Preoperative chemoprophylaxis is safe in major oncology operations and effective at preventing venous thromboembolism Journal Article


Authors: Selby, L. V.; Sovel, M.; Sjoberg, D. D.; McSweeney, M.; Douglas, D.; Jones, D. R.; Scardino, P. T.; Soff, G. A.; Fabbri, N.; Sepkowitz, K.; Strong, V. E.; Sarkaria, I. S.; MSKCC VTE Task Force
Article Title: Preoperative chemoprophylaxis is safe in major oncology operations and effective at preventing venous thromboembolism
Abstract: Background We prospectively evaluated the safety and efficacy of adding preoperative chemoprophylaxis to our institution's operative venous thromboembolism (VTE) prophylaxis policy as part of a physician-led quality improvement initiative. Study Design Patients undergoing major cancer surgery between August 2013 and January 2014 were screened according to service-specific eligibility criteria and targeted to receive preoperative VTE chemoprophylaxis. Bleeding, transfusion, and VTE rates were compared with rates of historical controls who had not received preoperative chemoprophylaxis. Results The 2,058 eligible patients who underwent operation between August 2013 and January 2014 (post-intervention) were compared with a cohort of 4,960 patients operated on between January 2012 and June 2013, who did not receive preoperative VTE chemoprophylaxis (pre-intervention). In total, 71% of patients in the post-intervention group were screened for eligibility; 82% received preoperative anticoagulation. When compared with the pre-intervention group, the post-intervention group had significantly lower transfusion rates (pre- vs post-intervention, 17% vs 14%; difference 3.5%, 95% CI 1.7% to 5%, p = 0.0003) without significant difference in major bleeding (difference 0.3%, 95% CI -0.1% to 0.7%, p = 0.2). Rates of deep venous thrombosis (1.3% vs 0.2%; difference 1.1%, 95% CI 0.7% to 1.4%, p < 0.0001) and pulmonary embolus (1.0% vs 0.4%; difference 0.6%, 95% CI 0.2% to 1%, p = 0.017) were significantly lower in the post-intervention group. Conclusions In patients undergoing major cancer surgery, institution of a single dose of preoperative chemoprophylaxis, as part of a physician-led quality improvement initiative, did not increase bleeding or blood transfusions and was associated with a significant decrease in VTE rates. © 2016 American College of Surgeons.
Journal Title: Journal of the American College of Surgeons
Volume: 222
Issue: 2
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2016-02-01
Start Page: 129
End Page: 137
Language: English
DOI: 10.1016/j.jamcollsurg.2015.11.011
PROVIDER: scopus
PMCID: PMC4729628
PUBMED: 26711793
DOI/URL:
Notes: Article -- Export Date: 4 April 2016 -- Source: Scopus
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MSK Authors
  1. Kent A Sepkowitz
    242 Sepkowitz
  2. Peter T Scardino
    621 Scardino
  3. Daniel D. Sjoberg
    138 Sjoberg
  4. Vivian Strong
    144 Strong
  5. Gerald A Soff
    59 Soff
  6. Nicola Fabbri
    13 Fabbri
  7. Mindy Sovel
    5 Sovel
  8. David Randolph Jones
    152 Jones
  9. Luke   Selby
    19 Selby