Thromboembolism in cancer patients. What should anaesthesiologists know
1Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
DOI: 10.22514/sv.2021.196 Vol.17,Issue S1,September 2021 pp.53-53
Submitted: 26 August 2021 Accepted: 06 September 2021
Published: 15 September 2021
Cancer patients are at high risk of thromboembolic complications (deep vein thrombosis, pulmonary embolism) which increase the morbidity and mortality rates. Τhe thromboembolic risk is further increased perioperatively in cancer surgery, rendering its prevention and management a clinical challenge. International Societies and Experts’ Panels have addressed this issue in an effort to fill in the existing gaps, since evidence is rather limited.
Thromboprophylaxis should be given to all patients undergoing cancer surgery. It should include pharmacological agents and should be initiated preoperatively and/or as soon as possible postoperatively. Mechanical prophylaxis alone is not recommended, and should be reserved only for cases where pharmacological thromboprophylaxis is contraindicated. Combined pharmacological/mechanical thromboprophylaxis should be used in high risk patients. The patient risk factors, co-morbidities, procedure type/duration and the surgical bleeding risk should be carefully assessed before deciding the scheme, drugs, dosing and timing of thromboprophylaxis. Low Molecular Weight Heparin (is the preferred agent), Unfractionated Heparin (if creatinine clearance <30 mL/min) and possibly Fondaparinux can be used for thromboprophylaxis. There is no consensus on the use of inferior vena cava filters; they are not recommended as a routine thromboprophylactic measure, but their placement could be considered in patients with pulmonary embolism or lower limb proximal deep vein thrombosis (especially during the first 2–4 weeks), if anticoagulants are contraindicated. The risk of intervention-related adverse effects/complications should be taken into account.
Postoperative pharmacological thromboprophylaxis should be maintained for at least 7–10 days. For high risk, major abdominal or pelvic surgery (laparotomy or laparoscopic), thromboprophylaxis should last longer (up to 4 weeks). Patients facing a high risk for both thrombosis and major bleeding should receive mechanical thromboprophylaxis first and pharmacological prophylaxis should be added as soon as possible. Early postoperative ambulation should be encouraged whenever possible.
Chryssoula Staikou. Thromboembolism in cancer patients. What should anaesthesiologists know. Signa Vitae. 2021. 17(S1);53-53.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.