Antithrombotic prophylaxis use and incidence of venous thromboembolism in lung cancer surgery: An observational retrospective study

Abstract

Introduction

Extended thromboprophylaxis with low-molecular-weight heparin (LMWH) for 28 days is recommended in patients undergoing major abdominal or pelvic cancer surgery, but the evidence for thoracic cancer surgery is weak. We aimed to evaluate the use of pharmacological thromboprophylaxis and incidence of venous thromboembolism (VTE) in adult patients undergoing lung cancer surgery in daily clinical practice.

Methods

Retrospective evaluation of a cohort of consecutive adult patients who had undergone lung cancer surgery. Patients were followed for 90 days after surgery.

Results

From 2000 to 2023, 405 patients were included (69% males; mean age 63.5 ± 10.1 years). Overall, 97.3% of the patients received LMWH thromboprophylaxis, with a median duration of 6 days (range, 1–30 days). Thromboprophylaxis use increased over time (from 94.9% in the period 2000–2012 to 99.1% in the period 2013–2023). During follow-up, 6 patients (1.5%) developed a VTE event: 3 isolated lower-limb deep vein thrombosis, and 3 non-fatal pulmonary embolism. Median time between surgery and the thrombotic event was 17.5 days (range, 4–78 days). Concomitant epidural analgesia and shorter hospital stay were associated with a lower risk of VTE. Three patients (0.7%) died during follow-up, none of them due to a VTE event.

Conclusions

While extended thromboprophylaxis could be considered for certain high-risk thoracic surgery cancer patients, our results do not support its widespread use due to the low rate of VTE after lung cancer surgery. More studies are needed to identify subgroups of patients that could benefit from tailored thromboprophylaxis strategies.