Key result
Early administration of low molecular weight heparin within 48 hours after radical gastrectomy increased the risk of postoperative bleeding compared to delayed use (7.5% vs 1.5%; OR 3.744, P=0.030).
Why the study?
Although LMWH is recommended to prevent VTE in gastric cancer, determining the appropriate timing to start anticoagulation is challenging due to the risk of surgical field bleeding after radical gastrectomy.
Does early administration of LMWH (within 48 hours) compared to delayed administration (beyond 48 hours) increase bleeding risk in patients undergoing radical gastrectomy?
Cohort (n=665)
No
Does early administration of LMWH (within 48 hours) compared to delayed administration (beyond 48 hours) increase bleeding risk in patients undergoing radical gastrectomy?
Delaying LMWH administration until after 48 hours post-radical gastrectomy may reduce postoperative bleeding without increasing VTE risk.
Optimal LMWH timing after gastrectomy remains uncertain; retrospective data leaves open the safest window pending prospective trials.
Although low molecular weight heparin (LMWH) is recommended to prevent venous thromboembolism (VTE) in patients with gastric cancer, it's difficult for surgeons to choose appropriate time to start anti-coagulation because of the risk of surgical field bleeding after radical gastrectomy. We compared the risk of VTE and bleeding between patients receiving LMWH within and beyond 48 h after surgery. The medical records of consecutive cases receiving radical gastrectomy from November 1st, 2017 to October 31st, 2018 in Zhongshan Hospital Gastric Cancer Center were carefully reviewed. Patients receiving LMWH within and beyond 48 h after surgery were regarded as Early Group (EG) and Delayed Group (DG), respectively. Incidence of VTE and bleeding complications were compared and risk factors of bleeding were evaluated. Six hundred and sixty-five cases were enrolled, including 465 in EG and 200 in DG. No significant differences of clinicopathological or operative features were observed except for fewer combined resection (DG: 5.0%, EG: 1.9%, P = 0.030) and shorter surgery duration (DG: 194min, EG: 168min, P < 0.001). No patients suffered from deep venous thrombosis or pulmonary embolism in our study. However, postoperative bleeding rate was higher in EG (DG: 1.5%, EG: 7.5%, P = 0.002). Multivariate analysis suggested that EG was the independent risk factor of bleeding (OR: 3.744, 1.13–12.36, P = 0.030). Use of LMWH 48 h after radical gastrectomy maybe a good choice for clinical surgeons to reduce postoperative bleeding rate without increasing VTE risk in gastric cancer patients.
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Zhou et al. (2022) conducted a cohort in Gastric cancer (n=665). Low molecular weight heparin (LMWH) within 48 hours after surgery vs. LMWH beyond 48 hours after surgery was evaluated on Postoperative bleeding (OR 3.744, 95% CI 1.13-12.36, p=0.030). Early administration of low molecular weight heparin within 48 hours after radical gastrectomy increased the risk of postoperative bleeding compared to delayed use (7.5% vs 1.5%; OR 3.744, P=0.030).
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