with a reduction in postoperative PE.

2013年1月至2018年12月，连续750名患者在牛津大学医院NHS基金会信托行原发性肺癌切除术。600名患者被纳入分析，倾向评分匹配得到253对匹配组。延长预防与肺栓塞(PE)显著降低相关(253例患者中10例(4%)vs. 253例患者中1例(0.4%)，p=0.01)。1例患者(0.4%)在治疗队列中发生出血并发症。多变量Logistic回归模型显示，延长血栓预防与术后PE降低独立相关。

Conclusions 结论

Patients undergoing lung cancer resection surgery are at moderate to high risk of postoperative thromboembolic disease. Extended dalteparin for 28 days is safe and is associated with reduced incidence of pulmonary embolus in patients undergoing resection of early-stage primary lung cancer.

接受肺癌切除术的患者术后发生血栓栓塞性疾病的风险中等至高。在接受早期原发性肺癌切除术的患者中，延长达肝素钠28天是安全的，并与减少肺栓塞的发生率有关。

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