Low molecular weight heparin use and thrombotic complications in upper gastrointestinal resection for malignancy in a multi-ethnic Asian population

Lydia L Y Tan; Gleaves Xuan; Prabhu Nesargikar; Shen Liang; Asim Shabbir; Guowei Kim; Jimmy B Y So

doi:10.1016/j.asjsur.2023.10.037

Low molecular weight heparin use and thrombotic complications in upper gastrointestinal resection for malignancy in a multi-ethnic Asian population

Asian J Surg. 2023 Oct 26:S1015-9584(23)01649-4. doi: 10.1016/j.asjsur.2023.10.037. Online ahead of print.

Authors

Lydia L Y Tan¹, Gleaves Xuan¹, Prabhu Nesargikar¹, Shen Liang², Asim Shabbir³, Guowei Kim⁴, Jimmy B Y So³

Affiliations

¹ University Surgical Cluster, National University Hospital, Singapore.
² Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³ University Surgical Cluster, National University Hospital, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴ University Surgical Cluster, National University Hospital, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: [email protected].

PMID: 39492271
DOI: 10.1016/j.asjsur.2023.10.037

Abstract

Objective: Epidemiological studies showed substantially lower venous thromboembolic event risk among Asians compared to Caucasians. Yet no Asian guidelines addresses thromboprophylaxis following major surgery for upper gastrointestinal (UGI) malignancy. We aim to evaluate effects of LMWH on thromboembolic and bleeding events in our population.

Methods: A retrospective study of all UGI resections for malignancy performed in a tertiary institution in Singapore between 2008 and 2018 was performed. Demographics, clinicopathological data and treatment outcome data were collected and analyzed.

Results: A total of 399 patients were included in the study. 210 (52.6%) received postoperative LMWH. Basic demographics-age, gender, BMI, smoking status were comparable. Most patients had cancers stage III or above (42.5% vs 34.6%) cancers. Patients who had open surgery were more likely to receive postoperative LMWH (81.8% vs 67.2%, p = 0.002). Postoperative mortality (3.2% vs 2.9%) and venous thromboembolic events (1.6% vs 1.4%) were similar. However, LMWH use was associated with increased blood transfusion (29.0% vs 12.7%, p < 0.001).

Conclusion: Incidence of venous thromboembolism was low and similar irrespective of postoperative LMWH use. However, LMWH use was associated with increased postoperative bleeding. Hence, we do not support routine LMWH for Asian patients undergoing UGI resection for malignancy.