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

Tomás Rubio; María Ibáñez; Clara Fernández-Arias; Manuel Carrasco; Alma Queralt; María Rodríguez; Pedro Ruiz-Artacho; Ramón Lecumberri

doi:10.1016/j.cireng.2024.11.018

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

Cir Esp (Engl Ed). 2025 Jan 22:S2173-5077(25)00011-0. doi: 10.1016/j.cireng.2024.11.018. Online ahead of print.

Authors

Tomás Rubio¹, María Ibáñez², Clara Fernández-Arias², Manuel Carrasco², Alma Queralt², María Rodríguez³, Pedro Ruiz-Artacho⁴, Ramón Lecumberri⁵

Affiliations

¹ School of Medicine, University of Navarra, Pamplona, Spain.
² Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain.
³ Thoracic Surgery Department, Clínica Universidad de Navarra, Madrid, Spain.
⁴ Internal Medicine Department, Clínica Universidad de Navarra, Madrid, Spain; Consorcio de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
⁵ Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain. Electronic address: rlecumber@unav.es.

PMID: 39855558
DOI: 10.1016/j.cireng.2024.11.018

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.

Keywords: Cirugía; Cáncer de pulmón; Embolia pulmonar; Lung cancer; Profilaxis; Prophylaxis; Pulmonary embolism; Surgery; Trombosis venosa; Venous thrombosis.