One Size Does Not Fit All: Venous Thromboembolism Prophylaxis in Colorectal Cancer

Colorectal Cancer

JSLS. 2020 Jul-Sep;24(3):e2020.00038. doi: 10.4293/JSLS.2020.00038.


BACKGROUND AND OBJECTIVES: Venous thromboembolisms (VTEs) in patients who have undergone a colorectal cancer operation increases morbidity and mortality, lengthens recovery time, and are costly. The current common standard is a 28-day prophylactic regimen of 40 mg enoxaparin daily. This study aims to examine the variability in prophylaxis discharge prescriptions at one institution, report 30-day postoperative incidence of venous thromboembolisms and bleeding, and to offer a new protocol for VTE prophylaxis in postoperative patients.

METHODS: This retrospective case series occurred at Abington-Jefferson Health Hospital in Abington, PA. The electronic medical record was searched for patients who underwent an operation for colorectal cancer from October 2019 to mid-March 2020 and all discharge prophylaxis regimens were recorded and patient demographics were analyzed. Outcomes were measured by rate of VTEs and postoperative complications such as bleeding, transfusions, re-admission, and intensive care admission in the 30-day postoperative period.

RESULTS: Eighteen of 57 patients received a medication besides 40 mg of enoxaparin daily. These 18 patients were divided into six different sub-groups of various prophylaxis regimens. No patients developed a venous thromboembolism. Four of 18 patients experienced postoperative bleeding complications.

CONCLUSIONS: Patients with similar pre-operative comorbidities have various venous thromboembolism perioperative prophylaxis regimens prescribed. Despite prescription variations, VTE rates remain negligible. Patients with different comorbid conditions may require alterations to the traditionally prescribed 40 mg enoxaparin daily. Upon discharge, aspirin 81 mg with 40 mg of enoxaparin daily for high-risk patients shows benefits, but requires further investigation.